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Ontario doctors’ association wants to open doors to US trained physicians

Authored March 27, 2023

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There are various reasons why physicians who are trained and licensed in the United States would want to practise in Canada. Higher salaries and less paperwork are just two.

“Doctors in Canada can bill for more of their time and earn up to
$100,000 more for their services,” states an article on a Canadian website that helps health practitioners with billing issues.

“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,” it adds.

According to a U.S.-trained family physician writing in the Canadian Medical Association Journal, American doctors are frustrated by insurance-company loopholes and technicalities they deal with when billing.

“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,” he writes.

Recognizing that Canada would benefit from having more U.S. physicians joining our health system, 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 (CFPC) or Royal College of Physicians and Surgeons of Canada (RCPSC) 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 co-ordinating minister under the Ontario Labour Mobility Act, 2009, and the Medical Regulatory Authorities in Canada.

Nova Scotia now accepts U.S. doctors

Nova Scotia is already recognizing the credentials of U.S. board-certified doctors without the need for them to write Royal College exams, according to a media report.

The CEO of the College of Physicians and Surgeons of Nova Scotia, Gus Grant, says his group has removed a barrier for doctors who trained in the United States but want to practise in that province.

“Our challenge is to address access to care in a way that is in a public interest, that ensures safety,” said Grant. “We are very much aware of the context we’re in right now.

“Many people can’t access the care that they need but that doesn’t change our mandate — that our responsibility is to license competent physicians and not to license incompetent physicians,” Grant adds.

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 explains.


Brooke Shekter is a lawyer with TTL Health Law. 

The opinions expressed are those of the author and do not reflect the views of the author’s firm, its clients, Law360 Canada, LexisNexis Canada, or any of its or their respective affiliates. This article is for general information purposes and is not intended to be and should not be taken as legal advice.



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