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Pathway to Licensure for International Medical Graduates via a Practice Ready Assessment – Family Medicine

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This policy outlines a pathway to licensure for independent practice in Nova Scotia via a Practice Ready Assessment (PRA).   

The policy applies to physicians who are trained and certified in Family Medicine or General Practice in an international jurisdiction that is not recognized by the College of Family Physicians of Canada (CFPC)26

One of the requirements for licensure for independent practice in Nova Scotia is that physicians must be certified by the CFPC or are eligible to challenge the certification examinations.  An international medical graduate (IMG) may acquire this eligibility, as well as a Defined licence7 to practise medicine in Nova Scotia, by successfully completing a PRA.   

Overview of Licensure for Independent Practice 

Requirements for Licensure 

The requirements for licensure to practise medicine in Nova Scotia are set by the Medical Act1 and the Medical Practitioners Regulations2.   

Licence Types 

There are three relevant licence types for independent practice as the Most Responsible Physician in Nova Scotia:  

Licence Type Description 
Full licence7 The Full licence is an ongoing, renewable licence for practice without supervision or conditions or restrictions. A Full licence may be granted to physicians holding:  A Medical Degree from a school listed in the World Directory of Medical Schools10;  The LMCC23 or an acceptable alternative to the LMCC16; and Certification by the RCPSC25 or the CFPC26 or the CMQ27.  
Restricted licence7 The Restricted licence is an ongoing, renewable licence typically issued to: Physicians who meet all or most of the criteria for a Full licence but have conditions and/or restrictions on their practice imposed by the College; or Relevant to this policy, a physician on a Defined licence who successfully undergoes a Comprehensive Clinical Assessment of Practice (CCAP)17 as determined by the Registration Committee will be issued a Restricted licence 
Defined licence7 The Defined licence is a renewable, but time-limited licence, issued for a maximum of 60 months to physicians who have a medical degree, but who have not yet obtained the LMCC and Canadian certification. Defined licensees must practise under the sponsorship and supervision of another physician15 as they pursue the qualifications for Full or Restricted licensure.   

Pathway from PRA to Independent Practice 

Upon review by the Registration Committee, successful completion of a PRA leads to a Defined licence7 to practise medicine in Nova Scotia. All Defined licensees are required to pursue the Full licensure requirements, namely the LMCC and certification with the CFPC. 

Defined licensees who achieve CFPC certification26 and the LMCC23 (or an acceptable alternative16), are issued a Full licence7.   

Defined licensees who do not achieve CFPC certification may be eligible to challenge a Comprehensive Clinical Assessment of Practice (CCAP)17.  Success in the CCAP leads to a Restricted licence7 with conditions and restrictions that are, in part, informed by the results of the CCAP. 

Practice Ready Assessments in Nova Scotia 

A PRA is a practice-based assessment used to determine whether the physician is ready for independent practice in Nova Scotia. 

PRAs in Family Medicine are conducted by the Nova Scotia Practice Ready Assessment Program – Family Medicine (NSPRAP)20

Candidates must also meet the requirements for licensure outlined in this policy. The College will refer eligible candidates to the NSPRAP for review.   

The NSPRAP makes the final decision whether to accept a candidate into the program. 

The PRA is conducted over a minimum of 12 weeks, by a minimum of two assessors, under a Clinical Assessment licence7.  This licence type is designed strictly for assessment purposes only and the physician holding this licence is never the most responsible physician. 

The cost of the assessment itself is the responsibility of the NSPRAP. The licence fee8 for the assessment and for ongoing licensure in Nova Scotia is the responsibility of the candidate.   

For more information, please refer to the College webpage for Practice Ready Assessments for International Medical Graduates6

Eligibility Criteria 

In accordance with Section 39 of the Medical Practitioners Regulations2, candidates for a Practice Ready Assessment must demonstrate the “capacity, competence and character to safely and ethically practise medicine” by meeting the eligibility criteria listed below. 

1. Eligibility to Work 


  • Must be Canadian citizens or legally entitled to live and work in Canada. 
  • Must not be prohibited or restricted from practising medicine through the decision of any adjudicating body or through voluntary agreement or otherwise (other than by conditions or restrictions imposed on a licence by a regulator). 
  • Must not have a criminal record. 

A note about documentation

Candidates must provide evidence that they meet the eligibility criteria listed in this document.  Documents may be required at various stages of the application and referral process. 

