Interested in practicing medicine as a doctor in British Columbia or Canada? The process for registration is not straightforward. Here is a useful summary for international medical graduates wanting to work in B.C, this is based on the personal lived experience of contributors. Always consult the provincial regulator as changes frequently occur.

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Read First: Essential Information

In North America there are three distinct but slightly interdependent processes you will need to undertake to work as a doctor. This is different to other regions. Understanding the distinction between licensing, training and migration is the key to navigating your journey to Canada. Doctors are commonly referred to as ‘physicians’ in North America which may differ to what you are familiar with.

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In B.C., the majority of doctors are not directly employed by health authorities. Instead they are sole traders and bind together as ‘groups’ to provide contracted clinical services to health authorities or bill the ministry of health for their services using standardised item codes. Doctors often form ‘medical corporations’ and receive no statutory benefits (sick leave, parental leave, extended health benefits) due to the nature of their businesses. There is no union or industrial agreement but Doctors of B.C. supplies industrial relations advice and the Canadian Medical Protective Association provides medico legal support.

 

Licensing

Obtaining a medical license will legally permit you to practice medicine. A local regulator (College of Physicians and Surgeons of British Columbia) is responsible for administering licensures and is bound by the Health Professions Act.

 

Medical Training

Refers to the education credentials a physician holds that will make them eligible to hold a medical licensure. The Canadian training journey has a number of components:

1. University Qualifications: Medical students complete an undergraduate degree and then enrol in a four year graduate medical degree. A medical student in their final two years is commonly known as ‘MSI’ (medical student intern) and undertake clinical rotations. The University of British Columbia is the only local medical school and very competitive with small class sizes.

2. Graduate Medical Education: The process where doctors-in-training to progress from holding a provisional license to a full unrestricted license for independent practice. This is generally a shorter and less standardised than in other countries with a few intricacies explained below.

• Residency: refers to the specialty vocational training programs Canadian medical students are matched in a highly competitive nation-wide process through a third-party known as the Canadian Residency Matching Service (CaRMS) process. Different programs offer extremely different experiences within a set minimum curriculum mandated by the two national regulatory colleges (the CFPC and RSPSC below). The completion of residency training and assessments is required for a physician to gain a medical licensure.

  • College of Family Physicians of Canada (CFPC)- establishes the standards for and accredits postgraduate family medicine training [family medicine/general practice]

  • Royal College of Physicians and Surgeons of Canada (RCPSC)- set standards for and accredits specialty medical education [all specialties]

• College exams: refer to standard fellowship examinations all physicians must pass to progress to be eligible for a full license. There is one exam for the CFPC for family doctors and a variety of exams for the RCPSC corresponding to the relevant specialty. These exams do not technically form part of residency training so it is possible for physicians to pass residency without completing their exams and therefore remain on a provisional licensure for a limited period of time (and four attempts) until they do.

1. Licentiate of the Medical Council of Canada (LMCC): is a series of three standardised examinations all physicians must complete to be eligible to obtain a licensure. This is independent of the university and graduate medical education process. The exams are scheduled roughly thrice yearly and called the MCCEE, MCCQE1 and MCCQE2, a maximum of four attempts are allowed. It is a legacy process aiming to assure the public of the standards of physicians enrolled on the Canadian Medical Register. The USMLE is equivalent and can be used interchangeably for the LMCC in some instances.

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Migration

Refers to the processes an individual must undertake to be eligible to work, live and hold a medical license in Canada. This is administered by Immigration, Refugees and Citizenship Canada (IRCC) with specialised provincial schemes setup for international medical graduates (IMGs).

 

 

Read Second: Decision Matrix

Some common scenarios below will help you make a decision about pursuing medical work in B.C.

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Scenario:  I want to relocate permanently (for at least eighteen months to B.C.) and have completed General Practice/Family Practice training and/or specialty training and I have  full licensure in Australia, UK, USA or Ireland.

Feasible? Yes

Explanation:  This is a common scenario. To relocate is the best way to move to practice medicine in B.C.

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Scenario: I want to do a clinical fellowship in B.C.

