Restrictive permit – Quebec-France MRA – Practice Ready Assessment (PRA)

On November 27, 2009, the Collège des médecins du Québec (CMQ), France’s Conseil national de l’Ordre des médecins and the French Minister for Health and Sports signed an agreement on the mutual recognition of physicians’ professional qualifications in order to promote medical workforce mobility between Quebec and France (Quebec-France MRA).

The agreement applies to physicians in Quebec or France who are legally authorized to practice medicine and have a qualification from an authority that is recognized or designated by Quebec or France. The MRA sets out the requirements for practice in Quebec and France, which are listed below.

Documents to consult (in French only)

Other routes to the permit to practice:

The agreement does not apply to physicians who completed their medical training or residency program in a faculty of medicine outside Canada, the United States or France or who practice a specialty that is not listed in the Quebec-France agreement. These physicians may also take the following routes to the permit to practice:

By recognition of the equivalence of a M.D. degree

Restrictive permit – Clinician – Practice Ready Assessment (PRA)

Restrictive permit – Sponsored professor

Permit under the Quebec-France MRA pursuant to section 35 of the Medical Act

Practice Ready Assessment (PRA)

Pursuant to section 35 of the Medical Act, the CMQ may issue a restrictive permit (Quebec-France MRA) in accordance with guidelines established for applicants who are eligible under the Quebec-France agreement on workforce mobility (see the excerpt - in French only). Requirements include completion of a three-month adaptation/assessment period during which the physician’s readiness to practice is assessed.

The CMQ’s Committee on Admission to Practice (CAP) is responsible for reviewing credentials and issuing permits.

The permit is restricted with respect to three aspects:

place of practice (only authorized to practice in a health care institution; the permit does not authorize “independent” or private practice);
the professional acts authorized;
validity (1 year, renewable annually).

A restrictive permit may be converted into a regular permit subject to certain requirements.

Please see the page Converting a restrictive permit into a regular permit.

Requirements – for practice in Quebec

You have a State Doctor of Medicine degree from a faculty of medicine that is located and provides training in France.
You completed your postgraduate training (residency/internship) in general medicine or in one of the other specialties listed in the agreement at a French university.
You have a specialist’s certificate (or equivalent credential*) from a French university in one of the other specialties listed in the agreement.
You are a member in good standing of the Conseil national de l’Ordre des médecins in France, registered on the Roll of the Ordre des médecins in France as a general practitioner or specialist without any practice restrictions or limitations resulting from an administrative measure, voluntary undertaking or disciplinary or criminal ruling. Nor are you the subject of any proceedings that could lead to a conviction or sanction that might have an impact on your registration with the CMQ.
You practiced competently in the area of medical expertise for which the restrictive permit application is being submitted for 12 months during the two years preceding your application.
You successfully completed an adaptation/assessment period.
You participated in the ALDO-Quebec educational activity within a maximum period of one year after your permit was issued.

* According to Section 10 of Chapter I, Title IV of the Mutual Recognition Agreement (MRA) of physicians’ professional qualifications, “in order to determine whether the specialized medical training corresponds to one of the fields listed in Schedule I, the Collège des médecins du Québec takes into account the opinion of a Qualification Board, excluding however an opinion on training acquired outside France.”

Therefore, the Committee on Admission to Practice (CAP) of the CMQ takes into consideration the opinion of a Qualification Board and will review all documents submitted by the applicant who received their specialist’s qualification by an ordinal qualification commission.

The CMQ attaches paramount importance to the years of postgraduate medical studies leading to a specialized studies diploma (DES) or a complementary specialized studies diploma (DESC), specific and qualifying for the specialty. The specialist’s qualification obtained in France by an ordinal qualification commission does not always guarantee the exact match with the specialty in Quebec.

Since the full process is lengthy (9 to 18 months on average) and you must maintain your clinical experience, we encourage you to keep practicing as you complete the steps.

Note that the CMQ does not intervene at all steps of the process.

The deadlines indicated at certain steps are given as an indication. They can vary significantly depending on the individual background of the candidates.

Any candidate for a restrictive permit has the right to report a situation of harassment and to request information and advice in relation to this situation, or even file a complaint with their assessment environment or the Commission des normes, de l’équité, de la santé et de la sécurité du travail (CNESST).

The harassment prevention and complaints policy of the assessment setting explains the steps to follow. Further details concerning the resource to which the candidate can refer to, in the event of a harassment situation, will be provided when the assessment period is launched.

The candidate must also notify the CMQ as soon as the assessment environment has been informed of a harassment situation.

Steps

Sponsorship is optional under the Quebec-France MRA.

To obtain sponsorship with a health care institution, you must register with Recrutement Santé Québec (RSQ) to obtain a letter of sponsorship. RSQ is an agency of the Ministère de la Santé et des Services sociaux (MSSS) that will help you identify a health care institution that is willing to recruit you (offer you a position) based on the medical workforce needs identified by the MSSS.

