Provinces Help International Physicians Practice in Canada

An Iranian-born surgeon now in family practice in Alberta expressed optimism about efforts underway to make it easier for international medical graduates (IMGs) to become licensed to practice in Canada.

“Many things have changed since I came to Canada” in 2002, Mitra Arjang, MD, told Medscape Medical News. “It has been getting better, but after not accepting IMGs for quite a few decades, there’s a huge backlog.”

Nova Scotia opened a Physician Assessment Centre of Excellence (PACE) and clinic with the dual aims of expanding primary care in the province and giving graduates of foreign medical schools an alternative path to prove their merit. A team of Nova Scotia physicians will supervise and assess participants in a 12-week program. Physicians who become licensed through the program will be required to sign a 3-year return-of-service agreement to practice in the province.

The program is a partnership between Nova Scotia, the College of Physicians and Surgeons of Nova Scotia, Halifax, and the Medical Council of Canada, which oversees physician assessment standards.

The PACE program builds on Dalhousie University’s Practice-Ready Assessment (PRA) program, which has conducted similar work and has issued 39 licenses since 2019. The timeline from the date of application to licensure was about 18 months. The program involves a team of Nova Scotia physicians who will assess the participants for independent licensure.

“The goal is to open the door as wide as possible without lowering the bar of competence required,” Gus Grant, MD, registrar and chief executive officer of the College of Physicians and Surgeons of Nova Scotia, told Medscape Medical News.

“What we have to do is develop ways by which internationally trained physicians can demonstrate that they have the training, the skills, and the competence to practice safely here,” he said.

Senator Stan Kutcher, MD, a member of the Independent Senators Group who represents Nova Scotia, said that this program could serve as a model for creating a new pathway toward licensing IMGs.

Many other provinces have efforts underway to help IMGs with experience achieve licensure in Canada. The Practice Ready Ontario program has announced a goal of providing up to 100 new family physicians by the end of 2025. Existing PRA programs added more than 600 family physicians to the Canadian health workforce in the past 5 years, according to the program’s website. The PRA — British Columbia has assessed 319 family physicians since 2015, and the latter have been placed in 77 communities.

No National Plan

But Kutcher, who is also a psychiatrist, stressed the lack of a cohesive national plan for helping more IMGs practice in Canada.

In January, Health Canada released a major report about the future of the nation’s health workforce. It included the results from a study that found a need for almost 23,000 more family physicians, or a 49% increase from the current supply. The report provided recommendations about training and retaining the domestic health workforce but paid less attention to assisting IMGs.

“Policymakers across the country are also working on other important areas such as increasing scope of practice, moving toward more team-based primary care models, and supporting qualified internationally trained healthcare professionals to practice in Canada,” according to the report.

An estimated 1 in 5 Canadians (about 6.5 million people) do not have a family physician or nurse practitioner whom he or she sees regularly, according to a national survey.

In a Senate debate in October 2024, Kutcher argued that a national PRA program for immigrant physicians could have eased this shortage. “Had a national PRA program been in place, it is very possible that we would not be in this situation now,” Kutcher said.

“Let me be very clear about the PRA route to licensure: It is tailored specifically for those experienced, mid-career physicians who have already been practicing medicine in another country,” Kutcher added. It’s not “for recent medical school graduates who have not previously practiced medicine.”

Canada already has had significant positive experiences with small-scale PRA programs, Kutcher told Medscape Medical News. “There have been PRA programs scattered across the country for over a decade, and these PRA programs have actually proved quite effective in enhancing the pathway to licensure for internationally trained physicians,” said Kutcher. “The trouble has been that they have been very few and far between, and their funding has been haphazard at best.”

Setbacks and Successes

Indeed, Arjang had a disappointing experience with one of these programs on her long journey toward practicing in Canada. She was among the IMGs who suffered a setback when provincial leaders suspended Ontario’s PRA Program in 2010. Officials cited a lack of positions for physicians who would gain certification this way, CBC reported.

Like many IMGs, she obtained certification from the Medical Council of Canada certificate, but the persistent hurdle was getting a residency needed for licensing. Arjang tried for highly competitive surgical residency programs but didn’t get a space.

During her years seeking licensure, Arjang remained active in medicine. She worked as a researcher at Sunnybrook Health Sciences Centre in Toronto from 2010 to 2013. For many years, she returned to Iran in the summer to practice and maintain her skills. She took a job in Alberta Health Services as a clinical surgical assistant in 2013.

Eventually, Arjang gave up trying to work as a surgeon in Canada and decided to pursue a residency in family medicine instead. She succeeded on her third try, completing a University of Calgary, Calgary, program in 2022. She has found this work rewarding and akin to the approach that surgeons took in Iran during her training.

In Canada, a surgeon may have no contact with a patient beyond performing a procedure, but in Iran, he or she has more responsibility for the recovery period. In Canada, “the family doctor is actually the owner of the patient wellness, or the main responsible provider in terms of patient wellness and health,” said Arjang.

“My training in surgery provided me with a strong foundation in taking full responsibility for patient care, from the procedure itself to the follow-up and transition of care,” she added. “Now, as a family physician, I bring that same level of responsibility and attention to the whole person, offering continuous and holistic care that goes beyond treating specific conditions. The shift to family medicine aligns with my passion for long-term patient relationships and comprehensive care.”

Kerry Dooley Young is a freelance journalist based in Washington, DC. She has written about medical research and health policy for more than 25 years. Follow her on LinkedIn and Bluesky.