The issue regarding internationally trained physicians (ITPs) in Canada centers on a critical bottle

The issue regarding internationally trained physicians (ITPs) in Canada centers on a critical bottleneck in the licensing process, which prevents thousands of qualified doctors, including Canadian citizens who studied abroad, from practicing medicine despite a nationwide doctor shortage.
The Core Problem: Residency Bottleneck
The primary obstacle is the requirement for a Canadian residency position, a mandatory step for full licensure. The Canadian Resident Matching Service (CaRMS) largely prioritizes graduates of Canadian medical schools (CMGs). ITPs must compete for a very limited number of spots, with typically over 95% of positions reserved for CMGs. This creates a significant gap where thousands of ITPs who are otherwise qualified cannot proceed to practice.
Systemic Barriers and Financial Implications
ITPs face several additional hurdles that CMGs do not:
Expensive Examinations: ITPs must pass costly national exams like the MCCQE Part I and the NAC Examination, a financial burden that can exceed $4,700 just for exam fees.
Provincial Variation: The licensing process is not standardized nationally, requiring ITPs to navigate complex and differing regulations in each province.
"Return of Service": Many ITPs who do secure a residency or alternative assessment program are forced to sign contracts that obligate them to work in under-served, often remote, communities for two to five years.
Foreign Trainees Revenue: Canadian medical schools generate substantial revenue (millions of dollars) by charging foreign governments approximately $100,000 per year per trainee to use Canadian training resources. These foreign doctors often return home after training, leading to criticism that these valuable training spots should be allocated to Canadian doctors facing the bottleneck.
Recent Policy Changes
In December 2025, the federal government announced specific immigration policy changes to help address the doctor shortage, but these primarily assist ITPs already within the Canadian system:
Express Entry Program: A new program to fast-track permanent residency for 5,000 international doctors with a minimum of one year of Canadian work experience.
Expedited Work Permits: A faster, 14-day processing time for work permits for nominated doctors, allowing them to work while their permanent residency application is in process.
These measures aim to utilize the pool of doctors already working in alternative roles in Canada, but they do not directly expand the number of residency positions available to new ITP applicants.