IMG Pathway to Practicing Medicine in Canada: Complete Guide (2026)

Moving to Canada as an International Medical Graduate is one of the most complex medical licensing processes in the world. Multiple exams, credential verification that takes months, provincial regulations that vary wildly, and a residency matching system that feels designed to confuse you.

But thousands of IMGs successfully navigate this pathway every year. The difference between those who make it and those who get stuck? They understood the complete picture before starting — not just the next step.

This guide maps out the entire IMG pathway to practicing medicine in Canada in 2026, including several major changes that took effect this year.

The IMG Pathway at a Glance

Step 1: Credential Verification (physiciansapply.ca)
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Step 2: Pass MCCQE Part 1
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Step 3: Pass NAC OSCE
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Step 4: Obtain LMCC (new streamlined process in 2026)
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Step 5: Apply to CaRMS or Practice-Ready Assessment
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Step 6: Complete Residency Training
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Step 7: Pass MCCQE Part 2
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Step 8: Provincial/Territorial Licensure

Let's break down each step.

Step 1: Credential Verification

Timeline: 3–6 months
Cost: ~$400 CAD

Before anything else, you must verify your medical degree through physiciansapply.ca. This is the MCC's centralized application platform for all IMG-related processes.

What gets verified:

• Medical degree authenticity (via source verification with your medical school)
• Graduation status
• Postgraduate training records (if applicable)
• Good standing with previous medical regulatory bodies

Start this immediately. Credential verification is the longest administrative step, and nothing else can proceed without it. Many IMGs lose months by waiting to apply until they feel "ready" for exams.

Language Proficiency

If your medical education was not in English or French, you'll need to prove language proficiency:

Some provinces have stricter requirements. Check your target province's medical regulatory authority early.

Step 2: Pass the MCCQE Part 1

Timeline: 3–6 months of preparation
Cost: ~$1,290 CAD
Format: 230 MCQs in two sessions (new 2026 format)

The MCCQE Part 1 is the biggest hurdle for most IMGs. The pass rate for first-time IMGs is approximately 58% — compared to 94% for Canadian graduates. This gap exists because the exam tests Canadian-specific content that foreign training doesn't cover.

Key Topics IMGs Must Specifically Study

2026 Exam Sessions

For a complete preparation strategy, see our 3-month MCCQE study plan. For choosing the right question bank, compare options in our Best MCCQE Qbanks 2026 guide.

Step 3: Pass the NAC OSCE

Timeline: 3–6 months of preparation
Cost: ~$2,915 CAD
Format: 12 clinical stations (11 minutes each)

The National Assessment Collaboration Objective Structured Clinical Examination tests your clinical skills in standardized patient encounters. It's mandatory for IMGs applying through CaRMS.

2026 NAC OSCE dates:

• May 2, 2026
• September 19–20, 2026

What the NAC OSCE Tests

NAC OSCE Preparation Tips for IMGs

1. Practice with partners — You cannot prepare for OSCEs alone. Find a study group or join a NAC OSCE prep course.
2. Learn the Canadian approach — Communication style matters. Be explicit about your reasoning ("I'm checking your blood pressure because...").
3. Always sanitize hands upon entering each station — this is evaluated.
4. Structure every encounter consistently — use the same framework for history, physical, management.
5. Time management is critical — 11 minutes per station with no extensions.

Step 4: Obtain Your LMCC

Cost: Included with exam fees

The Licentiate of the Medical Council of Canada is your national credential. It doesn't allow independent practice, but it's required for provincial licensing and CaRMS.

Major 2026 Change: As of January 26, 2026, the MCC removed the requirement for 12 months of postgraduate training to obtain the LMCC. You can now receive your LMCC after passing the MCCQE Part 1 and completing medical degree source verification. This change significantly accelerates the timeline for IMGs.

The LMCC is now issued digitally through your physiciansapply.ca account.

Step 5: Apply Through CaRMS

Timeline: Application cycle runs September–March annually
Cost: Application fees vary (~$400–700 CAD)

The Canadian Resident Matching Service is the primary pathway for IMGs to secure residency training. Without residency, you cannot practice independently in Canada.

