A Physicians First Guide to CPSO Licensure: From Application to Approval
The College of Physicians and Surgeons of Ontario (The CPSO) is Your Gatekeeper to Ontario Practice
If you’re a U.S.-trained doctor aiming to work in Ontario, Canada you must be licensed by the College of Physicians and Surgeons of Ontario (CPSO) before you can bill OHIP or legally treat patients.
This guide breaks down the three main CPSO pathways for U.S. specialists and explains exactly what documents, timelines, and steps are required.
The Three CPSO Pathways for U.S.-Trained Physicians:
Pathway A: The Fast Track (Board-Certified Specialists)
Who it's for: U.S. doctors with:
ACGME-accredited residency
ABMS (or AOA) board certification
USMLE Step 1–3 or equivalent
A valid U.S. license (full, unrestricted)
Outcome:
A restricted certificate to independently practice your specialty in Ontario. After 5 years, you can apply for a full independent certificate. This lets you practice in the specific location which you applied to work, and only within the approved scope of practice.
Pathway B: The Experienced Physician Path
Who it's for:
U.S. or Canadian practice experience (5+ years)
No board certification required
Must pass MCCQE or equivalent
Outcome:
You’ll need to complete one year of supervised practice in Ontario and then pass a CPSO assessment. Once you successfully complete the supervised practice and pass the assessment, you’re given a restricted certificate. The supervision is a largely administrative exercise but is intended and designed for you to have a mentor review charts with you to coach on charting in Ontario, and to be available to answer questions you may have about the practice or process as you acclimatize.
Pathway C: For Doctors Still Earning Certification
Who it's for:
Eligible to write U.S. board exams but not yet certified
Must have ACGME residency and USMLE
Outcome:
You’ll receive a time-limited certificate to practice under supervision for up to 3 years, during which you must pass your board exams. Then you can switch to Pathway A.
Application Process: What You Need to Do (Step-by-Step)
Step 1: Create a CPSO Portal Account
Visit the CPSO portal and complete the Self-Screening Questionnaire.
Step 2: Submit Required Documents
Prepare to upload or send:
Full CV with all practice history
Degree and residency program verification
U.S. license verification (no restrictions)
Board certification (if applicable)
Proof of good conduct
Medical school transcripts (sent directly from school to CPSO)
Step 3: Pay the Fees
You’ll pay registration and review fees—typically $800–$1,500 CAD depending on your application type.
Step 4: CPSO Initial Review (2–4 weeks)
They will contact you if additional documents or clarification are needed.
Step 5: Final Review or Committee Referral
If your file is clean and complete, you’re approved. Otherwise, it may go to the Registration Committee for a decision, which can take several weeks longer.
Common Mistakes That Slow You Down
Submitting incomplete CVs (missing practice gaps aren’t allowed - you should always account for your time even if it wasn’t in practice!)
Failing to send transcripts directly from your medical school
Not disclosing previous disciplinary actions or restrictions
Applying too early—you must have immigration status already organized
Strategy Tip: Prepare Early, Act Confidently
Start gathering your documentation before immigration is finalized. Even though you can’t apply without status, you can prep everything in advance to move quickly once approved.
Helpful Resources
Frequently Asked Questions + Answers
1. How do I apply for medical licensure in Ontario as a U.S. physician?
Create a CPSO portal account, complete the Self-Screening Questionnaire, and submit your application with all required documentation.
2. What documents are required for CPSO licensure?
You’ll need a CV, degree and residency verifications, U.S. license verification, board certification (if applicable), and direct transcripts from your medical school.
3. What are the CPSO licensing pathways for U.S.-trained doctors?
There are three: Pathway A for board-certified doctors, Pathway B for those with 5+ years of practice, and Pathway C for doctors still completing certification.
4. Can I practice independently right away in Ontario?
If you qualify under Pathway A, yes—with a restricted certificate. Otherwise, you may require supervision or an assessment period.
5. How long does CPSO approval take?
Initial reviews take 2–4 weeks. Committee reviews or incomplete files can extend the process to 6–12 weeks.
6. Do I need to pass Canadian exams for CPSO approval?
Not always. If you are ABMS-certified and meet all other conditions under Pathway A, Canadian exams like MCCQE may be waived.
7. What is a restricted certificate in Ontario?
It allows independent practice within your specialty but limits you from practicing outside your scope. After 5 years, it can become unrestricted.
8. Can I submit my transcripts myself?
No. Transcripts must be sent directly to the CPSO by your medical school.
9. What is the cost of applying for CPSO licensure?
Application and processing fees range from $800 to $1500 CAD, depending on the complexity of your case.
10. Do I need permanent residency before applying to the CPSO?
No—but you must have legal status, such as a valid work permit or PR approval. Without it, CPSO won’t process your application.
11. What if I’m eligible for board certification but haven’t written the exams?
You may qualify under Pathway C and receive a time-limited, supervised license while you complete certification.
12. Can I apply for licensure while my immigration is pending?
You can prepare your file, but you’ll need proof of legal status before CPSO processes your application.
13. What if my application goes to the CPSO Registration Committee?
The committee will review complex or unclear cases. It may request additional documentation or impose specific practice conditions.
14. Do I need to be fluent in French to practice in Ontario?
No. English fluency is sufficient for CPSO licensure and Ontario practice.
15. What happens after I get licensed by the CPSO?
You must then apply for an OHIP billing number and register for electronic billing tools to start receiving payment.
16. Can I practice during CPSO review?
No. You cannot see patients or bill OHIP until your CPSO registration is approved.
17. Can I get a license if I’ve had disciplinary action in the U.S.?
Possibly, but full disclosure is required. CPSO assesses all conduct and history before issuing a license.
18. What is an independent certificate of registration?
It allows full, unrestricted practice in Ontario and is typically available after 5 years under a restricted certificate.
19. How do I expedite my CPSO application?
Ensure your application is complete, accurate, and includes all required documents. Start gathering transcripts and references early.
20. Where do I submit my CPSO application?
Submit online through the CPSO Portal. Most documents are uploaded, but transcripts must be mailed by your medical school.
