We would like to thank Dr Haiju Henry Chirayath (Consultant Endocrinologist in Alberta, Canada) for his expert insights used in this article.

🤔Why is Canada an appealing choice?

    • Quality of life: Ranked in the top 10 of EIU’s annual Global Liveability Index 2024.

    • Take annual leave whenever you need and at short notice as most Canadian doctors are independent contractors!

    • Urban Life and Wilderness: You will be able to enjoy vibrant cities like Vancouver, Calgary, Toronto, and more within safe neighbourhoods, as well as beautiful landscapes such as the Rockies and Maple Forests.

    • A good work-life balance: Lower burnout rates, more flexible working hours than the UK’s 48+ hours/week, and minimal unpaid overtime

    • Strong Public Healthcare: Ensures universal access to residents and equitable care with less underfunding, more clinical autonomy and fewer strikes compared to the NHS.

    • Salaries: Canadian doctors earn more than their UK counterparts, even as junior doctors.

🇨🇦Canadian Healthcare System

Canada has a publicly funded healthcare system, often called “Medicare,” which is run separately by each province. All eligible residents are covered through provincial health insurance funded by taxes, and medically necessary hospital care and physician services are generally free at the point of use.

However, the exact coverage and healthcare structure can vary between provinces because each one manages its own system. Some services are not fully covered, such as prescription medications (outside hospital), dental care, physiotherapy, and vision care. As a result, many people use private health insurance through employers or personal plans to help cover these additional costs.

Private healthcare exists and mainly used for services not included in the public system.

Canada is known for relatively long waiting times for certain specialist appointments, investigations, and elective procedures compared with some other developed countries.

✨A Unique Working Structure for Doctors

Many doctors in Canada are independent contractors rather than direct employees of the healthcare system. This means they often have more control over their working hours, workload, and where they choose to practise compared with doctors in the NHS.

The role of a GP is very much different in Canada compared to UK. Family physicians (the Canadian equivalent of GPs) can work across a variety of settings, including community GP clinics, hospitals, emergency departments, and walk-in clinics. It is common for Canadian family doctors to combine several roles at once. For example, a doctor may spend part of the week seeing patients in a clinic and the rest working in a hospital. In comparison, UK GPs mainly work in community general practice, with hospital-based care usually delivered separately by specialist hospital teams.

 

🧾Incorporation and taxes

Many doctors in Canada choose to set up their medical practice as a business to help with tax planning, and they are independent contractors through this setup. This can help them save money on taxes. However, taxes can be more complicated and depend on things like whether they take income as a salary or dividends, how much money is kept in the business, which province they live in, and their overall income. Doctors should get advice from an accountant before doing this.

 

🏖️Annual leave

Most independent contractor physicians in Canada can choose when to take leave and generally have more flexibility in booking time off, sometimes even at relatively short notice. This is because they often control their own schedules. They just need to inform their secretary to cancel their schedule.

However, they do not receive paid annual leave in the same way NHS employees do. If they take time off, they are usually not paid during that period.

As Dr Henry said, “you can take holiday whenever you want, but you don’t get paid.” Unlike in the NHS, where you often need to give months’ notice and may not always get your preferred leave dates. This can feel like a big difference in Canada in terms of flexibility and the ability to take more spontaneous time off.

🏥Medical Training and Doctor Roles in Canada

Resident (Postgraduate training)

After medical school, all graduates complete a residency programme run through universities and teaching hospitals. The length of it varies based on the speciality. These residents are paid employees in training, similar to the UK foundation + Core/Registrar training. So, UK medical graduates can enter this path through CaRMS.

Fellow (Subspecialist in training)

This is an optional, further training program after residency that typically lasts 1-3 years. For example, if you chose internal medicine for residency and now want to further specialise in cardiology, you would do a fellowship in it. It is equivalent to UK higher speciality training (ST6-8) or post CCT fellowship.

Attending Physician (Fully qualified Doctor)

They are fully licensed doctors who can practice independently and can be referred to by their speciality, such as a surgeon or cardiologist. Equivalent to UK consultants and can run private clinics or work in hospitals.

Hospitalist

General doctors who work in the hospital inpatient setting are considered hospitalists. It often includes international medical graduates or family physicians. Thus, an entry point for UK-trained doctors is available via Supervised practice or a Provisional license in certain provinces.

Family Physician (GP)

Physicians are trained through a 2-year residency in family medicine and play a major role in primary care, often running their own clinics or working as locums. Thus, they usually act as gatekeepers for referrals, such as GPs in the UK.

