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College of Physicians and Surgeons of Ontario

The College of Physicians and Surgeons of Ontario (CPSO) is the governing body for physicians and surgeons in Ontario. The Office of the Fairness Commissioner (OFC) oversees the registration practices of the college to ensure that they are transparent, objective, impartial and fair for anyone who wants to practise as physician and/or surgeon in this province.

Registration Practices Assessment Report, 2013

This summary of the assessment includes recommendations for improvement.

Fair Registration Practices (FRP) Report, 2012

Registration Practices Assessment Report — Summary (Physicians and Surgeons)

Applications to Practise Processed by the CPSO in 2012
Jan. 1 to Dec. 31 Jurisdiction Where Applicants Received Their Training Total
Ontario Other Canadian Provinces USA Other International Unknown
New applications received1,5468221041,67704,149
Applicants who became members1,5468221041,67704,149

Fair Registration Practices (FRP) Report, 2011

Applications to Practise Processed by the CPSO in 2011
Jan. 1 to Dec. 31 Jurisdiction Where Applicants Received Their Training Total
Ontario Other Canadian Provinces USA Other International Unknown
New applications received1,5416981061,62803,973
Applicants who became members1,5416981061,62803,973

Fair Registration Practices (FRP) Report, 2010

Applications to Practise Processed by the CPSO in 2010
Jan. 1 to Dec. 31 Jurisdiction Where Applicants Received Their Training Total
Ontario Other Canadian Provinces USA Other International Unknown
New applications received1,380716901,52203,708
Applicants who became members1,392716901,52203,720

Fair Registration Practices (FRP) Report, 2009
Audit Report

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.

For a description of all OFC-monitored developments for this profession for 2009, see the 2009-2010 Annual Report.

Applications to Practise Processed by the CPSO in 2009
Jan. 1 to Dec. 31 Jurisdiction Where Applicants Received Their Training Total
Ontario Other Canadian Provinces USA Other International Unknown
New applications received1,420648841,58603,738
Applicants who became members1,380638841,53603,638

Fair Registration Practices (FRP) Report, 2008

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.

Applications to Practise Processed by the CPSO in 2008
Jan. 1 to Dec. 31 Jurisdiction Where Applicants Received Their Training Total
Ontario Other Canadian Provinces USA Other International Unknown
New applications received1,262678741,55303,567
Applicants who became members1,262668741,50303,467

During the fall and winter of 2007-2008, the OFC undertook a study of the CPSO to understand its 2007 registration practices and establish baseline data and information. PDF

Exemplary Practices

The OFC gathers regulatory bodies' exemplary licensing practices so that they may learn from one another. Practices for the College of Physicians and Surgeons of Ontario are listed below.

  1. Identifying acceptable alternatives for documentation of qualifications

    This practice will be of interest to regulators who...

  2. Implementing an efficiency initiative

    Following a review of its processes, the College of...

  3. Providing a clear overview of a complex registration process

    This practice may be of interest to regulators who...

  4. Using a service pledge to commit to published timelines

    This practice holds the regulator accountable to established...


Quick Facts

Number of Physicians and Surgeons37,684
Number of Internationally Trained Physicians and Surgeons10,408

You may find information about exam requirements and Canadian work experience requirements elsewhere on this site.


Location of Training, 2012

Ontario20,048
Other Canadian Provinces6,735
USA493
Other International10,408
Unknown0
Total37,684
Proportion of Internationally Trained Members (includes USA)29%

The Top Five Source Countries For Internationally Trained Physicians and Surgeons, 2012

Largest NumberSaudi Arabia
Second Largest NumberIndia
Third Largest NumberU.K.
Fourth Largest NumberIreland
Fifth Largest NumberU.S.
Number of Applicants681

The College of Physicians and Surgeons of Ontario falls under the jurisdiction of the Ministry of Health and Long-Term Care. The OFC does not assess credentials, handle complaints or intervene in particular cases. Our mandate is one of systemic change. Please contact the CPSO for further information about your ability to practise as physician and/or surgeon in Ontario.

Applicant Category Ontario Applicants:
number and per cent
Ontario Matches:
number and per cent
Canadians studying abroad 715 (35 %) 143 (59%)
US medical school graduates 46 (2 %) 18 (7%)
Immigrant physicians 1265 (62 %) 83 (34%)
Totals 2026 (99 %) 244 (100%)

Source: Canadian Resident Matching Service, 2012

Close

Vigilance and Action

Immigrant doctors struggle to access the residency training required for licensure in Ontario. Each year, residency positions are reserved for international medical graduates. However, statistics from the Canadian Residency Matching Service for 2012 show that most of these positions are granted to Canadians who study medicine abroad.

The OFC is concerned that efforts aimed at helping immigrants are not having the intended impact. In 2012, fewer than ten per cent (83 out of 1,265) of all immigrant physicians applying for residency were successful in obtaining a match.

We continue to urge the CPSO and the Ministry of Health and Long-Term Care to expand alternatives to residency, such as practice-ready assessment.

September 2013