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Expanding Pathways to Licensure for Internationally Trained Physicians in Ontario




Expanding Pathways to Licensure for Internationally Trained Physicians in Ontario: How to Get There and Why It Matters

Contributing authors:

Caroline Ewen, World Education Services (WES)

Dr. Makini McGuire-Brown, Internationally Trained Physicians of Ontario (ITPO)

Dr. Joanna Walters, Internationally Trained Physicians of Ontario (ITPO)

Dr. Renée Richards, Internationally Trained Physicians of Ontario (ITPO)

Joan Atlin, World Education Services (WES)

Karl Flecker, World Education Services (WES)


Executive Summary

The health care system in Ontario is in crisis. More than 1.3 million Ontarians don’t have access

to a family doctor, leading many people to turn to emergency departments or urgent care clinics

for issues that would be better addressed by a primary care provider. At the same time,

Internationally Trained Physicians (ITPs) continue to face significant systemic barriers to

becoming licensed and returning to medical practice. Practical, proven measures exist that

would enable ITPs to contribute their skills and training to the provincial health system.

This policy brief examines the stakeholder commitments, policy changes, and investments

required to fully integrate ITPs into the Ontario health care workforce. It also discusses the

associated benefits, including better access to care and a more equitable and sustainable

health care system.


Required Policy Changes

Expected Benefits

  • Implementation of Practice-Ready

  • Equitable expansion of medical residency training to ensure ITPs have access

  • Establishment of Clinical Assistants under a defined class of registration with the College of Physicians and Surgeons of Ontario (CPSO).

  • Enhanced equity in healthcare delivery

  • Improved patient health and well being

  • Better use of health human resources

  • Reduction in the underutilization of medical skills

  • Health cost savings



Taken together, these policy changes – Practice-Ready Assessments, equitable access to

residency training, and establishment of Clinical Assistant as a defined class of registration –

have the potential to rapidly increase the physician-to-population ratio and number of physicianextenders

throughout Ontario. Investment in these solutions should lead to improvements in

health care equity and patient health and well-being. It should also lead to cost savings in

training; savings related to improved access to primary care and reduced burdens on

emergency rooms; and greater efficiency in the health-human resource system, including

increased use of valuable ITP skills.

The issue of insufficient physician supply exists within the wider context of a rapidly

deteriorating health care system. Rebuilding the health care system that Ontarians deserve will

depend on new forms of collaboration among government, educational institutions, regulatory

bodies, physicians (including ITPs), employer organizations, and allied stakeholders. All must

commit to implementing lasting solutions at scale so that ITPs’ experience and training is

utilized to full advantage.


Recommended Citation: Ewen, C., McGuire-Brown, M., Walters, J., Richards, R., Atlin, J. and Flecker, K. (2023). Expanding Pathways to Licensure for Internationally Trained Physicians in Ontario: How to Get There and Why It Matters Toronto: World Education Services. Retrieved from www.wes.org/ca



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