CaRMS IMG Stream Key Dates (2026 Cycle)

Improving Your CaRMS Application

• Strong MCCQE Part 1 score — a pass is mandatory, but a high score helps
• NAC OSCE pass — required for eligibility
• Canadian clinical experience — observerships, electives, or volunteer work
• Reference letters from Canadian physicians
• Research experience — publications strengthen applications
• Personal statement demonstrating knowledge of the Canadian healthcare system

Alternative: Practice-Ready Assessment (PRA)

If you've already completed residency training abroad and practiced independently, some provinces offer PRA programs. These involve a 12-week supervised clinical assessment instead of full residency training.

PRA programs exist in: British Columbia, Alberta, Manitoba, Saskatchewan, Ontario, Nova Scotia, and Newfoundland.

Step 6–8: Residency, MCCQE Part 2, and Licensing

Once matched through CaRMS, you complete residency training (2–5+ years depending on specialty) and then:

1. Pass MCCQE Part 2 — a clinical skills examination taken during or after residency
2. Apply for provincial registration — each province has its own medical regulatory authority with specific requirements
3. Receive full licensure — you can now practice independently in that province

2026 Changes That Benefit IMGs

Several changes effective in 2026 make the pathway more accessible:

Common Mistakes IMGs Make

Starting exams before credential verification — Your physiciansapply.ca application must be processed first. Start it day one.

Studying with US-only resources — UWorld is excellent for clinical knowledge but contains zero Canadian content. Supplement with a Canadian-specific question bank.

Ignoring Canadian ethics and public health — This is where the CMG-IMG score gap is widest and where marks are easiest to recover.

Applying to CaRMS without Canadian experience — Programs strongly favour IMGs with Canadian observerships or clinical experience.

Underestimating the NAC OSCE — Clinical exams require practice with real people, not textbooks. Join a study group early.

Frequently Asked Questions

How long does the entire IMG pathway take in Canada?

From starting credential verification to full independent licensure, expect 4–8 years total. Breakdown: credential verification (3–6 months), MCCQE Part 1 prep and exam (6–12 months), NAC OSCE (6–12 months overlapping), CaRMS cycle (6–12 months), residency (2–5+ years), MCCQE Part 2, and provincial licensing. Many steps can overlap to compress the timeline.

Do I need Canadian citizenship or permanent residency to apply through CaRMS?

Canadian citizenship or permanent residency is generally required for IMG stream positions in CaRMS. Some provinces have specific visa-sponsoring programs, but these are limited. Securing PR through Express Entry (including the new physician category starting 2026) before applying to CaRMS significantly improves your options.

Can I practice medicine in Canada without doing a Canadian residency?

In limited circumstances, yes — through Practice-Ready Assessment (PRA) programs. These are available for IMGs who have completed residency and practiced independently abroad. PRA involves a 12-week supervised assessment in a Canadian clinical setting. Not all provinces offer PRA, and spots are competitive.

Which province is easiest for IMGs to get licensed in?

No province is "easy," but some are more IMG-friendly. Saskatchewan, Manitoba, and Newfoundland historically offer more IMG residency positions relative to their size. Ontario has the most total IMG positions but also the most applicants. Research each province's specific IMG programs and requirements.

How much does the entire IMG pathway cost?

Budget approximately $8,000–15,000 CAD for the examination and application phase alone (credential verification, MCCQE Part 1, NAC OSCE, CaRMS fees, travel for interviews). This does not include study resources, living expenses, or residency-related costs. Many IMGs work in non-medical roles during preparation to fund their pathway.

Start Your Pathway Today

The IMG pathway to Canada is long, but it's clearly defined. Every step has a process, a timeline, and specific resources to help you succeed.

The most common regret from successful IMGs? Not starting sooner.

Begin your credential verification today. Start studying for the MCCQE Part 1 with our 3-month study plan. And explore the best MCCQE question banks for 2026 to build your foundation.

Create your free AllQbanks account →

Related Reading

• MCCQE Part 1 Study Plan: Complete 3-Month Guide
• MCCQE Part 1 Pass Rate: Statistics & Trends
• Best MCCQE Qbanks 2026: Complete Comparison Guide
• MCCQE Part 1 2026: The New 100% MCQ Format Explained
• The Ultimate MCCQE Part 1 Guide
• Official MCC Website
• CaRMS Website