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FOREIGN-TRAINED DOCTORS IN CANADA
Foreign-trained doctors are vital to Canada’s healthcare system, but hurdles remain
Nearly one in three family doctors in Canada received their medical education abroad. As shortages deepen, provinces are recruiting more of them, while many foreign-trained physicians already in the country struggle to practise.
By The Immigrant Times
Before immigrating to Canada in 2008, Dr. Sivakumar Gulasingam was the lead physician at the National Rehabilitation Hospital in Sri Lanka. Like other foreign-trained doctors, he had to undergo extensive relicensing to practise in Canada. He describes “the barriers, hardships and sacrifices a professional has to endure in returning to their chosen career to practise,” as his greatest struggle. (Source: Canadian Immigrant)
Introduction
July 2026: Nearly one in three family doctors practising in Canada today received their medical education abroad. Without them, the country’s shortage of doctors, already severe in many communities, would be considerably worse.
In 2024, Canada had 99,555 practising physicians, according to the Canadian Institute for Health Information (CIHI). More than a quarter, 27 per cent, were internationally trained. Among family doctors, the proportion reached 32 per cent.
These doctors are not distributed evenly. Nearly half of all physicians in Saskatchewan were trained outside Canada, compared to fewer than one in ten in Quebec. Provinces with smaller populations, large rural areas, or fewer locally trained doctors often rely most heavily on international medical graduates.
Canada’s reliance on them is partly the result of long-standing policy choices. For decades, the country trained fewer doctors than its population required. Medical-school and residency places were limited, while provincial governments attempted to control healthcare expenditure and avoid what was once believed to be an oversupply of physicians. Although training capacity is now expanding, it takes years to produce a fully qualified doctor.
Meanwhile, internationally trained physicians who already reside in Canada still face limited residency opportunities, repeated assessments, and licensing systems that vary across provinces. The result is a striking contradiction: Canada recruits doctors from overseas while some individuals with medical qualifications remain unable to practise.
Foreign-trained doctors have become an integral part of Canadian healthcare, rather than a temporary response to an exceptional shortage.
Canada suffers from a shortage of family doctors
For many Canadians, the shortage is most clearly felt through the difficulty in finding a family doctor or another regular primary-care provider. CIHI (Canadian Institute for Health Information) reported in 2025 that 5.7 million adults did not have one. The impacts go beyond delayed routine appointments: patients without consistent primary care are more likely to rely on walk-in clinics and hospital emergency departments, while chances for preventive care and early management of chronic illnesses may be missed.
The number of doctors has continued to increase, but the headline figure hides significant pressures. Canada’s population grew faster than its family-physician workforce in 2023 and 2024, marking the first time this has happened for two consecutive years since the mid-1990s. The number of family doctors per 100,000 residents dropped from 124 in 2022 to 119 in 2024.
A doctor’s presence on a register does not reflect the level of comprehensive primary care they provide. Family physicians work in emergency departments, hospitals, mental health services, palliative care, and other specialised settings, as well as in community practices. Health Canada has noted that increasing the number of family doctors does not necessarily lead to more doctors taking responsibility for a consistent panel of patients.
The shortage is especially severe in rural, remote, and northern areas, where even a small number of departures can endanger an entire local service. In 2024, only seven per cent of Canada’s physicians worked in rural communities. Health Canada’s national workforce study found that needs were proportionately higher, supply was lower, and projected gaps were wider in rural and remote regions compared to cities.
There is no single, universally accepted measure of how many doctors Canada lacks. Different estimates are based on varying assumptions about working hours, care models, and the services provided by family physicians. A Health Canada study published in 2025 estimated a gap of 22,823 family doctors in 2022 and warned that it would widen without significant reforms. The figure should be viewed as a projection rather than an exact count of unfilled positions, but the trend is clear.
Canada does not train enough doctors
Canada’s current struggles originate from decisions made over thirty years ago. In the early 1990s, governments were worried that the physician workforce was expanding too rapidly and raising public healthcare costs. After the influential Barer-Stoddart report, medical-school admissions were cut by about ten per cent, and access for international medical graduates was also made more restrictive.
The cuts were later reversed as shortages became clear. Medical-school enrolment has increased significantly since 2000, but physician training responds slowly to changes in demand. A student typically needs several years at medical school followed by postgraduate residency training, and even longer for many specialties. A decision to add places today will not quickly add doctors to community practices.
Canada continues to train relatively few doctors by international standards. Health Canada, drawing on Organisation for Economic Co-operation and Development (OECD) data, reported that Canada produced 7.5 medical graduates per 100,000 people, compared with an OECD average of 14.2. It had 2.8 practising doctors per 1,000 people, below the OECD average of 3.7.
In 2022-23, Canadian medical programmes had a capacity for 3,005 entrants at 17 institutions. There were 3,393 first-year postgraduate residency places, of which 1,557 were in family medicine. Applications were plentiful; the constraints included public funding, teaching staff, clinical placements, and the number of experienced doctors available to supervise trainees.