Sponsorship currently includes financial support from RSQ. RSQ will cover the cost of the file review, labour market impact study (application for work permit needed to complete the adaptation/assessment period) and organization and completion of the required adaptation/assessment period (for the applicable fees, see the List of fees). The letter of sponsorship will be sent directly to the CMQ by RSQ.

If there is no sponsorship agreement, the physician must cover the fees for the adaptation/assessment period and also find a position (regional medical staffing plans – PREM). Also note that no immigration formalities will be completed by the CMQ for the non-sponsorship route; the steps must be taken by the candidates.

Please note that you are responsible for getting settled in Quebec and looking for a position (regional medical staffing plans – PREM). These factors are independent of the route leading to the issue of a permit.

Since April 1, 2016, all applicants who would like to obtain financial support from Recrutement Santé Québec (RSQ) have been required to conclude a sponsorship agreement. Without a sponsorship agreement, the Ministère de la Santé et des Services sociaux (MSSS) cannot guarantee a position. In Quebec, the place and type of practice are regulated by the MSSS, which establishes the regional medical staffing plans with its partners on an annual basis. Due to the increase in the size of medical program cohorts in Quebec, the number of positions in the regional medical staffing plan is limited. The MSSS can offer you, under certain conditions, sponsorship (an agreement between the MSSS, the applicant and the health care recruiter) in order to obtain a position in the regional medical staffing plan.
To submit an application, from your personal account on the MCC’s physiciansapply.ca site, please select:

Application for medical registration
QC Collège des médecins du Québec
Restrictive permit - Arrangement de reconnaissance mutuelle (ARM) entre le Québec et la France
Sponsored by RSQ (if you have the letter of sponsorship signed by all parties). Otherwise, select the option Not sponsored by RSQ.

If you wish to take the non-sponsorship route, you must :

hold immigration status allowing you to work and practice your medical specialty in Canada
provide the CCMQ with supporting documentation.

No immigration formalities will be completed by the CMQ; the steps must be taken by the candidates.

You will also have to provide the required documents. Some must be sent to the CMQ, while others must be submitted to physiciansapply.ca.

You are responsible for following up on any documents you submit to physiciansapply.ca (please authorize the CMQ to access all your documents).

Note that these documents will be source verified and must be given the verification status “Passed” during the restrictive permit application process for the permit to be issued.

Lead times :

Acknowledgment of receipt of the application: 5 business days
Issuance of the letter of conditions for the adaptation/assessment period once the file is complete: 10 business days
The Collège’s Medical Education Division will identify your assessment site and coordinate the adaptation/assessment period in collaboration with the site. Individual initiatives are prohibited.

Note that the adaptation/assessment period is not a training period; the goal is to assess your readiness to practice in the specialty in question in Quebec.

The length of time before you start your adaptation/assessment period will vary depending on a number of factors, including your availability, the identification of an assessment site, how long it takes to process the application for the work permit needed to complete the adaptation/assessment period, which is three to four months on average if you are sponsored by RSQ and eight to nine months if you are not sponsored by RSQ (the CMQ acts as employer for the duration of the adaptation/assessment period and submits the application to Immigration, Refugees and Citizenship Canada (IRCC).

The adaptation/assessment period lasts 12 consecutive weeks, preceded by a week of observation, takes place in an accredited university clinical setting or any other setting designated by the CMQ and includes the assessment of both skills and attitudes in the main areas of the specialty in question.

If you wish to take the non-sponsorship route, you must :

hold immigration status allowing you to work and practice your medical specialty in Canada
provide the CCMQ with supporting documentation.

No immigration formalities will be completed by the CMQ; the steps must be taken by the candidates.

Two reports (mid assessment and final) will be completed by the supervisor and sent to the CMQ. They will be entered in your file for the subsequent review of your permit application by the CAP.
Once you have completed your adaptation/assessment period, the Committee on Admission to Practice (CAP) will render a decision regarding the issue of the permit under the Quebec-France MRA pursuant to section 35 of the Medical Act based on the complete file, including the adaptation/assessment period assessment reports.

Lead times :

The CAP’s decision will be sent to you within 15 days of the date of the decision.

If you would like to request a review of the CAP’s decision, the procedure is as follows: you may request a review of the decision by the CMQ’s Request Committee provided you submit your request in writing to the secretary of the CAP within 30 days of receipt of the CAP’s decision letter. The Request Committee also gives you the opportunity to make oral observations at the committee meeting where your file will be examined. The Request Committee’s decision will be sent to you by registered mail within 30 days of the date of the decision. It is final and may not be appealed.
If the CAP has resolved to issue you a permit under the Quebec-France MRA pursuant to section 35 of the Medical Act, you will be asked to:

participate in the educational activity on the legal, ethical and organizational aspects of medical practice in Quebec (ALDO-Quebec) within a maximum period of one year after your permit is issued. Information is available about registration and locations.

complete the Update of medical activities and declarations form through the CMQ’s Online services. Please note that a bill for the applicable fee will be added to your file for the issue of the restrictive permit. You may pay the fee from your personal page on the portal of the CMQ’s website.

