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Internationally trained physicians (ITPs), who represent 20 to 25 per cent of the Canadian medical workforce, have long been a cornerstone of Canada’s health care system, particularly in remote and rural communities. Offering an accelerated route to licensure to physicians trained outside of Canada, the Practice-Ready Assessment (PRA) pathway has been instrumental in rapidly and safely integrating skilled doctors into the health workforce. By using workplace-based clinical assessments to ensure physicians meet Canadian standards, this pathway provides an alternative to lengthy retraining, reducing the time to enter practice in Canada while maintaining quality. With more than 1,500 ITPs having entered practice through the PRA route since 2018, it has reached a new milestone, as approximately 1.5 million people in Canada now receive care from physicians who have completed a PRA program. In a report on the primary care crisis in Canada released in October 2024, three Senators echoed this success, highlighting the PRA model as a fast and cost-effective solution for increasing the number of family physicians across the country, and calling for the expansion of PRA programs.
Before the pan-Canadian PRA collaboration launched in 2018, several provinces were operating their own PRA program to assess the skills of ITPs seeking to practise in their jurisdiction. Differences across programs, however, raised important concerns about fairness and consistency. Supported by funding from Health Canada, the National Assessment Collaboration (NAC) PRA was created to unify and standardize the PRA programs across Canada, ensuring that ITPs were evaluated fairly and consistently while maintaining high standards for patient safety nationwide. “At its core, the NAC PRA is a collaborative effort,” explains Sandra Roberts, program manager at the Medical Council of Canada (MCC). “It brings together provincial PRA programs, physicians, assessors, and regulatory bodies, all united by a shared commitment to providing patients in Canada with safe and effective health care.” She notes that this collaboration reflects the strength of a system where diverse professionals work toward the common goal of supporting qualified physicians in their journey to independent licensure, adding that recent data from the PRA programs’ annual evaluation show that the programs meet 97 per cent of pan-Canadian PRA standards, confirming the benefits of a consistent, high-quality national approach.
As early as 2012, the NAC PRA started laying the groundwork for the implementation of a pan-Canadian PRA route to streamline the evaluation process for ITPs, and began working on a framework to develop and maintain common assessment tools and guidelines. Recognizing the need to streamline the assessment process at the time, the MCC has been actively supporting this collaborative effort and has provided leadership and infrastructure to bring together provincial programs under the NAC PRA Working Group. This forum has enabled a coordinated and national approach to PRA through shared standards, tools and pan-Canadian collaboration. As part of this initiative, the Therapeutics Decision-Making (TDM) Examination —now used by most PRA programs in their selection of candidates— was implemented in 2018, marking an important step toward a standardized assessment that supports the safe integration of ITPs.
The pan-Canadian PRA collaboration has expanded significantly over the years, growing from the five provinces that first adopted the NAC PRA framework to nine provinces now offering a PRA program —with New Brunswick and Ontario launching theirs in 2023 and Nova Scotia establishing an innovative centralized PRA model with the opening of the Physician Assessment Centre of Excellence (PACE) in 2025. Notably, representatives from every province across Canada participated in the most recent NAC PRA Working Group meeting, reflecting the initiative’s broad national engagement and collaboration.
With financial support from their respective provincial governments, PRA programs have considerably increased their capacity to integrate more qualified ITPs —most of whom are already living in Canada as Canadian citizens or permanent residents— into the Canadian health care workforce. Ms. Roberts stresses that from 2018 to 2024, the number of physicians enrolled in a PRA program grew from 130 to 363 annually, representing a 179 per cent increase. She adds that while the PRA route initially focused on serving rural and remote communities, its scope has now evolved to serve all areas with high needs.
As PRA programs continue to expand, Ms. Roberts emphasizes the importance of ensuring that they address the needs of everyone involved, taking the experience of both PRA participants and assessors into account. The programs’ growth, for example, relies on recruiting more physician assessors, who serve as the backbone of PRA. “Their commitment continues to drive the programs’ success,” she explains. “Many assessors are former PRA candidates themselves who are motivated by a passion to support other ITPs and ensure patients have better access to care.” The success of PRA programs is also reflected through the perspectives of their participants. According to recent evaluation data collected by the programs, PRA participants report high levels of satisfaction across several key areas: 96 per cent said they received proper support throughout the process, and 94 per cent felt the assessments fairly reflected their previous clinical experience.
While the PRA route is well established, more comprehensive evidence needs to be collected to demonstrate its true impact in Canada and help shape its future success. In collaboration with all the PRA programs, a pan-Canadian study is being launched to track PRA outcomes over time, aiming to measure how successfully ITPs are integrating into the health care system and improving access to care in communities where they are most needed. This longitudinal research will identify strengths and areas for improvement in PRA programs and will also help ensure that practice-ready decisions are fair, effective, and in the public’s best interests.
With funding from Health Canada to support and strengthen the delivery of PRA programs across Canada, the MCC team has also started updating assessor training materials and tools to ensure they align with best practices and the ongoing evolution of competency-based medical education. “The tools originally developed were largely focused on family medicine,” explains Ms. Roberts about this major undertaking. “Part of the renewal is ensuring that there will be training materials and tools that will support all physicians across Canada, in both family medicine and specialty practices.”
By helping to address Canada’s health care needs, PRA programs are making a real difference, with more progress ahead. Reflecting on the future of PRA, Ms. Roberts believes that it looks bright. She is confident that provincial PRA programs will continue to collaborate and strengthen to open more doors for ITPs, ultimately connecting more patients to care. “PRA is more than a licensure pathway,” she says. “Beyond numbers, it represents hope for ITPs wishing to contribute their expertise and serve communities where health care services are deeply needed.”