Canadian Physicians and U.S. Immigration

Any foreign national who wishes to practice medicine in the United States must take into account certain immigration considerations. For Canadian citizens, however, there are a number of unique issues that tend to arise.

Canadian Physicians Do Not Need to Obtain ECFMG

A physician who graduates from one of the seventeen Canadian medical schools accredited by the Liaison Committee on Medical Education (LCME) with an M.D. degree is not considered to be a foreign medical graduate. A physician who graduates from one of these schools does not need to obtain the Educational Commission for Foreign Medical Graduates (ECFMG) certification, which establishes equivalent medical education and fluency in English, and does not have to complete relevant board examinations.

State Licentiate Eligibility Without U.S. Medical Residency or USMLE

In Canada, a physician is required to successfully complete the Medical Council of Canada Qualifying Examination (MCCQE) in order to obtain professional status as a Licentiate of the Medical Council of Canada (LMCC). This is a prerequisite to independent licensure to practice medicine in the provinces in Canada.

Generally, a graduate of a foreign medical school must complete an Accreditation Council for Graduate Medical Education (ACGME) accredited graduate medical residency program, and successfully complete the U.S. Medical Licensing Exam (USMLE), before applying for and being issued a state license to practice medicine. In many U.S. states, however, a physician licensed to practice medicine in Canada may apply for U.S. state licensure without completing a U.S. graduate medical residency program and/or taking the USMLE.

Canadians Require the USMLE for H1B Issuance

Although the USMLE is not required in most states for state licensure, successful completion of the USMLE remains an independent prerequisite* for any foreign physician (including Canadian physicians) to be issued an H1B visa or admitted in H1B status independent of whether the physician has a state medical license. The sole exception to this requirement is for physicians recognized as being of national or international renown. (*Technically there is an exception to the normal requirement for passing all 3 steps of the USMLE, but it is best utilized for mid-career physicians, not recent graduates, residents, or fellows.)

Home Residency Requirement

Canadian physicians, like other noncitizen physicians, are permitted to seek admission as J-1 exchange visitors to participate in graduate medical residencies and fellowships in the United States. Similar to other noncitizen physicians who participate in graduate medical education in the U.S. in J-1 classification, Canadian physicians are also subject to the two-year home residency requirement (HRR) under Section 212(e) of the Immigration and Nationality Act (INA). INA 212(e) prohibits a J-1 noncitizen subject to the home residency requirement from seeking to change status, apply for an immigrant visa or permanent residence, or apply for H or L visas. However, a Canadian citizen subject to the home residency requirement can be admitted in H1B status without first fulfilling or receiving a waiver of the home residency requirement by virtue of being visa-exempt, a benefit generally enjoyed by Canadian citizens.

As INA 212(e) prohibits the granting of an H1B visa, but not H1B status, a Canadian physician who participated in a J-1 program still can be admitted in H1B status.

Conclusion

Often, due to a shared heritage and geographical proximity, it is easy to forget that Canadians are, in fact, noncitizens who still must comply with U.S. immigration law. Within the context of Canadian physicians seeking to immigrate to the U.S., however, the prudent doctor should be mindful of certain carve-outs, caveats, and special considerations tucked away within U.S. immigration law and policy.