Health Law Blog

The doors are opening for U.S. - trained physicians

March 14, 2023

The College of Physicians and Surgeons of Ontario (CPSO) has suggested changes to registration policies intended to encourage more U.S. physicians to practise in Canada.

The proposals are outlined in Alternative Pathways to Registration for Physicians Trained in the United States. According to Dialogue, a CPSO publication, the draft policy is the result of the College’s efforts to “review its registration policies and determine whether additional registration pathways can be found to improve access for [those] seeking a licence to practise independently in Ontario.”

The changes would remove existing supervision and assessment requirements for physicians who are board-certified in the United States, enabling them to begin practising in Ontario immediately. As the article notes, “Given the broad similarities in training programs between the U.S. and Canada, and the historical experience with current assessment processes, Council believed the current supervision and assessment requirements were unnecessarily burdensome.”

New pathways

The draft policy also introduces a new pathway for U.S. physicians who completed their residency training and are eligible for their relevant board examinations. Those physicians will be encouraged to come to Ontario and practise under supervision while they complete their U.S. exams.

Dialogue notes that CPSO already has a similar route for College of Family Physicians of Canada or Royal College of Physicians and Surgeons of Canada exam-eligible applicants. “The draft contemplates mirroring this process for U.S. trainees,” it explains

Currently, U.S. board-certified physicians are captured under Pathway A of the Alternative Pathways to Registration policy, and can obtain a restricted licence to practise independently in Ontario after completing a minimum of one-year supervised practice and an assessment.

The draft policy modifies Pathway A to grant U.S. board-certified physicians a certificate to practise independently in Ontario without the requirement of supervision or assessment.

New way forward

U.S. board-eligible physicians are not currently captured under an alternative pathway to registration with the CPSO. The draft policy creates a Pathway C to grant physicians deemed board-eligible a time-limited, restricted certificate of registration to complete the U.S. board exam. The proposed certificate would expire within three years if the physician has not successfully written the board exam. Upon successfully obtaining board certification, these physicians would be granted a licence under the draft Pathway A.

In addition, physicians not certified by CFPC or RCPSC are unable to use the specialist title unless granted by the CPSO. Associated changes to the draft Specialist Recognition Criteria in Ontario policy were made to allow both groups of physicians specialist recognition in Ontario.

This draft policy – like all CPSO proposed changes to registration policies – was circulated to the Ministry of Health, the coordinating minister under the Ontario Labour Mobility Act, 2009, and the Medical Regulatory Authorities in Canada.

“No feedback was received on the proposed changes,” the article notes.

Nova Scotia now accepts U.S. doctors

Nova Scotia is the first province to recognize the credentials of U.S. board-certified doctors without the need for them to write Royal College exams, according to a March CBC report.

Dr. Gus Grant, CEO of the College of Physicians and Surgeons of Nova Scotia, said the change will remove a barrier for doctors who trained in the United States but want to practise in that province.

"I can't think of many of my med school classmates who would fancy the task of challenging the certification exams in the middle of their career," said Grant. "Because they're unattracted by the notion of getting a provisional licence when they enjoy a full one in their own jurisdiction."

Doctors trained elsewhere than Canada or the United States will continue to be issued provisional licences and have to write Royal College exams in order to be fully licensed to practise in Nova Scotia, he adds.

Incentives for U.S. physicians to move here

According to an article on, a Canadian website that helps health practitioners with billing issues, many physicians can earn a higher income in Canada than south of the border.

“Doctors in Canada can bill for more of their time and earn up to $100,000 more for their services,” What American doctors can expect when moving to Canada notes.

“Combined with Canada’s many other benefits – like beautiful landscapes, clean cities, and high levels of professional satisfaction for doctors – it’s no wonder more and more American doctors are crossing the border.”

An American-trained family physician writing in the Canadian Medical Association Journal notes that “thanks to insurance-company loopholes and technicalities, American family physicians aren’t paid up to 30 per cent of the time, whereas under a single-payer system, only about two per cent of their billings aren’t covered.”

By: TTL Health Law staff


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