From Clinical Assistant/Associate Physician to Independent Practice
- ITPC Directors
- May 9
- 1 min read
Updated: May 10
Why Ladder-to-Licensure Is the Practical Path Forward
May 2026
Policy Brief
Executive Summary
Canada’s healthcare system is experiencing sustained physician workforce shortages, reflected in reduced access to primary care, periodic emergency department closures, and growing pressure on healthcare delivery systems (Canadian Institute for Health Information, 2023; OurCare Initiative, 2023).
At the same time, internationally trained physicians (ITPs) already residing in Canada are actively contributing within supervised clinical roles, including Clinical Assistant (CA) and Associate Physician (AP) positions. These roles demonstrate that many ITPs are not only present within the system but are already functioning effectively within Canadian clinical environments. This presents a clear and actionable opportunity.
The core challenge is not solely a shortage of qualified physicians. Rather, it is the absence of a structured and consistent pathway that enables progression from supervised clinical work to independent licensure.
A ladder-to-licensure model addresses this gap by turning supervised Clinical Assistant (CA) and Associate Physician (AP) roles into pathways to full licensure, through the assessment of competence across defined routes, including in-role workplace-based assessment, Practice-Ready Assessment (PRA), and, where required, residency training. (Royal College of Physicians and Surgeons of Canada, 2017; Organisation for Economic Co-operation and Development, 2021).
Internationally Trained Physicians of Canada (ITPC)
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