🩺Degree verification and Registration

 

    • Create an account on physiciansapply.ca:

       

        • Setup cost: CAD 335 (£182)

        • It will allow you to upload your credentials, such as a copy of your passport, medical degree certificate, and transcripts.

        • Fill out the Certified Identity Confirmation form and upload it to get approval before applying for the exams. The official who also signs it after checking your passport can be a notary public, a lawyer, or a Consulate official.

        • Once these are source verified by the Medical Council of Canada (MCC) through your account (which takes 2-6 months), you can apply for the required exams.

        • Verification cost: CAD 232 (£126)

🛣️Choose your route: Residency or Practice?

Residency via CaRMS (Canadian Resident Matching Service)

This is the route that is most similar to applying for UK foundation or core training posts. So, you apply 1 year in advance (before your Foundation year 2) through CaRMS and enter residency in a specific speciality. This is suitable for those who want to work in Canada for the long term and are comfortable with exams and retraining. It is the same route for Canadian medical graduates. They apply through CaRMS during their final year of medical school and move directly into residency without extra exams like NAC OSCE.

Supervised Practice (Skip residency)

Instead of going through CaRMS, you apply directly to a province that allows supervised or provisional licenses, and after a period, you qualify for independent registration. It is limited to specific provinces and is suitable for graduates with at least some clinical experience, such as after FY1 or FY2, who are interested in hospitalist or GP-style roles.

📚Exams you May need to take

MCCQE Part 1 (Medical Council of Canada Qualifying Exam):

    • A computer-based exam that assesses your clinical decision-making and medical knowledge. It is expected to cover MBBS content and is divided into two parts- MCQs and Case-based scenarios. It is for the CaRMS pathway.

    • Duration: 6.5 hours (with scheduled breaks)

    • Applied through your physiciansapply.ca account and held across three sessions (April-May, Aug-Sep and Oct) at available Prometric test centres.

    • Fees: around CAD 1500 (£818)

    • Candidates are allowed a maximum of four attempts.

    • As of June 9, 2025, UK doctors no longer need to write this exam if they plan to practice in British Columbia, Alberta, Manitoba and Ontario. This only applies if you’re applying directly for provisional or supervised practice in those provinces.

 

NAC OSCE:

    • National Assessment Collaboration Objective Structured Clinical Examination is a 12-station clinical OSCE required for international graduates applying for CaRMS. Each station is around 11 minutes long.

    • It is conducted in person in Canada across May and September and is also applied through your physiciansapply.ca account.

    • Fees: approximately CAD 3220 (£1757)

    • Candidates are allowed a maximum of three attempts.

MCCQE1 and NAC OSCE are considered challenging as they not only test your knowledge but also clinical reasoning under strict timed settings. It requires a minimum of 3-6 months of preparation using mainly official MCC study materials, CanadaQbank and more.

For more information: MCC

Practice Ready Assessments (PRAs)

For the supervised pathway, after obtaining sponsorship and meeting the eligibility requirements, you will need to complete a 12-week clinical evaluation in a Canadian province. This is the Practice Ready Assessment (PRA) program. Then, you must sign a return-of-service (ROS) agreement, which means you are required to work in an underprivileged area for 3 to 5 years after completing the program. These are rural or remote regions, usually with fewer doctors and limited healthcare access. PRAs are available in the following provinces: Nova Scotia, Manitoba, Saskatchewan, Alberta, BC and New Brunswick. Costs around 6000-10,000 CAD (£3274-£5458).

IELTS Academic

Canadian provinces that require English language evidence for medical licensure can be met by UK graduates by taking the IELTS test and earning a score of 7.0 in total, with no band as low as 6.5. This rule applies to both pathways and is valid for two years.

💬The Interview

The residency interview is done online or in person, depending on the program. It is often scheduled between January and February once you have applied through CaRMS. The type of format is either one-on-one or panel and is conducted for 20 to 30 minutes. Typical questions asked and things to do:

 

    • “Why this speciality?”

    • Review your CV and identify the successes and challenges you can discuss.

    • Approach Interview questions calmly and can use the STAR framework.

    • Participate in mock interviews.

    • Prepare for any clinical or ethical scenarios and conduct thorough research on the specific program.

📍CaRMS Application Timeline

 

1. January-June (year before match): Complete Account creation and verification.

2. February-September (MCCQE Part 1 and NAC OSCE): Exam preparation and booking

3. September: Register at the CaRMS site and build the application as the portal opens. Documents that you submit are:

    • MSPR/dean’s letter (Medical School Performance Record): It is requested from your medical school.

