Improving Licensure Pathways for Immigrant Doctors in Canada

Project Title

_{Improving Licensure Pathways for Immigrant Doctors in Canada}

Researcher

_{The Honourable Ratna Omidvar (Former Canadian Senator & Immigration Policy Fellow, Toronto Metropolitan University)}

Background

^{On March 5, the Toronto Metropolitan Centre for Immigration and Settlement hosted a lunch and learn entitled: “Maximizing Medical Talent: Ready Solutions for Canada’s Healthcare Crisis.” The event convened industry stakeholders to explore how Canada can improve licensing pathways for immigrant doctors in Canada.}

^{Canada faces a primary care crisis with some 6.5 million Canadians without a family doctor. Meanwhile, many internationally trained physicians (ITPs) living in Canada remain underemployed due to complex licensure requirements and limited access to pathways that recognize foreign credentials and experience. These ITPs tend to have extensive clinical experience overseas and have met most provincial licensing requirements demonstrating they have the skills and knowledge to practice medicine safely in Canada. The main challenge they face, however, is getting access to a Practice Ready Assessment or medical residency to complete the licensing process.}

^{The lunch and learn panel expanded on three solutions which are also noted in a recent World Education Services report (external link)  to increase the licensure rate for ITPs: Practice Ready Assessment programs, clinical assistant roles, and medical residencies.}

Findings

_{Practice Ready Assessment (PRA)}

_{Practice Ready Assessment (PRA) programs are competency-based assessments that offer a streamlined path to licensure for ITPs who have recent clinical experience. These programs involve a structured period of supervised practice and evaluation, followed by eligibility for full licensure upon successful completion.PRA programs, already available in every province except for PEI, offer a practical and evidence-based way to integrate experienced immigrant doctors directly into the healthcare system without requiring a residency.}

_{PRAs are completed at nearly one-tenth the cost and time of medical residencies. Whereas it takes 2-years and costs an estimated $340,000 per family medicine residency, a PRA can be completed in 8-12 weeks and costs about $35,000.}

_{Despite this, only 1,000 PRAs have been completed since 2018. More effort and investment is required to increase the number of PRAs completed nationally. The Medical Council of Canada has created a national PRA framework which can be used in each province and territory. The federal government should work with the provinces and territories to use this framework and earmark more funding to significantly increase the rate of PRA completions in the near future.} 

_{Clinical Assistant Roles for Doctors Without Recency of Practice}

_{Many ITPs move to Canada with years of experience but find their skills deemed outdated by provincial regulators due to a lapse in practice after arrival. For ITPs with clinical experience abroad but who lack recent practice, clinical assistant (or associate physicians roles) offer a  (PDF file) meaningful opportunity to work in the healthcare system in some provinces. (external link)} 

_{Clinical assistants work under the supervision of licensed physicians, supporting clinical teams in hospitals and gaining exposure to the Canadian healthcare environment. These roles provide valuable opportunities for skill retention, cultural adaptation, and local experience — all of which are essential for eventual licensure. While clinical assistants are not independently licensed to practice medicine, these roles can serve as bridges, helping ITPs prepare for formal assessments so they can then become eligible to complete a PRA and obtain a Canadian medical license.}

_{To make this pathway more effective, provinces should introduce it as a regulated profession in jurisdictions where it does not exist. In provinces where it exists, it should be recognized as meeting recent practice requirements in order to provide a ladder to full licensure and the availability of these positions should be expanded and standardized training modules developed. These two measures would encourage more immigrant doctors to pursue this path rather than exiting the profession entirely.} 

_{Expanding Medical Residency Opportunities for Immigrant Doctors}

_{Medical residency programs are the traditional route to licensure in Canada but are notoriously limited in availability. ITPs often find themselves competing for a small number of residency positions, most of which are allocated to Canadian medical graduates. To increase the licensure rate of immigrant doctors, provincial governments and medical schools must create more residency positions specifically for ITPs. This requires dedicated funding, policy adjustments to residency matching systems, and targeted programs that prioritize rural or high-need specialties.}

_Conclusion

_{Addressing the licensure barriers for immigrant doctors requires a multifaceted approach and efficiency. PRA programs provide a fast-track competency assessment for experienced physicians with recent practice. Clinical assistant roles support skill maintenance and integration for those without recency of practice. These roles can help increase the capacity of the health care system and can be designed to help these physicians meet the recency of practice requirements that would then make them eligible to complete a PRA in order to become a licensed physician. Finally, expanding medical residency opportunities for ITPs without any clinical experience offers an additional entry point into the medical profession. Pursuing these three solutions, in addition to other solutions that harness Canadian healthcare talent, will help to alleviate the country’s primary care crisis and better ensure high-quality healthcare for all.}

Keywords

_{Primary Care Crisis; Licensure Barriers; Practice Ready Assessment; Clinical Assistance tant Roles; Residency Expansion}