How do IMGs get licensed to practise in Canada?
Pick the sentence that describes you.
Nine provinces run a Practice-Ready Assessment (PRA) for family physicians. You practise under observation for a period, typically around 12 weeks, and a pass leads to a licence in that province, usually with a return of service. Selection is competitive, and each province sets its own exam and currency rules. Every fact on this page was read on the official pages it cites in October 2026.
Two routes lead to specialist practice. The Practice Eligibility Route (PER) is national and run by the Royal College; its eligibility step is document based and can be started from abroad, and certification follows the exam and two years of supervised practice in Canada. The specialist PRA is provincial and workplace based. Four provinces run one, Alberta, Manitoba, Quebec, and Nova Scotia, each for the disciplines it is currently assessing, and each asks for a job offer first.
Clinical assistant and associate physician roles let you work under a licensed physician's supervision. You are never the most responsible physician. The role is not a licensure pathway on its own, but licensed time in it counts toward the currency requirement of some PRA programs.
Residency positions are filled through the CaRMS match. You apply to programs, interview, rank them, and the algorithm matches you. Most programs ask for the MCCQE and the NAC, and most program descriptions say what they want in your CV and personal letter. What all 875 programs asked for in 2027
The Medical Council of Canada (MCC) runs the MCCQE, the NAC Examination, and the TDM Examination. Which ones you need depends on the route and the province. Start with the format of each exam, then build a study plan around it.
Answer a short set of questions about your training, your practice, and your exams, and the screener compares your profile against every family medicine PRA program and every clinical assistant and associate physician licence. Nothing you type is stored.
Compare the routes, side by side
Three things to settle before you compare programs
- Which MCC exams do you hold?
- Most routes list the MCCQE. Check whether yours also needs the NAC or the TDM before you book anything. Exam dates and deadlines →
- How recently did you practise?
- Count your months as the most responsible physician in the last three and five years. Licensed supervised work counts differently in each province; unlicensed work does not count.
- Is your language test current?
- The national standard Ontario's college applies: IELTS Academic 7.0 in each component, OET Medicine grade B in each subtest, or CELPIP General 9 in each skill, in the same sitting, within the last 24 months. From January 1, 2027, Nova Scotia accepts OET only. Quebec requires French. Language and immigration links →
The words you will see everywhere
- IMG
- International medical graduate: a physician whose medical degree is from outside Canada. Also written ITP, internationally trained physician.
- MCC
- The Medical Council of Canada. It runs the national exams and the physiciansapply.ca portal where your credentials are source verified.
- MCCQE
- The MCC's written qualifying exam. Most routes list it, and it is the exam this site's books and daily MCQs prepare you for. Format and blueprint →
- NAC Examination
- The MCC's clinical skills exam for IMGs, run as an OSCE: a circuit of timed stations with standardized patients. Required by some PRA programs and most residency programs. How it is scored →
- TDM Examination
- The Therapeutics Decision-Making Examination. The MCC says most PRA programs use it; Quebec and Nova Scotia do not list it. Since September 2026 you apply for it directly through the MCC. What it tests →
- LMCC
- The Licentiate of the Medical Council of Canada, the MCC credential for a graduate of an acceptable medical school who has passed the MCCQE and had the degree source-verified. The MCC dropped its postgraduate training requirement on January 26, 2026, and issues the LMCC automatically to anyone who applied for the MCCQE after that date. Regulators refer to it in their licensing rules.
- CaRMS
- The Canadian Resident Matching Service, which runs the residency match. The first-year match is the R-1. Timeline and data →
- PRA
- Practice-Ready Assessment. A provincial program that observes you in real practice and, on a pass, licenses you with a return of service. Family medicine programs exist in nine provinces; a few provinces also assess other specialties. Family medicine PRA programs compared →
- PER
- The Practice Eligibility Route of the Royal College of Physicians and Surgeons of Canada. It assesses a specialist's training on paper against the Specialty Training Requirements and, if equivalent, opens the door to the certification exams. No return of service. The PER guide →
- STR
- Specialty Training Requirements: the Royal College document describing what a residency in each specialty must contain. The PER measures your training against it.
- Clinical assistant / associate physician
- Supervised roles for physicians without an independent licence. Licensed in most provinces, unlicensed in Ontario, Quebec, and the territories. Not a pathway by itself. Province by province →
- Currency of practice
- How recently, and how much, you practised. Measured in hours or months over the last three to five years, and the requirement candidates most often fail on paper.
- Return of service
- The commitment to practise in the province, often in a community it designates, after a PRA. Three-year terms are common; Manitoba's training program carried four in its last published application package.
- The College
- Each province's medical regulatory authority, such as the CPSO in Ontario or the CPSBC in British Columbia. It issues the licence. Every regulator, linked →
Free links for every stage: Free Resources.
Common questions from IMGs starting out
How do IMGs get licensed to practise medicine in Canada?
