Can IMG Doctors Work In Canada Without Residency?

There are two ways International Medical Graduates (IMGs) Doctors can practice medicine without Canadian residency after completing a residency in their home country. The first is the province-based specialist with a hospital-based specific license where IMG doctors from any country are eligible. The second is the Royal College Specialist pathway where IMG doctors who meet specific criteria set forth by the Royal College of Physicians and Surgeons of Canada are eligible.

If you are an IMG doctor planning to practice Medicine in Canada, this will help you understand all your options. These alternate Entry Path Programs are created for IMG doctors who are specialized, exceptional, and outstanding to be an important part of the USA or the Canadian healthcare system. Through these pathways, IMG doctors can work directly as a fellow and/or faculty in Canada without residency. In this article, I will focus on Canada and if interested you can check my article about the USA with this link. I will share my first-hand experience with both of these pathways in Canada and let’s jump in right away.

Rajeev S. Iyer MBBS, MD, FASA

Associate Professor of Anesthesiology,

University of Pennsylvania, Philadelphia, USA

How Can IMG Doctors Work In Canada Without Residency?

According to the Royal College of Physicians and Surgeons of Canada “International medical graduates are candidates who have completed postgraduate residency training outside of Canada or the United States. To be eligible for Royal College exams, candidates do not have to live in Canada or hold Canadian citizenship.”

I will expand on the two major options here and then we will really dive deep into these options where i will share my personal experience.

1. Province based specialist with a hospital-specific license where IMG Doctors from any country are eligible. This is via Postgraduate Education Certificate. This is a great option for IMG doctors from low to middle-income countries like India, China, Brazil, Pakistan, Bangladesh, etc. I will explain this in more detail. If you are reading this, I am going to assume you are more likely to be in this category.
2. Royal College Specialist pathway where IMG doctors who meet specific criteria set forth by the Royal College of Physicians and Surgeons of Canada are eligible. The Royal College of Physicians and Surgeons in Canada offers three options for IMG’sIt is important to understand an important difference here: The Royal College of Physicians and Surgeons in Canada defines these pathways that i will explore more. In addition, a license to practice medicine is required and this is issued by the State Medical Boards which in Canada are regulated by different provinces. For e.g. College of Physicians and Surgeons of Ontario. 
   1. Approved jurisdiction
   2. Practice eligibility route
   3. Subspecialty Examination Affiliate Program (SEAP)

First things first, check your eligibility criteria. Your medical training must be recognized by the World Health Organization (WHO) and you can check your medical college/school from this link. Alright congratulations, your medical training is recognized by WHO!

How Can IMG Doctors Work in Canada as Province Based Specialists?

I have come across many IMGs who have been successful as province based specialists using the postgraduate education certificate. The selection for this is based on a bit of luck and the time you are in Canada. I have included a screenshot from the College of Physicians and Surgeons of Ontario showing an example. I will run through this example and explain each step in the process. This is a candidate whom I know personally and can comment on the entire history much better than what you see on the website.

Year	Position in the province based specialist pathway
2013	This IMG Doctor entered Canada in 2013 as a fellow. This is the first certificate of registration you see above.
	The pre entry assessment program is where the hospital faculty observe you as a fellow. This involves assessment of clinical work, communication, collegiality etc. This lasts for a few weeks. Most people ace through this with no problems. However, i did come across someone who did not clear this.
2013-2016	This IMG doctor then went on to do multiple fellowships.
2016	This IMG doctor received a Postgraduate Education Certificate. This means this candidate is now working as an Assistant Professor with a restricted license.
2016-2023	This IMG doctor was given 7 years to prove academic excellence as set forth by the Hospital where this person is working. In this case, the certificate of registration expires in 2023.
2022	This IMG doctor got promoted to Associate Professor. Once promoted to Associate Professor from Assistant Professor, the restrictions on the license is lifted. This means this person is now free to move to other hospitals or provinces if they wish. I know a few people who have been successful using this route.

This is a classic example of a successful IMG doctor. Having known this person personally for so many years, I am very proud of the success. This IMG doctor got the Postgraduate Education Certificate relatively soon but there are others who have required more time whom I personally know. Once the specialist graduates to Associate Professor their status will be turned to “Active” as I have shown in the screenshot below.

 

You can check the status of any doctor in Ontario by using this link. If you are wondering how you can do this for yourself, you have to get to Canada as a fellow. Reach out to me on my youtube channel or Instagram on Anesthesia Guru by clicking the attached links.

How Can IMG Doctors Work in Canada as Royal College Specialists?

The Royal College of Physicians and Surgeons of Canada has approved a few countries outside Canada and USA where the training is similar to Canada. There are three pathways the Royal College offers

1. Approved jurisdiction
2. Practice eligibility route
3. Subspecialty Examination Affiliate Program (SEAP)

I will explain the approved jurisdiction route here.

