Proposed Changes to Alternative Registration Pathways

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Illustrated arrows pointing to old way and new way

Proposed changes bring clarity to process

Council is proposing substantive revisions to an existing registration policy to reflect streamlined process changes, and bring increased clarity to applicants and the public.

“Over the past 12 years, we have been closely monitoring the use and uptake of Pathways policies — and what we have learned has resulted in recommendations for a redesigned policy. Specifically, the proposed amendments are designed to provide increased clarity to the public and profession,” said Dr. Judith Plante, the chair of the Registration Committee, and the College’s new President.

The Alternative Pathways to Registration policy, with the proposed changes, is now out for consultation.

The policy sets out a variety of Pathways for specific groups of applicants. The current registration requirements vary depending on the source of the applicant’s medical degree, where the applicant is currently practicing and where they received their postgraduate training.

CPSO developed the four original pathways in 2008 to expand the qualifications for certificates of registration in Ontario. The Pathways make it easier for candidates to become registered in Ontario by removing barriers and providing alternative options for acceptable qualifications (namely US training and Board certification). The Pathways also add another route to licensure for applicants who are not certified by the Royal College of Physicians and Surgeons of Canada (RCPSC) or the College of Family Physicians of Canada (CFPC), and do not currently hold a certificate of registration in a Canadian jurisdiction.

The biggest proposed difference is that we will no longer distinguish route based on source of MD.

Current Pathways

The current Pathways are applicable to the following groups of physicians:

Pathway 1: Physicians with a Canadian medical degree and postgraduate training without RCPSC or CFPC certification

Pathway 2: International medical graduates (IMGs) with Canadian postgraduate training without RCPSC or CFPC certification

Pathway 3: Physicians with a U.S. or Canadian medical degree or Doctor of Osteopathy degree with U.S. postgraduate training and certification

Pathway 4: IMGs with US postgraduate training and certification

What Stays the Same

Under this policy, eligible candidates are issued an initial certificate of registration to practise medicine under supervision, during which time CPSO receives regular reports from the supervisor.

After one year of practise in Ontario, CPSO conducts a comprehensive assessment of the candidates’ practice. Upon successful completion of the assessment (as determined by the College’s Registration Committee), the candidates will be issued a certificate of registration to practise medicine independently in their scope of practice. Unsuccessful completion of an assessment will result in the expiry of the certificate of registration, unless it is renewed by the Committee with additional, terms, conditions and limitations (i.e. increased supervision, additional assessment, etc.).

What Changes

The biggest proposed difference is that we will no longer distinguish route based on source of MD. “As we do not treat candidates differently based upon the source of medical degree, it seemed unnecessary to make it appear as a distinguishing factor,” said Ms. Samantha Tulipano, Director of CPSO’s Registration and Membership Services.


  • No longer distinguish route based on source of medical degree. As we will no longer distinguish the Pathway/route based on source of MD — all other eligibility requirements under Pathway 1 & 2 and Pathway 3 & 4 are the same, therefore we will merge Pathway 1 & 2 into one route (proposed Pathway B), and Pathway 3 & 4 into another route (proposed Pathway A).
  • Remove the requirement for a mentor.
  • Be more specific about the supervisory requirements by updating the language in the undertakings to specify a period of limited direct observation for an initial period to be determined, and regular direct observation where appropriate.
Illustration of proposal to combine pathways 1 and 2, and 3 and 4

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