Feasible?  Yes

Explanation: This is a common scenario and the system is very setup for it. Applications are managed through UBC and are often setup two years in advance.

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Scenario: I want to do research in a non-clinical capacity in B.C.

Feasible?  Yes

Explanation: This is feasible and may not require a medical licensure but will require sponsorship for a work permit.

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Scenario: I have finished my specialty/GP training and want to complete short term locums in Canada and to move around the country. I wish to come for anywhere between three and nine months.

Feasible?  No

Explanation: Unless you are already practicing and licensed in another province (state) in Canada this is unrealistic and likely not achievable. There is no national registration. If you wish to practice independently you will need to be fully trained and a Canadian citizen or PR. With the exception of possibly some remote places where you can get a LIMA for a work permit this is not feasible.

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Scenario: I have done some post graduate work and/or training in my home country and wish to locum or temporarily work as a doctor in training in Canada.

Feasible?  No

Explanation: Canadian training programs are extremely regulated. Residents are employed through localised programs which ‘match’ local graduates to short and specific rotations. Junior doctors are employed by universities with a focus on learning and are not employed by hospitals so there are no RMO/SHO jobs outside training. Visiting residents might be able to do unpaid ‘visiting electives’ of several weeks. You are better off applying for a fellowship role or coming after completion of training.

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Scenario: I wish to do an entire local specialty residency in Canada.

Feasible?  No

Explanation: This is a tricky scenario and technically possible. Training places are viciously competitive with a preference for local graduates. You will need to already by a Canadian PR or citizen and have completed the MCCQE part 1 examination and be eligible for the Canadian Resident Matching Service CaRMS.

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Scenario: I wish to do a long term clinical research project in Canada.

Feasible?  Maybe

Explanation: You will need to be licensed as a physician first.

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Scenario: I want to work in B.C for a period of nine to eighteen months as a GP or specialist.

Feasible?  Maybe

Explanation: This is possible if you have the requisite fellowship which is recognised by the CFPC or RCPSC. You can work on a provisional licensure but will need a supervisor. In the event you wish to stay you will need to complete your full LMCC licensing exams (MCCQE1, MCCQE2) and PR processes.

 

Read Third: so how does this affect me?

A complex interplay between the above three factors (licensing, medical training and migration) means that anyone wishing to work as a doctor in Canada must be aware of the processes required to obtain and maintain their professional duties.

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There is a high administration burden that is not for the faint hearted! If you persist the lifestyle rewards of being able to live in such an incredible province is worth it.

 

 

Read Fourth: the process

The following summary represents my best effort to guide you in applying to work in B.C. This information is relevant to fully qualified physicians or those wishing to do a fellowship year as these are really the only two feasible pathways to work in Canada.

 

I highly recommend giving yourself at least twelve months to complete the process and budgeting around $15,000CAD for fees and costs. It is recommended that you start from the first step and simultaneously work your way down the list as many overlap. A rough timeframe it takes to complete each step is indicated. Your objective is to streamline an application for licensure with the College of Physicians and Surgeons of British Columbia (CPSBC).

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10 Steps for fully registered family practice or specialist doctors:

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Step 0:

If you are not yet 100% certain on moving to BC and want to explore job opportunities and gain expert advice on your situation it is worthwhile reaching out early to HealthMatchBc and the local Divisions of Family Practice in the area you wish to work.

 

Step 1 [2 months]: Get documents in order, work out what you want to do, confirm your eligibility

1. Establish what work you are wanting, read the guide above and then visit the CPSBC’s website where there is a flow chart on licensure eligibility in B.C and a breakdown of the process in addition to the useful summary from HealthMatchBC.

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You should need to confirm your postgraduate training eligibility at this point to plan any additional work required (step 2a) to move to Canada.

• For GP/Family Practice doctors you will need evidence of the following post graduate training/rotations over at least 2 years of approved training in the UK (MRCGP), Ireland (MICGP), Australia (FACRRM and/or FRACGP) and USA (ABFM). If you are from another country you should review the PRA-BC program which offers an alternative pathway.