Expansion is now underway. Toronto Metropolitan University opened a new medical school in Brampton in 2025 and is expected to have 94 undergraduate places each year when fully developed. A new regional medical campus at the University of Prince Edward Island admitted an inaugural class of 20 students. Ontario alone has announced hundreds of additional undergraduate and postgraduate places.
These changes are vital, but numbers alone do not solve the problem. There must be enough supervision and clinical training capacity to match residency spots. Family medicine also needs to stay appealing to graduates, and work conditions must allow doctors to manage community practices without being swamped by administration or excessive workloads.
Recruiting doctors from overseas is left to the Provinces
Healthcare is mainly managed by Canada’s provinces and territories. As a result, there is no single national system that determines how many foreign-trained doctors should be recruited, where they should work, or how quickly their qualifications should be recognised. Provincial health authorities, hospitals, professional recruiters, and individual communities all have a role.
Recruitment takes various forms. Provinces advertise vacancies abroad and attend medical conferences in countries including the United Kingdom and the United States. Some recruit experienced physicians for positions linked to provisional licences or practice-ready assessments. Others offer residency places to international medical graduates, a group that includes immigrants educated overseas as well as Canadian citizens who studied medicine abroad.
The largest countries of medical graduation among internationally trained physicians working in Canada in 2024 were South Africa, India, and the United Kingdom. This pattern reflects historical links, the use of English in medical education, and earlier waves of recruitment. It does not mean that all internationally trained doctors recently arrived, or that all were foreign citizens when they entered practice.
Recruitment often targets family medicine and areas that have difficulty attracting Canadian-trained doctors. It is usually associated with a return-of-service agreement, which requires the doctor to work in a specific community or region for several years. In rural areas, this can ensure a vital supply of doctors. It can also place newcomers in some of the country’s most challenging practices, where professional support, suitable housing, and employment opportunities for partners may be limited.
The number of foreign-trained doctors differs significantly across Provinces
CIHI (Canadian Institute for Health Information) classifies physicians by where they obtained their initial medical degree. Based on this, more than 27 per cent of Canada’s doctors were international medical graduates in 2024, up from just under 26 per cent in 2015. However, the national figure conceals significant differences.
Saskatchewan had the highest proportion: 47 per cent of its physicians, or 1,271 doctors, were foreign-trained. The shares were 36 per cent in Alberta, 33.9 per cent in Manitoba, 31.3 per cent in Ontario and 31.1 per cent in British Columbia. Ontario had by far the largest absolute number, with 11,150 internationally trained physicians.
Quebec stood apart. Only 8.3 per cent of its physicians, 1,620 doctors, were trained abroad. The province also had one of the country’s highest rates of first-time medical-school enrolment in 2024-25. Language, local training capacity, and differences in licensing and recruitment policies all help explain why reliance on the province varies so widely.
These figures describe the doctors who succeeded in entering practice, not the larger number of medically educated people who might be available. A study based on Canada’s 2021 census found that 67 per cent of landed immigrants with the highest level of education in medicine worked in healthcare, but only 41 per cent worked as general practitioners, family doctors, or medical specialists.
The remaining group cannot simply be regarded as doctors who are ready to fill vacancies. Some may have left medicine, lack recent clinical experience, or require extensive further training. Canadian regulators also have a duty to ensure that every doctor meets common standards of knowledge, language, and patient safety. However, the extent of underutilisation indicates that Canada’s problem is not merely a shortage of qualified individuals. It is also a lack of accessible pathways for assessing their competence and, if necessary, bringing it up to Canadian standards.
Provinces and even towns compete for doctors
The shortage has intensified competition for doctors. Provinces offer signing bonuses, relocation support, training grants, and incentives for several years of service. Communities add their own enticements, including assistance with finding accommodation, clinic facilities, employment for a partner, and introductions to schools and local organisations.
Saskatchewan’s Rural Physician Incentive offers up to C$200,000 over five years to doctors practising in eligible rural and remote communities. Nova Scotia offers qualifying physicians as much as C$125,000 over five years to establish practices outside its Central Zone. Ontario’s Northern and Rural Recruitment and Retention Initiative provides grants ranging from approximately C$85,000 to C$125,000 over four years, depending on a community’s rurality and the doctor’s speciality.
Some municipalities go further. Huntsville, Ontario, has offered family doctors between C$60,000 and C$80,000, depending on whether they take over or establish a practice and accept patients from the local waiting list. Community-supported extras include a car lease and leisure memberships.
Such offers show how crucial a single doctor can be to a town. They also expose a weakness in Canada’s fragmented system. A doctor recruited by one community may have moved from another Canadian town facing the same shortage. Wealthier municipalities are better equipped to fund generous packages, and a rising bidding war cannot boost the national supply.
Financial incentives may attract applicants, but they do not guarantee they will stay. Doctors are more likely to remain where workloads are manageable, colleagues and locums are available, their families can settle, and they feel supported by the community. Therefore, successful recruitment depends as much on the conditions surrounding a post as on the size of its signing bonus.
