The COVID-19 pandemic has highlighted in Canada how short the country is on medical doctors. It seems that international medical graduates (IMGs) — those who have graduated from a medical school not accredited in Canada or the United States — are needed more than ever in Canada. While there's demand nationwide, the Maritime provinces (Nova Scotia, New Brunswick, Prince Edward Island and Newfoundland and Labrador) especially need more medical support from IMGs.
If you're an IMG looking to make a move to Canada to work as a physician — you might be a doctor with several years of professional experience or perhaps you’ve just completed medical school — we've created this guide to help make the path clearer. We'll explore how IMGs make a living and find job opportunities, as well as how they can get financially settled in a new country.
How Canada's healthcare system works
Canada has a publicly funded healthcare system that is universally accessible. It ensures that anyone who needs hospital services or medical care from a physician can receive it, regardless of their financial situation. Each province and territory delivers health care to its residents under its own healthcare insurance plan.
These provincial plans don’t cover everything. When Canadians need what are called extended healthcare benefits — which can include prescription drugs, dental care and vision care, depending on the province — they typically must pay out of pocket unless they have extended healthcare benefits through their employer or have paid for a private health-insurance plan.
When it comes to mental health, physician-provided mental health care is covered by the public system, as is mental health care in hospital, whether a specialty psychiatric hospital or a general hospital. Most private psychologists, though, are not covered and must be paid independently or through a private health-insurance plan.
How much do doctors make in Canada?
Physician incomes vary widely depending on your area of specialty and the province or territory you practice in.
Physicians in Canada make an average of $388,000 per year (2021 figure). However, that number does not reflect a physician's take-home pay.
For example, a doctor’s gross clinical income might be $400,000, but $150,000 of that might go to overhead expenses, such as rent, staff, equipment and insurance. Another $100,000 might go to personal income tax. After those expenses are deducted, the doctor might be left with take-home pay of $150,000.
READ MORE: How much do doctors make in Canada?
International medical graduates: Practising in Canada
1. Application and eligibility
While there are a few ways to immigrate to Canada as an internationally trained physician, the fastest route to permanent residency is via Canada's Express Entry system.
Express Entry is available to people with certain skill types that fall into category A, B or 0 (zero). Physicians are considered skill type “A" and gain entry through the Federal Skilled Workers Program. Express Entry uses a points-based system and typically welcomes the highest-ranking candidates to apply for permanent residency.
If you don't have enough points to qualify, you might then choose to pursue a Provincial Nominee Program in one or more provinces. Each province or territory has its own nominee program to help reduce gaps in its labour market and population demographics (except Quebec, which has a different program called Recrutement Santé Québec). These programs typically search for applicants with work experience in fields where workers are in demand. These programs are called “nominee" programs because the federal government still has to approve permanent residency status; it's not up to the province alone.
2. Converting your credentials: Getting a licence in Canada
The first step to becoming a practising physician in Canada is to check whether your school of medicine is recognized in Canada. Look up your school in the World Directory of Medical Schools and verify that Canada is listed under the “Sponsor notes” tab.
Next, you will need to have your credentials verified by the Medical Council of Canada (go to the Services tab.) Once all your documents, including your degree and transcripts, have been approved you will get a finalized Education Credential Assessment report.
From there, you may need to take further tests or do more training to receive a qualification called the Licentiate of the Medical Council of Canada (LMCC). International medical graduates will have to meet the requirements of the LMCC before they can apply for a full licence to practice in Canada.
Depending on your credentials, you may also have to redo your residency training. For physicians specializing in orthopedic surgery, for example, Canada typically does not recognize training from outside Canada, the U.S. or Commonwealth countries. Bear in mind also that it can take years to get a residency placement here, through the Canadian Resident Matching Service.
Depending on your specialization, you may need to take further exams after your residency. If your job involves surgery, for instance, you'll need to take an exam set by the Royal College of Physicians and Surgeons of Canada.
Certification and retraining varies, depending on where you live in Canada, your specialty, and the country in which you did your medical training. Your road to converting your credentials may not be the same as another international trained medical graduate, which is why it's important to do as much research as possible.
3. Finding jobs and opportunities
After you've ensured you have all the necessary credentials and job requirements, you can start your job search.
Networking with your peers through your educational program, residency and professional groups and events can give you a leg up when it comes to finding employment opportunities. You may meet people in a similar line of work, or people who can recommend you for certain positions.
There are also job boards in Canada that post employment ads for unfilled positions. These include nationwide sites like healthcarejob.ca and healthcarecan.ca. Hospital websites also post recent openings.
When you know what province or territory you want to live in, you can also look up more regional resources, such as Health Force Ontario.
The financial realities of living in Canada
Before you relocate, get a good understanding of Canada's financial system, as well as how much it might cost to live in Canada.
1. The cost of living in Canada
The cost of living in Canada may be higher than what you’re used to. For the most part, Canadians spend 35% to 50% of their earnings on housing and utilities, which includes heating in the winter months. For an average-size apartment in a large city, or a large apartment or a house outside the large cities, you might end up spending $2,000 or more per month if renting.
2. Finding housing
It can be difficult to secure housing before arriving in Canada, so it may be easier to stay with friends or family first, or find a short-term rental through a hotel or Airbnb as you look for a place.