  • 8 weeks of general rotations in: medicine, surgery, OBGYN, paediatrics (note subspecialty rotations are not accepted, eg: respiratory medicine is not accepted but general medicine is)

  • 4 weeks of rotations in: psychiatry, emergency medicine, general family practice

• For specialty doctors you should review the training requirements specific to your discipline here and make sure the accredited training you have completed is compliant.

 

2. If you believe your situation is feasible then proceed to collate your documentation.

You will need copies of:

• Passport

• A recent passport sized colour photograph within 6 months

• Your medical degree/s

• Your postgraduate training information: official transcript documents/letters of confirmation from every (yes not joking) rotation/period of work following graduation indicating competencies, dates, location, duration, discipline and successful completion. Include explanation of periods not officially employed.

• Specialty certification

• University academic record

• Certificates of good standing from any medical licensing body you have been registered with

• Certificate of membership and good standing from any relevant medical college you hold registration with

• Letters of reference confirming currency of practice including a description of duties, nature/scope of practice and attesting to competencies, performance, hours and/or days of work weekly to verify currency of practice (minimum 960 hours) for the last three (3) years

 

Documents you will eventually need and are worth preparing whilst you wait during processing:

• Police certificates for every jurisdiction you have ever lived since the age of 18. This does not have to be done immediately but will be needed eventually so best to start thinking about it.

• Licensing exam results (PLAB, AMC, USMLE)

• Any approved English or French language test results you may have completed previously or as part of an ‘express entry’ PR application: CELPIP, IELTS, TEF Canada, TCF Canada.

 

Step 2 [5 months]: Open a Medical Council of Canada ‘PhysicianApply’ online account and get your medical training documents verified

1. Go to: https://physiciansapply.ca/ and sign up for an account and read the information background here.

2. Submit your documents for verification. Each document attracts a fee so get it right the first time and submit as many as possible to avoid future delays. Be sure to read the instructions on who qualifies as a certifying official. You should submit: medical degree (in English), record of postgraduate training (all rotations since graduation from the training organisation/college and not from your employer) and specialty certificate.

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Outcome: This process will generate a ‘Medical Education Credential Assessment Report’ (ECA) which verifies your documents which can be ‘shared’ with any health authority and licensing body across Canada. It is also used for migration purposes.

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Note: Your documents are sent to the ECFMG for verification however frustratingly the MCC retains all the rights to the verification of your education so you cannot use any previously verified documents as part of an application for licensure elsewhere (USA, South Africa etc). You will also not be able to request these documents be shared with other organisations outside Canada in the future.

 

Step 2a [completed whilst waiting for MCC document verification]: Complete any outstanding CFPC training requirements and/or receive your assessment of training from the RCPSC

• Use the time whilst waiting for your ECA to complete any outstanding training requirements outlined in step 1.

  • Some candidates have voluntarily spent unpaid time in a training environment with a learning plan and logbook to satisfy additional training in specific specialties. For example, General Practice fellows who have not specifically completed a four-week psychiatry rotation can shadow or spend time in a community mental health clinic.

  • Alternatively, if you are unable to do additional training you can undertake an ‘assessment of competency acceptable to the registration committee’ in any Canadian province. This will involve writing to the committee with letters of support attesting to your skills in a specific area that are akin to the requisite training rotation. Refer to the CFPC ‘red book’ to ensure your training and support letters indicate that you are compliant with the standards.

 

Step 3 [1 month]: sign up for CFPC (family medicine college) or RCPSC (specialist college) membership

• Family physicians: sign up for CFPC membership and apply for ‘Certification without Examination’ using the plethora of documents you have already assembled (note you are exempt from the CCFP exam but not from the LMCC exams). The CFPC must send this eligibility letter directly to the CPSBC but be sure to get a copy yourself.

• Specialists: It is recommended to apply for an assessment of your approved training at this stage which costs around $4000CAD. After a ‘positive ruling’ you will have five years to practice and to complete the relevant college exam.

 

 

Step 4 [3 months]: apply to HealthMatchBC or an identified third party for a preliminary licensure eligibility assessment

HealthMatchBC assists you navigating your application for licensure with the CPSBC. Signup for an account online.

