Restrictive permit – Clinician – Practice Ready Assessment (PRA)

7-minute video.

The restrictive permit (clinician) route to medical practice in Quebec is intended for practicing clinicians who are international medical graduates (IMGs) and who:

• have completed postgraduate training that is roughly equivalent in duration and content to that required in Quebec for the medical specialty in question;
• have a specialist’s certificate in the medical specialty in question;
• have practiced in the medical specialty in question for 12 months during the last two years.

If you are a medical graduate from France and have a State Doctor of Medicine degree, you may be eligible under the agreement between Quebec and France on the mutual recognition of physicians’ professional qualifications (Quebec-France MRA): please see the page Restrictive permit – Quebec France MRA – Practice Ready Assessment (PRA).

Restrictive permit (clinician) - Practice Ready Assessment (PRA)

Pursuant to section 35 of the Medical Act, the Collège may issue a restrictive permit (clinician) in accordance with guidelines established for clinicians (in French only) (see the excerpt from the minutes of the meeting of the Board of Directors, CDA-20-151). Requirements include completion of a 12-week assessment period during which the physician’s readiness to practice is assessed.

The Collège’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.

The guidelines also set out the criteria for revoking a restrictive permit:

• the permit holder is struck off or resigns from the Roll of the Order;
• the permit holder no longer has privileges in a health care institution, confirmed by a resolution of the health care institution’s board of directors;
• the permit holder ceases to practice.

Requirements

• You have a Doctor of Medicine degree or an equivalent degree from a school or faculty listed in the World Directory of Medical Schools published by the Foundation for Advancement of International Medical Education and Research (FAIMER).
• You have completed a required examination: MCCEE or MCCQE Part I or USMLE / Step 2 CK.
• You have completed postgraduate training that is roughly equivalent to that required in Quebec for the specialty for which the restrictive permit application is being submitted.
• You have a specialist’s certificate (or equivalent credential) in the discipline for which the restrictive permit application is being submitted.
• You practiced competently in the area of medical expertise for which the restrictive permit application is being submitted for twelve months during the two years preceding your application. 
• You have provided proof of French language proficiency or passed the Office québécois de la langue française (OQLF) examination.
• You successfully completed an assessment period.
• You participated in the ALDO-Quebec educational activity before your permit was issued.

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.

Step 1 – Obtain sponsorship with a health care institution through RSQ

To obtain sponsorship with a health care institution, you must register with Recrutement Santé Québec (RSQ) first to obtain a letter of sponsorship in order to submit an application for a restrictive permit (clinician) to the Collège (select Médecins on the RSQ site).

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 (sponsorship) 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 the work permit needed to complete the required assessment period) and organization and completion of the assessment period (for the applicable fees, see the List of fees).

The letter of sponsorship will be sent directly to the Collège by RSQ.

If you do not obtain sponsorship, you will not be able to continue the steps to obtain a restrictive permit. In this case, you may consider the regular permit route: please see the page Regular permit to practice – By recognition of the equivalence of an M.D. degree. 

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Step 2 – Pass a required examination

 You must pass one of the following Examinations:

• Medical Council of Canada Evaluating Examination (MCCEE) – before 2019, or
• Medical Council of Canada Qualifying Examination Part I (MCCQE - I) or
• United States Medical Licensing Examination / Step 2 Clinical Knowledge (USMLE / Step 2 CK).

To apply to take an examination, please open a personal account on the Medical Council of Canada’s physicansapply.ca site and select Examinations.

The MCC’s website provides information about eligibility criteria, examination centres and dates, examination fees, preparatory resources, grading, results and other useful information. 

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Step 3 – Submit an application for medical registration and the required documents

If you have obtained sponsorship through RSQ and passed the required examination, you may submit an application for a restrictive permit (clinician).

To submit an application, from your personal account on the MCC’s physiciansapply.ca site, please select:

1. Application for medical registration
2. QC Collège des médecins du Québec
3. Restrictive permit - Clinician sponsored by Recrutement Santé Québec.

 
You will also have to provide the required documents. Some must be sent to the Collège, 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 Collège 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. 

Acknowledgment of receipt of the application: 5 business days

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Step 4 – Review of the complete file by the Committee on Admission to Practice (CAP)

You have completed Steps 1 to 3, which means your file is ready for review by the Committee on Admission to Practice (CAP). The Committee meets regularly to study applications for eligibility for a restrictive permit so that you can continue the process in order to complete the required assessment period (Step 6).

The CAP’s decision is sent to the applicant by letter. If the response is positive, you may go on to Step 5. If the response is negative, please refer to Step 7 (application for a review of the CAP’s decision). 

Meeting of the Committee on Admission to Practice every 5 to 6 weeks approximately

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Step 5 – Provide proof of French language proficiency

Before you start your assessment period, you will have to provide proof of your French language proficiency (this link provides information about the examination, French courses and exemption critieria):

1. Pass the French examination administered by the Office québécois de la langue française (OQLF)
   OR
2. Secondary school certificate or other certificate as stipulated in the exemption criteria

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Step 6 – Complete an assessment period

The CAP has authorized you to continue the process in order to complete an assessment period. The Collège’s Medical Education Division will identify your assessment site and coordinate the assessment period in collaboration with the site. Individual initiatives are prohibited.

Note that the 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 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 assessment period, which is three to four months on average (The Collège acts as employer for the duration of the assessment period and provides the candidate with the documents required to apply for a temporary work permit with Immigration, Refugees and Citizenship Canada (IRCC)).

The 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 Collège and includes the assessment of both skills and attitudes in the main areas of the specialty in question.

Two reports (mid assessment and final) will be completed by the supervisor and sent to the Collège. They will be entered in your file for the subsequent review of your permit application by the CAP. 

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Step 7 – Final decision of the CAP

Once you have completed your assessment period, the Committee on Admission to Practice (CAP) will render a decision regarding the issue of the restrictive permit (clinician) based on the complete file, including the assessment period reports. The CAP’s decision will be sent to you within 15 days of the date of the decision.

Meeting of the Committee on Admission to Practice every 5 to 6 weeks approximately

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 Collège’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 you are dissatisfied with the processing of your application, you may file a complaint with an independent government body: the Commissioner for Admission to Professions. This recourse also applies to your dealings with third-party organizations involved in the process.

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Step 8 – Administrative formalities once the restrictive permit (clinician) has been issued

If the CAP has resolved to issue you a restrictive permit (clinician), you will be asked to: 

• participate, before the restrictive permit is issued, in the educational activity on the legal, ethical and organizational aspects of medical practice in Quebec (ALDO-Quebec). Information is available about registration and locations;
• complete the Update of medical activities and declarations form through the Collège’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 Collège’s website.

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

Once you have received your permit to practice, you must take out professional liability insurance (in French onyl) 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 Collège's secure site.

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.

For information, write to: permisfqc@cmq.org.
 
To contact the Roll of the Order, write to: tableau@cmq.org

For information about your RAMQ file, please call: 1 800 463-4776. 

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Telemedicine is important for you as well. Learn more in the Telemedicine section.

• Restrictive permit – Quebec-France MRA – Practice Ready Assessment (PRA)
• Restrictive permit – Sponsored professor
• Restrictive permit – Clinician – Practice Ready Assessment (PRA)
• Restrictive permit – Adaptation or assessment periods – PRA
• Converting a restrictive permit