Canada has a publicly-funded healthcare system, in which roles and responsibilities are divided between the federal, territorial, and provincial governments. The ‘Canada Health Act’ outlines the basic foundations for healthcare across the country, but the operational logistics are managed at the provincial level. For example, the Québec Health Insurance Plan is managed by Régie de l’assurance maladie (RAMQ).
The healthcare system is financed with general revenue raised trough federal, territorial, and provincial taxation. Most of the services that a patient receives from a GP or a hospital are covered by public health insurance, without direct charges at the point of service. Also, citizens may purchase private health insurance for some services.
Medical Licensure/Registration
As Canada is divided into distinct territorial and provincial healthcare regions, U.S. physicians face the regulations of provincial physician colleges to obtain medical licensure in a specific province.
US physicians looking to obtain a medical license in Québec generally do not need to repeat residency training, and US-accredited specialty and subspecialty training are typically recognized as equivalent to Canadian specialty and subspecialty training. However, a period of supervision may be required.
Here is more information on obtaining a medical license in Québec. Typically, US trained physicians applying for licensure in Quebec will need to meet the following requirements before applying for registration.
Proof of French Language Proficiency
Medical Degree from an accredited Allopathic or Osteopathic school
Completion of an ACGME-accredited postgraduate training program
Pass the Royal College of Physician and Surgeon Certifying Exams. These exams typically take place only once per year, and registration deadline is sometimes up to one year prior to exam writing date. Notably, for family medicine physicians ABFM board accreditation may be accepted and you typically will not need additional exams.
Completion of the ALDO-Québec educational activity on the legal, ethical, organizational practice of medicine in Quebec
Physicians are often required to show that they have a job lined up before they are allowed to begin the cross-border licensing process.
Finding a Job
A great place to start the job search is to look at the job listings on the Canadian Association of your Specialty such as the Canadian Psychiatric Association and the Canadian Orthopaedic Association or province-specific organizations, such as the Fédération des spécialistes du Québec. You can also reach out to physician recruiting firms. In addition, professional networks and word of mouth may help.
Salary and Work Culture
While the Canadian government provides health insurance to its patients, it does not employ physicians directly. Doctors working in the public system are considered to be self-employed; they directly bill the provincial health insurance for services they provide to patients. In the case of Québec, physicians bill RAMQ. Individual physicians are responsible for their own retirement plans, maternity leaves, sick leaves, etc. They may use a Registered Retirement Savings Plan for retirement and purchase disability insurance.
Income varies by location and specialty. Remote regions and regions-in-need may offer higher pay. Cost of living and expenses associated with practice also vary by region and specialty. In general, doctors in Canada are able to live comfortably. Family physicians in Quebec make approximately 255,000 CAD while a specialist makes around 367,000 CAD.
With regard to malpractice, doctors become members of the Canadian Medical Protective Association, a not-for-profit, mutual defence association. Fees vary depending on specialty – with malpractice coverage for psychiatry being about $1000 per year. Doctors may also purchase malpractice insurance if they desire extra protection.
A significant proportion of doctors in Canada support the idea of universal health care. Practice in Canada, including in Québec, is thought of as having less administrative burden than practice in the US. Despite working long hours, there is a strong lifestyle culture in Québec. Money is not necessarily a top priority and physicians in Quebec have previously rejected a pay raise.
Immigration
For those applying for a temporary work permit under the Temporary Foreign Worker Program in Canada, prior to arriving in Canada, U.S physicians typically must obtain an approved job offer (one that has received a positive Labour Market Impact Assessment (LMIA), completion of Immigration, Refugees, and Citizenship Canada (IRCC) general eligibility requirements, and an IRCC medical exam. A LMIA is a document that an employer needs to hire a foreign worker. This document demonstrates that there is no Canadian citizen available to do the job, proving there is a need to hire a foreign worker.
A physician may also apply to work in Canada as a Federal Skilled Worker. The IRCC uses an online process to select skilled immigrants and candidates assessed according to a ranking system that considers: language proficiency, education, Canadian work experience, amongst other factors. All candidates in this pool are assigned a score according to these factors, and candidates with existing job offers are given additional points. The highest ranking candidates will be invited to apply through a “draw” – and the candidate will have 60 days to complete an application for permanent residency.
Irrespective of route, U.S. physicians are encouraged to look at the latest requirements for U.S. immigration to Canada on the Immigration, Refugees, and Citizenship Canada (IRCC) website.
A Canadian citizen or permanent resident may be eligible to sponsor their spouse as well as their children for permanent residency under IRCC’s Family Sponsorship Class.
Bottom Line
The process to work as a U.S. physician in Canada is typically encumbered by an extensive licensing/supervision process, despite many credentials of US-trained doctors being recognized by most provincial colleges. Nevertheless, many provinces are still in need of trained physicians, and there is a large migration of U.S. physicians to Canada each year. If a U.S. physician wishes to migrate to Québec, fluency in French is a non-negotiable requirement.
Dr. Nadia Daly is a Harvard Medical School-educated Child and Adolescent Psychiatrist and visual artist from Montréal, Québec.
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