*Note: you can apply through an alternate agency for this step. But it is not recommended as HealthMatchBC are extremely familiar with the process.

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1. Provide a CV and all previously mentioned documentation importantly including any additional training or competency documents received as part of Step 2a.

2. HealthMatchBC will submit your case to the CPSBC for an initial eligibility assessment.

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Outcome: If you have everything in order you should receive a positive indication that your application package to the CPSBC confirms you are eligible for a provisional licensure. All doctors will have five years to start practicing and complete your minimum six month supervised period and MCCQE1 and MCCQE2 exams.

 

Step 5 [2 months]: apply for a job independently or through HealthMatchBC

You can start applying for a job at any stage but you must indicate you are awaiting confirmation of a provisional licensure from the CPSBC. HealthMatchBC will assist you in finding a relevant job if you do not already have any leads. You need to make it clear to prospective employers that you require a supervisor who will report on your progress to the CPSBC. 

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You can contact health authorities directly, individual clinics or look at postings for physicians on HealthMatchBC. For Family Physicians the local ‘divisions’ of family practice are excellent places to start as they will know reputable clinics who can support IMGs who are looking to sponsor staff.

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Outcome: accept a formal written offer of employment in Canada.

 

Step 6 [3 months]: work permit (skip this step if already PR/Canadian citizen)

You need to be sponsored to enter Canada on a work permit which will expire after 3 year or the maximum term of your contract. Physicians cannot use the two year ‘working holiday visas’ available to some people aged 35 and under. You will be sponsored by the relevant health authority in the catchment area your employment is based.

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If you apply for the PNP program (step 7) then your employer will not have to do the Labour Market Impact Assessment (LMIA) demonstrating that there is need for you as a foreign worker to receive the medical job. Otherwise your employer/health authority will need to demonstrate (as per the B.C. ministry of health) that your position is in an under-served area of need and the CPSBC will write a supporting letter for immigration Canada.

1. Apply for your work permit online

2. Complete your biometric scanning (fingerprints) at a local testing centre note you may need to travel at own cost to a major city (eg: Sydney) to do this.

 

Step 7 [1 month]: apply for the provisional nomination process (PNP) for PR (skip this step if already PR/Canadian citizen)

You will need to be a Canadian PR or citizen if you wish to have a full unrestricted medical licensure. The PNP program ensures skilled foreign workers can gain PR in B.C. If you do not wish to stay beyond your work permit you do not need to do this but it is highly recommended to do it as otherwise you will need to do the LIMA process which is unlikely to be successful unless you are working in a very remote area.

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You will need a PNP for every PR application you submit, there are two types of PR applications you can submit (see step 8 for more information).

1. Apply for the PNP online

2. Receive supporting documentation from the relevant Health Authority

 

Step 8 [6-15 months]: apply for PR including biometrics and a language test (express entry only)

There are two ways to apply for PR, I suggest you do both as any fees will be refunded if unsuccessful! Check the processing times online by selecting ‘Economic Migration’ under application type and ‘Provisional Nominees’ under economic class and you can see the processing time differences. Remember that your PNP expires so you need to get onto this ASAP.

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1. Paper entry: this can be completed before you arrive. This is mailed to Canada however ultimately issued in your country of origin so there can be very long delays. This is a much easier application with fewer automatic barriers and a higher chance of success, but takes longer. No language test needed.

2. Express entry: takes roughly 9 months in total and is based on a scoring system where applicants are selected in monthly national drafts. As a doctor you will be highly competitive however small errors and nuances can automatically render an application ‘incomplete’ leading you to start the process again! It can take longer if you are not fastidious with the details. You will need a language test.

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Read all instructions carefully and be prepared to answer questions about every international trip you have ever taken. You will also need:

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1. Police certificates: from every country lived in since age 18, dated within the last six months.

2. A medical examination: involves a chest x-ray and urinalysis, performed by a designated Canadian physician within six months of your PR being issued. This means that you will likely need a repeat medical examination closer to your PR being issued. Expect it to take about half a day.

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Once you receive your confirmation of PR (CoPR) you will need to present it to a Canadian Border Services Officer by either driving to the USA border, flying into Canada or making an appointment with the IRCC.