If you are a physician trained in one of the below countries then you can apply to the Royal College for your training assessment. Once the Royal College formally approves, you will be eligible to write the final certifying exam. You will have 5 years to complete this exam once you are approved. In my experience, physicians I know have completed this in a year or two. Once you clear this exam, you will be a fellow of the Royal College and receive either of the following certification based on your qualification

• FRCPC (Fellow of The Royal College of Physicians of Canada) or
• FRCSC (Fellow of The Royal College of Surgeons of Canada)

Here is the list of countries under approved jurisdiction:

• Australia & New Zealand
• Hong kong
• Singapore
• South Africa
• Switzerland
• UK and Ireland

Here is where it gets confusing. The requirements for each specialty and each province is different. I encourage you to check the most recent requirements on the Royal College website.

How Can IMG Doctors Work in Canada through the practice eligibility route?

If you are an international physician not from the above countries and you are already in Canada working as a clinical fellow, then you should investigate this option. The Royal College website does not clarify which IMG doctors from which country are eligible for this. I have emailed the Royal College about this and I will update if I receive any answer.

There are two things that happen here

• Evaluation of training: Your time in training should be equal to the Royal College training equivalent. This depends on the specialty and for anesthesiology, the training requirement is 5 years. I have used anesthesiology as an example and you can check your specialty requirements from this link.
• Evaluation of practice (or your clinical work)

This path is available only for primary specialty and not for sub-specialty. For example, if you are anesthesiology trained, then you can be FRCPC in anesthesiology but not in pediatric anesthesiology, cardiac anesthesiology, etc.

What are the steps IMG doctors should take for the practice eligibility route?

Here are the major steps to apply for the practice eligibility route.

Step 1: Training document evaluation

1. Apply for your training document evaluation to the Royal College. This should be done at the website physicians apply.
2. You create an account on the physicians apply website. Then you pay non-refundable fees. There are many different fee structures and you can check this link for the latest information.
3. Submit these documents for source verification. There may be additional requirements
   • Medical degree or diploma
   • Medical degree transcript
   • Internship
   • Postgraduate training
   • Specialty certificate
   • Medical license or registration
4. Pass the Medical Council of Canada Qualifying Examination (MCCQE) Part I. There are specific study materials you check out here

Step 2: Royal College Exam

1. Once you receive eligibility for the exam you will have a 5-year period to complete the exam. This exam has two parts – Written and Applied. Both should be completed within the 5-year period.
2. This exam is taken at a Royal College center in Canada.

Step 3: Practice time in Canada to assess practice

1. This is the last step. Here you must complete 2-5 years of clinical work in Canada and then apply to the Royal College for assessment of practice time. Out of these 5 years, a minimum of 2 years must be in Canada to become certified.
2.  Alright, now you have completed the training assessment, examination, and practice, and passed your exams. viola..congratulations. You are now board-certified by the Royal College.

The expense for this is high and can run up to $7,000 or more at the time of my writing.

How Can IMG Doctors Work in Canada through the Subspecialty Examination Affiliate Program (SEAP) pathway?

The Subspecialty examination affiliate program will get you eligible for subspecialty certification. As an IMG registered with a postgraduate office in an accredited Royal College subspecialty training program but not Royal College certified in a primary specialty. The training assessment is applied at this website.

If the Royal College grants you eligibility then you have 5 years to take the exam. If you pass the exams, you will receive a Royal College attestation and can join Royal College as a sub-specialist affiliate. However, the confusing part is, this does not confer Royal College certification or fellowship.

Bottomline: Can IMG Doctors Work In Canada Without Residency?

IMG doctors can work in Canada without repeating residency or requiring citizenship.

IMG Doctor trained from a High Income Country Outside USA or Canada

If you are from the below countries, you are eligible for the Royal College Specialist pathway. You have to follow the above steps and receive eligibility, clear the Royal College Exams and be Royal College Certified.

• Australia & New Zealand
• Hong kong
• Singapore
• South Africa
• Switzerland
• UK and Ireland

IMG Doctor trained from a Low Middle Income Country

If you are from a country not from the above-listed ones then you are definitely better off with the province-based specialist hospital restricted license. This is based on my personal experience and many IMGs I personally know in Canada. You can always choose to repeat your residency. But remember getting a residency in Canada is not easy as there are very limited programs and most programs want to choose local graduates. The options for doing residency are much more in the USA.

However, if you are already in Canada as a fellow this is a great option to explore as you do not have to repeat residency all over again.

Check the below videos to explore the options for alternate entry path programs in the USA:

IMG Secrets: Where I Provide Secrets To Help You Succeed As An IMG