There are two ways in. If you have not finished a residency, or are willing to retrain, you apply to a Canadian residency through the CaRMS match. If you completed residency abroad and practised, you apply as a physician who is already trained: a Practice-Ready Assessment (PRA), run by nine provinces and mostly for family medicine, or the Royal College's Practice Eligibility Route (PER) for specialists. Most routes ask for Medical Council of Canada exams, and the licence itself comes from the medical regulator of the province where you will work.
Do IMGs have to redo residency to practise in Canada?
Not always. A Practice-Ready Assessment is for IMGs who completed residency and practised independently abroad, and the PER is for specialists whose training the Royal College rules substantially equivalent. Residency through CaRMS is the route if you have not finished postgraduate training or are willing to retrain.
Do IMGs need permanent residency to get licensed in Canada?
For the CaRMS R-1 match, yes: applicants must be Canadian citizens or permanent residents, with one exception, Quebec's particular stream in the second iteration. For the family medicine PRA programs, only Practice Ready Ontario requires citizenship or permanent residence.
Which exams do IMGs need to practise in Canada?
For residency, CaRMS asks for both the NAC Examination and the MCCQE, with a few provincial exceptions. For the practice-ready routes it depends on the program: some PRA programs use the MCCQE, most use the TDM, and Nova Scotia's lists no exam at all. The PRA comparison shows each one.
Who issues a medical licence in Canada?
The medical regulatory authority of the province or territory where you will work, such as the CPSO in Ontario or the CPSBC in British Columbia. The MCC runs the exams and the Royal College and the CFPC certify, but neither issues the licence.
Can I start the licensing process from outside Canada?
Yes, for several steps. You can write the MCCQE at Prometric centres in more than 70 countries, and you apply for it online through physiciansapply.ca, where the MCC source-verifies your degree. Specialists can start the PER from abroad, because its eligibility step is document based. The NAC Examination is held only in Canada.
Sources (23), checked October 9, 2026
- Medical Council of Canada, Pathways for international medical graduates. Checked 2026-10-09. Supports: the two ways in, provincial licensing, source verification on physiciansapply.ca.
- Medical Council of Canada, Practice-Ready Assessment. Checked 2026-10-09. Supports: nine provinces run PRA programs, mostly family medicine; about 12 weeks; a few provinces assess other specialties; return of service.
- Royal College of Physicians and Surgeons of Canada, Practice Eligibility Route. Checked 2026-10-09. Supports: what the PER is and its document-based eligibility.
- CaRMS, R-1 eligibility criteria. Checked 2026-10-09. Supports: citizenship or permanent residence, the NAC and MCCQE, language validity date.
- CaRMS, R-1 summary of MCC examination requirements. Checked 2026-10-09. Supports: provincial exceptions to the exam rule.
- CaRMS, R-1 eligibility criteria, Quebec. Checked 2026-10-09. Supports: the particular stream open without permanent residence.
- Medical Council of Canada, MCCQE. Checked 2026-10-09. Supports: the MCCQE for residency, some PRA programs, delivery in over 70 countries.
- Medical Council of Canada, NAC Examination. Checked 2026-10-09. Supports: the NAC as an OSCE required for residency.
- Medical Council of Canada, TDM Examination eligibility and application. Checked 2026-10-09. Supports: TDM use by most PRA programs and direct applications.
- Medical Council of Canada, LMCC. Checked 2026-10-09. Supports: the LMCC criteria and automatic issue.
- NS PACE, Selection and review. Checked 2026-10-09. Supports: no mandatory exam in Nova Scotia.
- Gouvernement du Québec, Permis restrictif clinicien. Checked 2026-10-09. Supports: Quebec's exam list without the TDM.
- Touchstone Institute, Practice Ready Ontario. Checked 2026-10-09. Supports: citizenship or permanent residence required in Ontario, licensed clinical assistant time.
- CPSA, Registration assessments. Checked 2026-10-09. Supports: Alberta's specialist assessment.
- University of Manitoba, International Medical Graduate (IMG) programs. Checked 2026-10-09. Supports: Manitoba's specialist PRA and job offer.
- CPSNS, Pathway to conditional licensure via a practice-ready assessment, specialties other than family medicine. Checked 2026-10-09. Supports: Nova Scotia's specialist PRA and job offer.
- PRA-BC, Know your ROS community. Checked 2026-10-09. Supports: a 3-year return of service.
- Health Careers Saskatchewan, SIPPA. Checked 2026-10-09. Supports: a 3-year return of service, currency of practice.
- University of Saskatchewan, SIPPA FAQs. Checked 2026-10-09. Supports: licensed and unlicensed clinical assistant time in Saskatchewan.
- University of Manitoba, IMG program application package (2023 admission, PDF). Checked 2026-10-09. Supports: Manitoba's four-year return of service.
- CPSO, Language proficiency. Checked 2026-10-09. Supports: the IELTS, OET and CELPIP standard and the 24-month window.
- CPSNS, English language proficiency. Checked 2026-10-09. Supports: OET only from January 1, 2027.
- Collège des médecins du Québec, Connaissance du français. Checked 2026-10-09. Supports: French required in Quebec.
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