    • Medical School Transcripts

    • Personal statement: For every programme you apply to, you need to tailor a personal statement outlining the reasons you have chosen that speciality.

    • References/Recommendation letters: These are provided by physicians, professors, or non-clinical individuals called referees who write a letter recommending you for the medical training. They are requested through your portal and can upload it directly.

    • IELTS, MCCQE and NAC: The scores are directly uploaded from your physiciansapply portal.

    • Photo: Optional, and would indicate if required for that programme.

    • CV: Fill out our CaRMS online CV section and do not upload it separately.

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4. Late November: Submit all the above documents by this time for all the speciality programs you want to apply to, and also pay the specified application fee for each.

Remember to check the list of available positions and acceptance for UK graduates for each programme and any special requirements.

5. January- March: Rank preferred programs after interviews in order of your preference.

6. Mid-March (Match day): Results are announced, and a computer algorithm will match you based on your and the program’s rankings, along with the available spots. If unmatched, you enter the second iteration.

7. Congratulations! Residency starts around July 1.

👨‍⚕️After securing a Residency or Provisional post

Once you’ve been matched to a training program or approved for supervised practice, here’s what happens next:

Work Permit/Visa

Apply to the Canadian High Commission in the UK for an employer-specific (Closed) work permit, which is issued based on your employment offer provided by the university or the health authority. Processing time is around 8-12 weeks and costs ~CAD 155 (£84) + CAD 85 (Biometrics) (£46).

Visa information

Immigration Medical Exam

All clinical workers undergo this exam with an IRCC-approved panel physician, which includes a history, physical exam, CXR, and blood tests. It is valid for 12 months and costs approximately £250-£400.

Provincial Registration

After a successful match or PRA approval, apply for provisional medical registration through the provincial medical regulatory authority.

Documents typically include:

    • Finalised contract/offer letter

    • IELTS score (if required)

    • Police check

    • Fees (around CAD 500–800(£272-£436))

Each province has its own timeline and documentation checklist.

Orientation and Licensing

Once licensed, you’ll be required to attend orientation programs run by the medical school or hospital. You can now begin working as a resident physician or provisionally licensed doctor.

💰How Doctors are Paid: The Fee-for-Service Model

The healthcare system in Canada is quite different compared to other countries. Most physicians in Canada work as independent contractors rather than salaried employees. A common payment model is “fee-for-service,” where doctors bill the provincial government for each patient consultation or procedure performed. In many practices, administrative staff or billing companies manage the invoicing process.

Although many doctors are paid per patient they see, payment systems vary depending on the province and specialty. Some doctors are instead paid a salary, or are paid based on hours worked, or the number of patients they care for.

  UK F1 (avg 2024/25) UK F2 (avg 2024/25) Canada PGY-1 (avg)
Annual Income (pre-tax) £32,398 £42,008 ~£43,300
Average working hours 46-48 hours/week 48 hours/week 75 hours/2 weeks

Foundation year 2 in UK is the best compartor to first year of residency in Canada as both roles sit at the same stage in training and normally the programs prefer the candidate to have a 12-month internship prior to applying for training in Canada.

⚖️ Benefits vs Drawbacks

✅ Benefits

 

    • Greater autonomy over clinic schedules and workload

    • More flexibility with holidays and time off (can be taken at short notice)

    • More control over where and how you practise

❌ Drawbacks

 

    • Holidays are usually unpaid (less financial security during time off)

    • Fee-for-service model: Income depends on patient volume, so there can be pressure to maintain high numbers of appointments in clinics and surgeries

    • Less structured employment compared with the NHS

🇨🇦Ready for your Canadian chapter?

Moving from the NHS to Canada is a significant step, but this guide outlines the key stages – from credential verification and exams to CaRMS or supervised practice routes and provincial registration. Following these steps will help you navigate the pathway to working as a resident or licensed physician in Canada.

📚Resources

Study Resources:

Guides:

    • For official and further information: MCC

    • Articles and resources on working internationally as a doctor in Canada: BMJ-Working Abroad.

Thanks for reading! If you have any comments or suggestions, please feel free to share them below and we’ll get back to you as soon as we can.

Reviewed by Dr Haiju Henry Chirayath

Consultant endocrinologist in Alberta, Canada, with international experience across the UK, Canada, and UAE. He is also a researcher, author, and website creator focused on helping patients with endocrine disorders.

Reviewed by Maria Diamond

Article Lead at More than Medics