Lead times

Acknowledgment of receipt of the application: 24 to 48 hours
Issuance of the permit within 24 to 48 hours when the file if complete (all the required conditions are met)

Once you have received your permit to practice, you must take out professional liability insurance and complete your first registration on the Roll of the Order. To do so, you must complete the online form First registration on the Roll of the Order on the CMQ's secure site.

Lead times

Processing of the first registration on the Roll of the Order and transmission to the RAMQ on the business day following receipt of the completed form

Contact

For information, write to: permisfqc@cmq.org.
To contact the Roll of the Order, write to: tableau@cmq.org.
For your RAMQ file, please consult this page for contact information.

Requirements – For practice in France

With respect to the provision relating to the Mutual Recognition Agreement (MRA), the “Décret 2010-1125 du 23 septembre 2010 relatif aux procédures d’autorisation d’exercice des titulaires de titres de formation obtenus dans la province de Québec pour les professions de médecins […]” [Decree 2010-1125 of September 23, 2010 regarding the procedures for authorizing holders of credentials obtained in the Province of Quebec to practice the medical profession] sets out the requirements of section L. 4111-3-1 of the Code de la santé publique [Public health code].

This Decree sets out the Eligibility criteria, Procedure, File content, Individual authorization to practice and Registration on the Roll of the Order.

The process in France may take a few weeks. If you do not receive a response, please write again.

Eligibility criteria

The MRA applies to physicians who:

have a Doctor of Medicine degree from one of Quebec’s four faculties of medicine (M.D. – Quebec);
have completed postgraduate training in family medicine or in one of the specialties listed in the agreement in a program accredited in Quebec; (Residency – Quebec);
have a credential in general medicine or in one of the specialties listed in the agreement from a Quebec university (specialist’s certificate in family medicine or in another specialty listed in the agreement – Quebec);
are registered on the Roll of the CMQ as a general practitioner / family physician or specialist without any practice restrictions or limitations resulting from an administrative measure, voluntary undertaking or disciplinary or criminal ruling (member in good standing of the Collège des médecins du Québec).

Procedure

As provided for in section D.4111-22 of the Code de la santé publique, physicians whose specialty is listed in Schedule 1 who apply for authorization must submit their file by registered mail with acknowledgement of receipt to the Conseil national de l’Ordre des médecins in France.

Once the file is complete, the Conseil national de l’Ordre des médecins has one month to issue an opinion that must be sent to the Ministry of Health (sections D.4111-23 and D.4111-24 of the Code de la santé publique).

The Minister of Health must then render a decision regarding the physician’s individual authorization to practice.

Liste des spécialités québécoises et françaises comparables (in French only).

File content

In accordance with the order of September 23, 2010 that sets out the documents that must be provided for the examination of applications submitted by holders of credentials obtained in the Province of Quebec in order to practice medicine in France, all physicians must complete the application for authorization form and attach the following documents:

a copy of the degrees, certificates and other credentials attesting to completion of medical training;
a certificate from the Collège des médecins du Québec certifying that the degrees, certificates and other credentials attesting to completion of medical training issued pursuant to its legislative, regulatory or administrative provisions correspond to the specialties listed in Schedule I;
a copy of the permit to practice;
proof of registration with the Collège des médecins du Québec (no more than 3 months old);
certificates specifying practice in the area of medical expertise for which the application for authorization is being submitted during the two years preceding the application;
a certificate from the Collège des médecins du Québec confirming the absence of any disciplinary or criminal sanction that might prohibit or restrict practice of the profession in Quebec (no more than three months old);
a sworn statement certifying that the applicant is not the subject of any proceedings that may lead to a conviction or sanction that might have an impact on registration with the Order.

Form to be completed and returned to the Conseil national de l’Ordre des médecins.

Conseil national de l'Ordre des médecins

4, rue Léon Jost
75855 PARIS Cedex 17

Tel.: 01 53 89 32 00
Fax: 01 53 89 32 01
Email: conseil-national@cn.medecin.fr

Individual authorization to practice and registration on the Roll of the Order

Authorization from the Minister to practice alone does not authorize the recipient to practice medicine in France.

Indeed, as provided for in section L.4111-1 of the Code de la santé publique, no one may practice medicine in France unless they are registered on the Roll of the Ordre des médecins.

As soon as physicians receive the ministerial order authorizing them to practice, they must contact the Order’s departmental board in their place of practice to start the registration process.