College of Physicians and Surgeons of Ontario

Registration Processes: The College of Family Physicians of Canada (CFPC) introduced two routes to CFPC certification without examination – one for family physicians with an established practice in Canada, and the other for graduates of family medicine training systems in international jurisdictions recognized by the CFPC. Late in 2009, the CPSO passed a new registration policy recognizing these two new routes.

Mutual Recognition Agreement (MRA): An MRA is an agreement between organizations in different jurisdictions. Each organization validates/accepts the licence/certificate granted by the other. The CPSO entered into an MRA with the medical regulatory authority in Quebec, the Collège des médecins du Québec (CMQ). Under this agreement the CPSO and CMQ recognize one another's qualifications for independent practice. Physicians must still apply for a licence and complete credentialing requirements, but the agreement enables a more streamlined credentialing process. The CPSO–CMQ agreement marks the first such province-to-province MRA entered into by the CPSO.

In October 2008, CPSO notified the OFC that the previous summer its council had approved a new policy that established four new "pathways" to registration for medical graduates trained in other Canadian and in international jurisdictions. These pathways were numbered 1 to 4. The CPSO further advised the OFC that it had developed, and was circulating to stakeholders and the OFC for comment, two additional pathways, numbered 5 and 6.

Pathway 5 defines an "approved" jurisdiction for the purposes of the registration of an international medical graduate (IMG) as one with a postgraduate medical education system for non-family-medicine specialists that has been approved by the Royal College of Physicians and Surgeons of Canada (RCPSC). At present, the RCPSC-approved jurisdictions are Australia, New Zealand, South Africa, the United Kingdom, the Republic of Ireland, Switzerland, Singapore and Hong Kong.

Pathway 6 addresses the registration of IMGs with medical degrees from unapproved jurisdictions – that is, those with postgraduate training that has not been approved by the RCPSC. In order to be eligible for registration, these applicants must meet all the requirements for an Independent Practice Certificate and have five or more continuous years of independent practice in Canada.

In its December 2008 response to the college, the OFC expressed two concerns about Pathways 5 and 6. First, Pathway 5 raises the issue of fairness, because the RCPSC-approved jurisdictions do not include four of the CPSO's top five "intake" countries for internationally trained applicants (see Figure 5 on page 28). Second, Pathway 6 raises the issue of transparency. It is unclear how applicants can fulfil the requirement to have five or more continuous years of independent practice in Canada when their medical degrees and postgraduate training have not been approved by the RCPSC. The OFC recommended that the CPSO provide Pathway 6 applicants with additional, clear information about how they can satisfy the practice requirement.

Although the OFC was not asked to comment on Pathways 1 to 4, it included observations about them in its response to the CPSO. These pathways, which went into effect on December 1, 2008, are intended to fast-track the registration of physicians trained in other Canadian jurisdictions and in the United States. The OFC welcomed Pathways 1 to 4 as positive steps towards improving entry to the profession for these applicants. It pointed out, however, that Pathways 1 to 4 do not address the issues faced by qualified applicants already in Ontario. Rather, they appear to focus on fast-tracking new physicians at the expense of those who have been in the province for some time. The latter will fall further behind, as their qualifications are no longer considered current.

The OFC also noted that qualified applicants already in Ontario represent an important source of talent – they have valuable skills, and could help relieve the province's shortage of doctors. The OFC suggested that it is important to recognize these applicants, regardless of where they were trained, and to give them fair consideration as well.

Successful completion of approved residency training is a key requirement for obtaining an Independent Practice Certificate. The OFC has identified access to an approved residency program as a significant barrier for IMGs pursuing registration. Providing alternatives for these individuals would improve the CPSO's registration processes. The OFC recommended that the CPSO explore alternatives to the residency program to provide qualified applicants with options for satisfying the residency requirement.