A Canadian doctor can work in the United States, but transferring a medical career across the border involves a rigorous, multi-layered process. This journey requires navigating the national medical evaluation system and securing the necessary legal authorization for employment. Physicians must plan a comprehensive strategy that addresses both their medical qualifications and their immigration status.
The Initial Hurdle: ECFMG Certification and USMLE
The first significant step for any foreign-trained physician, including those from Canada, is obtaining certification from the Educational Commission for Foreign Medical Graduates (ECFMG). This certification evaluates the qualifications of international medical graduates before they can enter the US healthcare system. A policy change now requires ECFMG certification for those graduating from Canadian medical schools on or after July 1, 2025.
The certification process requires passing the first two parts of the United States Medical Licensing Examination (USMLE): Step 1 and Step 2 Clinical Knowledge (CK). Step 1 focuses on basic sciences, while Step 2 CK assesses the application of clinical science knowledge. ECFMG certification is a prerequisite for entry into ACGME-accredited US residency programs and for obtaining a medical license in most states.
Recognition of Canadian Residency and Training
Postgraduate medical education completed in Canada is viewed as equivalent to that in the US, providing a streamlined pathway for Canadian-trained specialists. Training programs accredited by the Royal College of Physicians and Surgeons of Canada (RCPSC) are recognized by the Accreditation Council for Graduate Medical Education (ACGME), the US body overseeing residency and fellowship programs. Similarly, training accredited by the College of Family Physicians of Canada (CFPC) is comparable to ACGME-accredited family medicine programs.
This equivalency allows Canadian-trained physicians to be eligible for specialty board certification in the US. For instance, an RCPSC-certified specialist can often bypass the need to repeat US residency training to qualify for examination by a US specialty board. The acceptance of Canadian training reduces the burden of re-training and accelerates the path to independent practice in the US.
Navigating Essential Immigration Pathways
Canadian physicians seeking to work in the US must secure one of several non-immigrant work authorizations tailored to their professional role. The TN (Treaty National) status, available under the USMCA, offers an efficient pathway, though it is restricted to physicians engaged in teaching or research, not primary clinical practice. For those entering US residency or fellowship, the J-1 Exchange Visitor status is commonly used, sponsored by the ECFMG.
The J-1 visa imposes a two-year home country physical presence requirement, meaning the physician must return to Canada for two years after training before being eligible for an H-1B visa or permanent residency. Canadian citizens are an exception, as they can transition directly from J-1 to H-1B status without fulfilling the two-year requirement, though a waiver is still needed for permanent residency application. The H-1B Specialty Occupation visa is the preferred option for post-training clinical practice, as it is employer-sponsored and allows for “dual intent.”
The Final Step: State Licensing and Credentialing
A physician must be licensed by the specific state where they intend to practice, as medical regulation is a state-level function. State medical boards review a physician’s entire professional history before granting a license. These boards have varying requirements, with some states demanding one year of accredited graduate medical education, while others require two or three years.
The Federation of State Medical Boards (FSMB) provides a central resource, but physicians must verify the requirements for each jurisdiction, which may include specific clinical hours, background checks, and a jurisprudence exam. After obtaining the state license, the physician undergoes hospital credentialing to obtain admitting and surgical privileges. This involves a detailed review of the physician’s competence and professional conduct by the hospital’s medical staff.
Understanding Compensation and the US Job Market
Compensation for physicians moving to the US is generally higher than in Canada, particularly for specialists. The US healthcare system, based on a fee-for-service and private insurance model, allows for greater earning potential in specialized fields. US physicians typically earn between $260,000 and $324,000 annually, while their Canadian counterparts range from $206,000 to $261,000, but the gap narrows when considering general practitioners.
The US market requires physicians to navigate higher operational costs, including expensive malpractice insurance premiums, which are often subsidized in Canada. The complex US insurance and billing system also necessitates increased administrative staffing and overhead, unlike the single-payer system in Canada. Despite the potential for higher gross income, US physicians contend with greater administrative burden and the necessity of obtaining comprehensive malpractice coverage.