Unnecessary bureaucracy often delays recognition of foreign-trained doctors
Every doctor in Canada must be licensed by the medical regulator in the province or territory where they practise. Requirements vary depending on a doctor’s training, speciality, and experience, but usually include verification of the medical degree, examinations, proof of recent practice, language proficiency, postgraduate training, and professional certification.
For many international medical graduates, the usual path involves securing a Canadian residency spot and completing postgraduate training. Residency has long been one of the main bottlenecks. CIHI found that places allocated to international graduates increased from 338 in 2017 to 425 in 2024, while some vacancies initially reserved for Canadian graduates became available to them later in the matching process.
Access has expanded more quickly since then. Data from the Canadian Resident Matching Service show that 931 international medical graduates entered postgraduate training in 2026, more than double the 411 recorded in 2017. Demand still far exceeds the number of available places, and unsuccessful applicants may spend years retaking examinations and reapplying.
Experienced family doctors may qualify for a quicker practice-ready assessment. Instead of redoing a full residency, suitable candidates undertake a supervised, workplace-based assessment, usually lasting around 12 weeks. Nine provinces now run such programmes. Those who pass can receive a provisional or restricted licence and are often required to work in an underserved area for a set period.
Provinces have also implemented faster recognition processes for doctors trained and certified in selected countries whose systems are deemed comparable to Canada’s. These pathways allow physicians to enter practice more swiftly but also result in a two-tier system: a doctor from one recognised jurisdiction might bypass steps that remain mandatory for an equally experienced applicant from elsewhere.
Licensing should not be reduced to unnecessary bureaucracy. Differences in medical education, scope of practice, and clinical experience are genuine, and patients deserve consistent standards. The more challenging question is whether Canada assesses competence as directly and efficiently as it could. Repeating training due to limited assessment capacity wastes both medical skills and public opportunities.
Growing reliance on foreign-trained doctors raises global concerns
International migration offers doctors the opportunity to advance their careers, boost their incomes, and start new lives. Canada benefits from their knowledge and experience, and doctors who meet its standards should have the same rights, working conditions, and opportunities as colleagues trained domestically.
However, large-scale recruitment also shifts part of the costs of medical education from the countries where doctors are trained to the country where they eventually practise. This situation becomes particularly contentious when a wealthy nation that has limited its own training capacity recruits from health systems with more severe shortages.
The World Health Organisation’s Global Code of Practice does not aim to stop individual health workers from migrating. It, however, discourages employers and recruitment agencies from actively targeting countries with critical workforce shortages. Its 2023 safeguards list includes 55 countries with very low health worker density and insufficient coverage of essential services. The WHO recommends government-to-government agreements and support for the source country during recruitment.
Canada introduced its own ethical recruitment framework in 2025. It indicates that active recruitment from developing nations facing critical shortages is not advisable and that recruitment should only occur when a feasible pathway to Canadian employment exists. It also encourages governments to invest in domestic education, enhance retention, and better utilise internationally trained professionals already within Canada.
The distinction between active recruitment and individual migration is important. It would be unfair to restrict a doctor’s freedom to move because their country has not provided adequate pay, security, or professional opportunities. Responsibility mainly lies with recruiting governments and institutions: they should understand the impact of their campaigns, engage with source countries, and ensure that the benefits are shared.
For Canada, ethical recruitment should be part of a wider effort to increase self-sufficiency. That involves training more doctors, expanding residency and assessment capacity, improving working conditions, and reducing the loss of qualified physicians already in the country.
Foreign-trained doctors will remain indispensable to Canadian healthcare. The objective should not be to reduce their contribution, but to end a system in which dependence on them compensates indefinitely for weak domestic planning, while many face avoidable barriers and other countries bear part of the cost.
Terminology and methodology
This article uses “foreign-trained doctor”, “internationally trained physician”, and “international medical graduate” to describe a doctor whose initial medical degree was obtained outside Canada. The terms refer to the location of medical education, not to nationality, birthplace, or immigration status. They include Canadians who studied medicine abroad and exclude immigrants who received their initial medical degree in Canada.
National and provincial physician figures are from CIHI and relate mainly to 2024, the latest complete year available. They are headcounts of registered physicians and do not by themselves measure hours worked, the number of patients seen or the availability of comprehensive primary care. Estimates of shortages vary according to methodology and should not be read as exact counts of vacant posts.
Sources
Canadian Institute for Health Information; Statistics Canada and Health Canada; Canadian Resident Matching Service; Medical Council of Canada; Government of Saskatchewan, Rural Physician Incentive update; Government of Nova Scotia, “Physician Incentive Program Expansion”; Government of Ontario, “Northern and Rural Recruitment and Retention Programme”; Town of Huntsville, “Physician Incentive Scheme”; World Health Organisation (WHO).
Please email The Immigrant Times’ editor for a detailed list of sources used for this article.
Further reading from The Immigrant Times: Foreign-trained doctors in Europe || Foreign-trained doctors in Germany || Foreign-trained doctors in the US ||
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