You may want to eventually buy a home, but if you're not sure where you'll end up working long-term, renting is usually a good way to start. To find available rental units, you can visit apartment buildings to jot down posted phone numbers or look for listings in local newspapers, on Facebook groups or on websites such as ViewIt.ca.
When you find a rental you want, the landlord might ask for proof of income or bank statements to check you can pay rent on time. They may also want to see a Canadian credit report (see “Establishing credit” below). Landlords will also likely ask for a security deposit, also known as “last month's rent.” Generally, the security deposit can't be more than one month's rent.
Be aware that rental units in Canada are typically unfurnished, so you will need to furnish a place yourself.
3. Establishing credit
If you are applying for a mortgage or a personal loan in Canada, you'll need to produce a Canadian credit report. A good credit score is evidence that you’re financially responsible and you pay your debts.
Even if you're renting an apartment, a prospective landlord may request a copy of your credit report. They will typically ask for your consent, and then pull the report from Equifax or TransUnion, the two main credit bureaus in Canada.
Having a good credit score can also help you get lower interest rates on credit cards, car insurance, or a mortgage if you’re buying a home.
One of the easiest ways to start building credit in Canada is to get either a credit card or a line of credit. A line of credit typically offers lower interest rates than a credit card, but it may be harder to get without a credit history; you may need another person to co-sign, which means that the other person agrees to repay the debt if you're unable to.
Luckily, many banks have products and services designed to help newcomers get settled, such as personal credit cards, student credit cards and business credit cards. For instance, the Scotiabank StartRight program can help you get a credit card and access other services as well. Just make sure you're aware of the interest rate and any annual fees. These may be higher since you're still building credit in the country.
For personal banking, another good place to start would be Scotiabank Healthcare+ — a physician banking program that's geared to your unique needs as a physician. From credit cards and lines of credit to private banking, this service offers specialized banking solutions created for medical professionals.
4. Insurance coverage
Many physicians in Canada are self-employed and are not covered by an employer benefits package. So they tend to purchase their own insurance coverage, such as disability and critical illness insurance, life insurance and extended health benefits (including prescription medications and dental care).
If you're a medical resident, you will likely have all this coverage through your residency association. However, depending on your personal situation, you may wish to increase your life and disability insurance through a private insurer.
If you need some guidance on what insurance coverage you need, your provincial medical association can help. They can do a needs analysis so that you get the most suitable insurance coverage for your situation.
If you have your own medical practice, you will also want to get these three types of practice insurance:
- Overhead insurance: If you're unable to work for a few months, overhead insurance will cover your rent, employee salaries and regular practice expenses, thus complementing your disability insurance.
- Office insurance: This provides coverage for fire, theft, or the loss of important items like computers and communication systems. You'll also be covered for personal injury and public liability.
- Malpractice insurance: Physicians in Canada must get medical liability coverage through the Canadian Medical Protective Association (CMPA). However, each medical association or federation typically has a reimbursement agreement with its own provincial and territorial government, so physicians can get a good portion (or all) of these fees back.
If you're employed as a medical administrator and offering non-clinical professional services that don't fall under the CMPA umbrella, consider researching extra professional liability protection.
5. Financial planning
International medical graduates wanting to work in Canada should factor in the time it takes to get established. You may not be able to start working as a physician right away. And if you need to do (or redo) your residency training, it can take years to get a residency placement, which can make it tough to cover your living costs. This is why understanding your finances and creating a financial plan to get by in the meantime will serve you well.
To ensure you're on track financially, you'll want to plan how you'll pay the costs related to your profession while still committing to your long-term goals, such as retirement.
By consulting an MD Early Career Advisor, you can create a plan that's tailored to your exact situation. An Early Career Advisor can also help you prepare for training costs and transition into your own practice.
6. Tax preparation and other accounting services
You may want to hire an accountant to take care of the financial side of your practice. As a practising physician, filing your tax returns can be quite complex, so this will be well worth the expense.
If you are a salaried physician or a resident (i.e., you get a regular paycheque from your employer), you should be aware of certain deductions that will be taken from your pay. One of these is your Canada Pension Plan (CPP) contributions, which are in return for benefits you’ll receive when you’re retired. Another deduction is for Canada's Employment Insurance (EI) program. This program provides temporary income support if you're unable to work, provided you meet the requirements to qualify. The EI program also provides special benefits for things like pregnancy and parental leave.
If you’re an employee, both the CPP and EI deductions will appear on your pay stubs and on the T4 slips you’ll receive once a year when it's time to file your taxes.
On the other hand, if you're a self-employed physician, you'll pay a calculated amount for CPP at tax time. As for EI, enrolment in this program is optional if you’re self-employed.
We hope this guide sheds some light on what's required to start working and managing your money as an international medical graduate in Canada. For more information, please speak with an MD Advisor*.
The above information should not be construed as offering specific financial, investment, foreign or domestic taxation, legal, accounting or similar professional advice nor is it intended to replace the advice of independent tax, accounting or legal professionals.
* MD Advisor refers to an MD Management Limited Financial Consultant or Investment Advisor (in Quebec), or an MD Private Investment Counsel Portfolio Manager.