Upon initiation of the application process, you will be assigned a Registration Coordinator who will direct you regarding the specific documentation required for your application. You will also be advised when the documentation is required. Required documentation could include, but is not limited to: 

  • Confirmation of credentials, source verified by physiciansapply.ca24 
  • Certificates of Professional Conduct14 
  • Proof of eligibility to work in Canada 
  • Proof of offer of employment in Nova Scotia 
  • Letters of employment and letters of reference 
  • Curriculum vitae 
  • Criminal record check 

2. Credentials 

Candidates must have all of the following credentials: 

Credential Description 
Medical Degree Medical degree from a school listed in the World Directory of Medical Schools10
Medical Council of Canada (MCC) Be a Licentiate of the Medical Council of Canada (LMCC) or Qualify for an Acceptable Alternative to the LMCC16.

3. English Language Proficiency 

In accordance with Section 39 of the Medical Practitioners Regulations2, candidates are required to demonstrate proficiency in the English language, in a manner prescribed by the Registrar. 

All physicians must have the ability to effectively communicate with patients, other professionals and the College as described in the College policy on English Language Proficiency12.  

4. Postgraduate Training 

Candidates must have successfully completed a postgraduate training or internship program leading to certification, recognition and practise in Family Medicine or General Practice in their training jurisdiction.   

The program must include 24 months of training in Family Medicine or General Practice, with a minimum of 8 weeks of postgraduate training successfully completed in the following rotations: 

  1. Family Medicine/ General Practice 
  2. Internal Medicine 
  3. Surgery 
  4. Pediatrics 
  5. Psychiatry* 
  6. Obstetrics/ Gynecology* 
  7. Emergency Medicine** 

* At the discretion of the Registrar, candidates for practice ready assessment in Family Medicine, may be excused the requirement for 8 weeks of postgraduate training in Psychiatry and/or Obstetrics/Gynecology, provided they have the equivalent amount of extra training in Family Medicine. 

** The College will consider Emergency Medicine rotations as part of the 24 months of postgraduate training required. 

5. Practice Experience 

Candidates must have the following independent practice experience: 

  • At least 24 months of independent practice in Family Medicine or General Practice following completion of 24 months total of postgraduate training or internship in Family Medicine. 
  • Currency of practice in Family Medicine must include a minimum of 6 months of regular (at least half time calculated at 900 hours per year), independent family practice in the 3 years immediately before the date of application to the College. 

All candidates must provide an explanation for any gaps in practice. 

6. Prior Practice Ready Assessments 

Candidates must have fewer than two previous unsuccessful attempts in Canadian practice ready assessment programs, as collected by physiciansapply.ca24

7. Requirements for Entering Practice 

At the time of licensure, candidates must have the following: 

  • A Medical Identification Number for Canada (to be issued at time of licensure). 
  • Medical liability protection, malpractice insurance or other form of indemnity in the manner and amount required by the Registrar. 
  • Enrolment in the Continuing Professional Development (CPD) program with the College of Family Physicians of Canada26.  

Note that there are other requirements for practising medicine in Nova Scotia that are outside the requirements of licensure.  For more information, please refer to the College website page on What You Need to Know to Practise Medicine in Nova Scotia5.

Getting Started with a PRA 

Before starting an application for a PRA, candidates should review: 

  • The eligibility criteria in this document. Contact the College of Physicians and Surgeons of Nova Scotia4 for questions related to eligibility. 
  • The ‘How to Apply’ section on the College webpage for ‘Practice Ready Assessment for International Medical Graduates’6.  This page outlines all of the steps in the application process for PRAs. 
  • The website for the Nova Scotia Practice Ready Assessment Program – Family Medicine20

Family Medicine candidates start the application process for a PRA by applying for licensure through physiciansapply.ca24. The College reviews the application and if the candidate is eligible for licensure, refers the candidate to the NSPRAP.  The NSPRAP makes the decision of whether to accept the candidate into the program. 

Practice Ready Assessment Process 

Approval for Practice Ready Assessment 

All PRAs must be conducted in accordance with this policy and with agreement between the College, Nova Scotia Practice Ready Assessment Program20, and Nova Scotia Health18 or the IWK Health Centre19.  A PRA will not be endorsed in a retrospective manner by the College under any circumstances. 

Once the assessment has commenced, it will be considered a PRA attempt whether the candidate withdraws or completes the assessment. All PRA attempts are reported to the Medical Council of Canada and will be noted in future applications.   

