Your Path to Practicing in Ontario Starts Here – Immigration, Mindset & Initial Strategy
The Path to Ontario Practice
If you're a U.S.-trained physician—especially a specialist—exploring a move to practice medicine in Ontario, Canada, you're not alone. The process is detailed, but has become easier over the last few years. We’ve been helping physicians find their path to practice in Ontario for years, and here are our secrets and best practices.
This guide is the first in a 5-part series focused on helping you legally immigrate, get licensed by the CPSO, register with OHIP, and build a successful, profitable practice in Ontario.
Step 1: Choose the Right Immigration Path
Before you can treat patients in Ontario, you need legal status to work in Canada. Here are the three main routes:
1. Express Entry (Federal Skilled Worker Program)
Best for: Physicians who want to permanently relocate
You’ll be scored based on:
Age
Education
English/French proficiency
Work experience
2. Work Permit (Employer-Sponsored)
Best for: Physicians with a job offer from an Ontario clinic or hospital
Usually quicker than Express Entry but temporary in nature
May lead to permanent residency later
3. Provincial Nominee Program (Ontario Immigrant Nominee Program – OINP)
For high-demand specialties or rural placements
Some pathways are fast-tracked for health professionals
4. Canadian Experience Class (CEC)
For physicians who have worked in Canada for a year or more in a skilled occupation
Step 2: Know What You’ll Need
Even before applying for immigration, prepare these:
Valid passport
Copies of your U.S. medical degree and board certification, with transcripts of your courses if available (not always published but we’ve seen regulators request them)
Updated CV with practice history
U.S. medical license in good standing
Language test results (IELTS/CELPIP) – not always required, but helpful
Criminal Background Check
Step 3: Shift Your Mindset from US Doctor to Canadian Entrepreneur
Your license gets you in the door—but what will keep you in the game is understanding the business of medicine. You need to:
Understand your billing and the insurance climate in Ontario
Know your gross profit, not just top-line billing
Build a team (admin, billing support) who lets you focus on care
Prepare to invest in systems that help you scale
Avoid the trap of "I’ll figure it out later" — now is later
This is the start of where we see US physicians either thrive or struggle, and it starts with Self-Awareness and Culture-change Adaptability. Know who you are, what kind of clinic you want, and what kind of life you’re building. Know that in Ontario, there’s one medical insurer and while they try to make billing seem easy, the opportunities to claim properly are nuanced and complex. Also know that TPA’s are NOT common in Ontario and clinics here do not use billing specialists for their submissions. The opportunity costs and lost income can be 20% - 80% of possible revenue if you’re not careful.
Step 4: Understand the Impact of Immigration on CPSO Licensing
Your immigration status impacts when you can apply for CPSO licensure
You need either permanent residency or a valid work permit for CPSO licensure
Without this, CPSO won’t issue you a registration—even if you’re otherwise qualified
So for planning your timeline: We’ve never seen this process take less than 6 months. If you want to practice in Ontario in 9 months, begin your immigration work today.
Step 5: Define Your Practice Goals
Before moving, before licensing, before billing—ask yourself:
What kind of medicine do I want to practice?
Do I want to work in a hospital, clinic, or both? And what are my motivations for practice?
Do I prefer urban centers or underserved areas with higher demand?
These answers help you target the right work opportunities and offers, which in turn, help you fast-track immigration.
Resources & Helpful Links
Canada.ca – Express Entry and other program links are above as well
HealthForceOntario Jobs, Cherry.Health, and Ontario Medical Association are a few of the popular physician career sites. We also have clients looking for physicians and are happy to make a few introductions.
Q&A
1. What immigration options do U.S. doctors have for Canada?
U.S. doctors can apply to immigrate to Canada through Express Entry, employer-sponsored work permits, or the Ontario Immigrant Nominee Program. Each pathway has different timelines and requirements based on experience, specialty, and language proficiency.2. Can U.S. physicians use Express Entry to move to Ontario?
Yes. Express Entry under the Federal Skilled Worker Program is open to U.S.-trained physicians. You'll need to meet eligibility based on points for age, education, work history, and language ability.3. What is the Federal Skilled Worker Program for doctors?
It’s part of Express Entry. It allows foreign professionals, including physicians, to apply for permanent residency based on their skills and job prospects in Canada.4. How long does it take to get a work permit in Canada for doctors?
It typically takes 2–4 months if you have a valid job offer and supporting documentation. Processing times may vary based on country of origin and case complexity.5. Is board certification required for licensure in Ontario?
Board certification isn’t always required, but U.S. board-certified specialists qualify for the fastest CPSO licensing pathway (Pathway A), which avoids supervision or retraining.6. Can I get a job offer before applying for CPSO licensure?
Yes. A job offer is helpful for immigration and work permit applications, but you cannot practice until you are licensed by the CPSO.7. Do I need a job to apply for Canadian immigration?
No, but having a job offer improves your immigration score and speeds up some processes like work permit issuance or provincial nomination.8. Can I work in Canada as a doctor without permanent residency?
Yes, if you have a valid work permit and meet CPSO licensure requirements. However, many doctors transition to permanent residency afterward.9. What is the Ontario Immigrant Nominee Program for health professionals?
The OINP allows Ontario to nominate health professionals for permanent residence based on provincial needs. Some categories prioritize physicians and expedite processing.10. How does immigration status affect CPSO registration?
You must have legal status in Canada—either a work permit or permanent residency—before you can obtain a license to practice medicine in Ontario.11. What documents do I need to immigrate as a doctor to Canada?
Typical documents include your passport, CV, proof of medical education, U.S. medical license, board certification (if applicable), language test scores, and a job offer (if any).12. Is IELTS required for U.S. doctors moving to Canada?
Not always. If you studied and practiced in an English-speaking country like the U.S., you may be exempt. However, some immigration pathways may still ask for test scores.13. Can I practice medicine while waiting for CPSO approval?
No. You must be licensed by the CPSO before seeing patients or billing OHIP. However, you may secure a job and begin onboarding in the meantime.14. Do Ontario clinics hire U.S. specialists on work permits?
Yes. Many clinics actively recruit U.S.-trained specialists, especially in high-demand fields like radiology, anesthesia, and psychiatry.15. What’s the best province for U.S. doctors to move to?
Ontario is ideal due to demand, competitive compensation, and licensing pathways that recognize U.S. training. British Columbia and Alberta are also options.16. Can I start a clinic in Ontario as a foreign-trained doctor?
Yes, but you must be licensed by the CPSO and authorized to bill OHIP. You'll also need a professional corporation, office space, and overhead support.17. Is there demand for U.S.-trained specialists in Canada?
Yes. Ontario and other provinces face shortages in specialist fields, especially outside major urban centers. U.S. board certification is highly respected.18. How do I become a permanent resident in Canada as a doctor?
Apply through Express Entry or be nominated through the OINP. You’ll need a strong application score and may benefit from a job offer.19. How does OHIP work for foreign doctors?
Once licensed and registered with the Ministry of Health, foreign-trained physicians receive a unique billing number and are paid for insured services they provide.20. What is the first step to moving to Canada as a physician?
Your first step is to evaluate immigration eligibility—through Express Entry or with a job offer—and start gathering documentation for your application.21. Who can help with immigration for doctors?
Use licensed immigration lawyers or consultants familiar with health professional pathways. You can also contact PFF for vetted referrals.22. What is the fastest path to practice in Ontario from the U.S.?
The fastest route is: secure a job offer → apply for a work permit → use CPSO Pathway A (for U.S. board-certified doctors) → apply for OHIP number.
