IMG Secrets

Which Country Is Best for IMG Doctors? USA vs. Canada (Alternate Entry Path Program)

Based on my personal experience of seeing multiple IMG doctors who are specialists in Canada and the USA, the answer depends on where your primary training is from. If you are a specialist, trained in a high-income country like Australia & New Zealand, Hong Kong, Singapore, South Africa, Switzerland, UK, and Ireland, then the USA scores marginally higher than Canada. If you are an IMG specialist trained in a low to middle-income country like India, China, Brazil, Pakistan, Bangladesh, etc., then the USA is the clear winner.

I will explain to you the specific differences so you know why I say this and you can make the right choice if you had an option. Let’s jump into finding more right away

Rajeev S. Iyer MBBS, MD, FASA

Associate Professor of Anesthesiology,

University of Pennsylvania, Philadelphia, USA

Can IMG doctors work in Canada and USA without residency?

First, I will tell you if it is even possible to work in USA and Canada without residency and then explain in brief the different pathways. This will make it easy for us to compare both systems and make sense.

Both USA and Canada offer pathways to work without residency and be a part of their system.

USA: In the USA, Alternate Entry Path Program is created for international physicians who are exceptional and outstanding to be an important part of the US academic system.

I will quote this verbatim from the ABA Website. “The Alternate Entry Path (AEP) program allows international medical graduates who are certified by the national anesthesiology organization in the country where they trained and practicing anesthesiology in the U.S. to qualify for entrance into our exam system for primary certification in anesthesiology. A record of documented achievement in teaching and/or scholarship, rather than the potential for future success, is critical to acceptance into the AEP program, as is the ability of the sponsoring department to provide an outstanding academic environment.”

There are two ways to get into the Alternate Entry Path Program

  1. Clinician Educator Pathway
  2. Research & Fellowship Pathway

Check the full guide about the options in the USA and how to be successful using this link: How to practice anesthesia without USA residency? Alternate Entry Path Program

Canada: There are two major options for IMGs to practice in Canada –

  1. Royal College Certified Specialist: The Royal College of Physicians and Surgeons options
  2. Province Based Specialist with hospital specific license: This is via Postgraduate Education Certificate. This is an option from IMGs from low to middle-income countries like India, China, Brazil, Pakistan, Bangladesh, etc.

I will quote this directly from the Royal College of Physicians and Surgeons of Canada website “International medical graduates are candidates who have completed postgraduate residency training outside of Canada or the United States. To be eligible for Royal College exams, candidates do not have to live in Canada or hold Canadian citizenship.”

The Royal College of Physicians and Surgeons in Canada further offers three options for IMG’s

  1. Approved jurisdiction
  2. Practice eligibility route
  3. Subspecialty Examination Affiliate Program (SEAP)

Check the full guide about the options in Canada and how to be successful using this link: Can IMG doctors work in Canada without residency? 

Which Country Is Best for IMG Doctors – USA or Canada?

After knowing all the pathways of the USA and Canada, the critical question is which one should you be choosing if you had the option of both. Based on seeing IMG doctors in both USA and Canada who have been through all the above pathways here is what I think.

IMG from High Income Country

  • Australia & New Zealand
  • Hong kong
  • Singapore
  • South Africa
  • Switzerland
  • UK and Ireland

If you are from the above listed countries, the decision comes up to where you want to live. Do you have a family that you would like to stay close by? From the alternate entry path program standpoint, whether you chose USA or Canada, you will ultimately be board certified in the USA and Royal College certified in Canada. So, the eventual outcome does not make a huge difference. However, the USA is much more desirable than Canada for the reasons I have mentioned below.

IMG from Low Middle Income Country

  • Afghanistan
  • Angola
  • Armenia
  • Bangladesh
  • Benin
  • Bhutan
  • Bolivia
  • Burkina
  • Faso
  • Burundi
  • Cambodia
  • Cameroon
  • Cape Verde
  • Caribbean
  • Central African Republic
  • China
  • Egypt,
  • El Salvador
  • Ethiopia
  • Guatemala
  • Haiti
  • Honduras
  • India
  • Indonesia
  • Kenya
  • Lebanon
  • Madagascar
  • Micronesia
  • Mongolia
  • Morocco
  • Myanmar
  • Nepal
  • Nigeria
  • Pakistan
  • Papua New Guinea
  • Philippines
  • Senegal
  • Sri Lanka
  • Sudan
  • Syria
  • Tonga
  • Tunisia
  • Uganda
  • Ukraine
  • Uzbekistan
  • Vietnam
  • Yemen Z
  • Zambia
  • Zimbabwe & others

If your specialist training is from a low-middle income country, then you are definitely better off with the alternate entry path program in the USA. This is based on my experience and many IMG doctors I personally know of in Canada and USA. The opportunities you have to grow and the support structure is far larger in the USA than in Canada. A huge benefit in the USA is that the alternate pathway will give you board certification by the American Board of Anesthesiology while in Canada the Royal College Certification is largely biased to favor certain countries.

Is Being an IMG Doctor in USA Better Than in Canada?

In short, being an IMG doctor in the USA is better for one main reason. Irrespective of what country you are trained from, the alternate entry path program offers opportunities to you. At the end of a successful pathway, you are eligible for board certification by the American Board of Medical Specialties.

While in Canada, this is not the case. Those who enter the pathway through the province based pathway in Canada, almost never become Royal College certified. On the other hand, the Royal College eligibility is biased towards certain high income countries.

Here are some specific differences between USA and Canada. As you see in the table below, the USA scores much higher in all aspects than Canada with the exception of immigration. Although I am not an immigration consultant nor an attorney, based on my experience, getting a visa and permanent residency in Canada is simpler than in the USA.


If you are trained from the following high-income countries (Australia & New Zealand, Hong Kong, Singapore,  South Africa, Switzerland, and the UK and Ireland) then whether you choose the USA or Canada is a personal choice although the USA scores much higher than Canada. This is irrespective of where your country of birth and medical training is in. For example, if you are from India and did your medical training in India but Anesthesiology in Singapore then you are eligible for Royal College Certification through one of the three methods mentioned above. 

If you are trained in low-middle income countries, then the USA is clearly the winner. After you finish your alternate entry path program you will be eligible for board certification in the USA, whilst this option does not exist in Canada.

IMG Secrets: How to be successful as an IMG in USA & Canada?

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