Licensure for Practice Ready Assessment 

Candidates selected for a PRA will be assessed for licensure and, if successful, issued a Clinical Assessment licence7 for the purpose of the PRA. This licence type is designed strictly for assessment purposes only and the physician holding this licence is never the most responsible physician. 

Practice Ready Assessment Recommendation 

The Registration Committee of the College will review the reports from the Recommendations Committee of the NSPRAP to determine one of the following: 

  1. The physician has demonstrated the competencies necessary for Defined licensure, with or without conditions and restrictions on the licence.   
  1. The physician has demonstrated the competencies necessary for a different form of licensure.  
  1. The physician has not demonstrated competencies for any form of licensure.  

Outcomes of Practice Ready Assessment  

  1. For candidates who have demonstrated the competencies necessary for Defined licensure: 
  • The College will provide a letter of recommendation to the CFPC to endorse the candidate’s eligibility for the CFPC certification exam. The CFPC will then provide confirmation of when the candidate will be eligible to challenge the certification examination. 
  • Based on the Registration Committee’s review of the PRA results, the licence may include additional conditions and/or restrictions beyond those typically applied to a Defined licence13. The College will issue the candidate a Defined licence with supervision, starting at Standard Level supervision15. Within three months of their Defined licence being issued, the candidate will be required to apply to the CFPC26 for their eligibility to challenge the certification examination. The candidate must provide confirmation of the application to the College.   

Please refer to the College policies regarding Defined licensure13, 15 for more information. 

  1. For candidates who have demonstrated the competencies necessary for a different form of licensure, the candidate will be invited to apply for that licence type.   
  1. For candidates who have not demonstrated competencies necessary for any form of licensure, the candidate will be denied licensure. This must be disclosed to other Medical Regulatory Authorities if asked about a history of being denied licensure. As with any referral to the Registration Committee, the candidate can request to withdraw their application and referral to the Committee. In this case, there will be no licensing decision rendered. 


The candidate has the option to appeal the decision of the Registration Committee through the College’s Registration Appeal Committee. 

The candidate must notify the Registrar of their intent to appeal the decision of the Registration Committee within 30 days from the date of the Committee’s initial decision.  

Once the Registrar receives the candidate’s request for an appeal, they will give the Registration Appeal Committee all the information required to conduct a thorough and fair review of the candidate’s file, including but not limited to: 

  • all of the information provided to the Registration Committee; 
  • the decision of the Registration Committee; and  
  • any supporting documentation provided by the candidate. 

The Registration Appeal Committee is comprised of three physicians and at least one representative of the public. All decisions of the Registration Appeal Committee are final. 



  1. Medical Act 
  2. Medical Practitioners Regulations 
  3. Section 59-63 of Regulations for Restricted Licence 

College Website 

  1. Home Page 
  2. What You Need to Know to Practice Medicine in Nova Scotia  
  3. Practice Ready Assessment for International Medical Graduates 
  4. Licence Types 

College Policies 

  1. Fee Schedule 
  2. Registration & Licensing Policies and Guidelines 
  3. University or School Approved by Council + World Directory of Medical Schools 
  4. Currency of Practice Experience 
  5. English Language Proficiency 
  6. Requirements and Conditions for a Defined Licence 
  7. Certificates of Professional Conduct 
  8. Supervision Levels for College-Directed Supervision 
  9. Acceptable Alternatives to the LMCC
  10. Comprehensive Clinical Assessment of Practice 

Nova Scotia Health Authorities 

  1. Nova Scotia Health 
  2. IWK Health Centre 

Practice Ready Assessment in Family Medicine 

  1. Nova Scotia Practice Ready Assessment Program in Family Medicine 
  2. NAC PRA Family Medicine Standards 

Dalhousie University Faculty of Medicine 

  1. Home Page 

Medical Council of Canada 

  1. MCC Examinations 

Certifying Colleges 

  1. Royal College of Physicians and Surgeons of Canada 
  2. College of Family Physicians of Canada (CFPC) 
  3. Collège des Médecins du Québec (CMQ) 

Applicable Legislation: Medical Practitioners Regulations Sections 14-15, 36-38, 39-45, and 59-63 

Approved by: Registration Policy Committee, Executive Committee  

Approval date: June 22, 2021 & June 24, 2021

Review date: June 2022