 

Step 9 [2 weeks]: travel to Canada activating your work permit and licensure, apply for MCCQE1

Now you can travel to Canada. You are supposed to start work within two weeks of your arrival date but this can be delayed by your CPSBC activation interview. You will activate your work permit upon arrival, it is a single cream coloured sheet which you should not loose.

 

Please see other information on this website about migration and arrival processes which are not unique to practicing as a doctor.

1. Schedule an initial interview with the CPSBC to activate your provisional licensure. You will need to attend the Howe St office in-person with your original medical education qualifications to activate your provisional license prior to starting practice. Your interview must not be any more than 2 weeks prior to your start date. Book well in advance.

2. As soon as your provisional licensure is active and you have certainty that you can work in Canada it is best to apply for the MCCQE1 exam as places are limited.

 

Step 10 [18 months]: start working and qualify for a full unrestricted medical license

As soon as you’ve started working you should work to set yourself up for a full licensure, this takes time.

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1. Prepare for your two licensing exams. All physicians will need to complete the MCCQE1 (one day computer based clinical cases testing knowledge learnt in medical school) and MCCQE2 (two-day osce exam with limited venues and availability testing knowledge learnt in residency).

   1. For specialists: undertake your RCPSC exam within five years of practice

   2. For family physicians: gain exemption from CFPC exams (see step 1) or complete PRA-BC program with 3 year return of service and examination

2. Complete a minimum of three months (or until you’ve completed your LMCC exams) of supervised practice in B.C with a supervisor evaluation report to the CPSBC. You will need additional annual reports after this until you’ve qualified for a full licensure.

3. Attend the BC Physician Integration Program for International Medical Graduates within six months or practice (online lectures and one in-person workshop day).

4. Obtain PR.

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Outcome: you can submit an ‘Application for Medical Registration’ via PhysicianApply and progress to a full unrestricted medical licensure in B.C.

 

 

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6 Steps for Completing a Fellowship Year in B.C.

Completing fellowships in B.C. are more straightforward than the process for a full unrestricted license. Fellows are issued an education licensure which is restricted to practicing under named supervisors in named locations. Fellowships are arranged by UBC with a clear application process and guidelines for fellows.

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When you complete a fellowship you are employed by UBC and paid by the relevant department you are completing your fellowship under. Your work permit will expire two weeks after the nominated completion date.

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Fellows can continue to work in B.C but will be subject to the provisional licensing process outlined above. Given the competitive nature of some fellowships and the 6-month application timeline it is best to apply at least 24 months prior to your desired starting date.

 

Step 1: arrange fellowship through contacting relevant department and supervisor/s

Step 2: complete UBC fellowship application including training plan and agreement

Step 3: open a Medical Council of Canada ‘PhysicianApply’ online account to get your medical training documents verified.

You will need copies of:

• Passport

• A recent passport sized colour photograph within 6 months

• Your medical degree/s

• Your postgraduate training information: official transcript documents/letters of confirmation from your college/s from every (yes not joking) rotation/period of work following graduation indicating competencies, dates, location, duration, discipline and successful completion. Include explanation of periods not officially employed.

• Specialty certification (eg: FRACP certificate)

• University academic record

• Certificate of membership and good standing from any relevant medical college you hold registration with

Step 4: apply to CPSBC for an education licensure, this requires

• A letter from UBC stating the registration requirements

• Certificates of good standing from any medical licensing body you have been registered with

Step 5: apply for a work permit online. You will need a letter of offer from UBC, CV, passport, postgraduate employment information, a reference from current employer, biometrics and a medical examination.

Step 6: arrive in Canada and have an initial CPSBC interview to be issued an education license.

 

 

Useful Resources

 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6181104/

https://physiciansapply.ca/how-to-become-a-practising-physician-in-canada/

https://www.healthmatchbc.org/Physicians/Licensing-and-Registration

https://www.cpsbc.ca/for-physicians/registration-licensing/applying/imgs

https://www.cfpc.ca/en/education-professional-development/residency-program-accreditation

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