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     Residency in Canada

The Canadian residency match is run through CaRMS. As a DO, you will have to pass the MCCQE Part I and NAC-OSCE examinations in order to be eligible for residency applications. There are two iterations, or streams, which you can apply through to Canadian residencies. The 1st stream occurs earlier than the 2nd stream and is the stream all Canadian Medical Graduates enter (graduates of Canadian Medical Schools). As a DO, you are considered an International Medical Graduate (IMG) in Canada, despite graduating from a US medical school. This change was implemented in 2016. As an IMG, if you enter the 1st stream and match into a residency, you will be required to complete a Return of Service agreement, meaning you will have to serve in an underserved population in Canada for 5 years, just like IMGs.

You are able to apply for Canadian and US ACGME residencies at the same time. However, the 1st iteration of the Canadian match usually occurs earlier than the US match. In 2021 and 2022, the CaRMS match has and will occur after the ACGME match. If you match into a Canadian residency, you will automatically be withdrawn from the ACGME match and vice versa.

Canada has a 2nd iteration - this is composed of IMGs, DOs, and other Canadian graduates who didn't match in the 1st iteration. All applicants are considered equal and fight for the remaining, unfilled residency spots in Canada. If you match into a Canadian residency in the 2nd iteration, you are not required to complete a Return of Service requirement.

It is important to note that the 2nd iteration occurs after the US ACGME match. This means that if you match into a US ACGME program, you will automatically be withdrawn from the 2nd iteration of the Canadian match.

We recommend that you apply to both CaRMS 1st iteration and US ACGME residency programs if the CaRMS match occurs before the ACGME match. Do not skip the ACGME match in an attempt to match in Canada- it is too risky. 


Previously, with determination and persistence, Canadian DO graduates could enroll in a Canadian primary care residency program with relative ease. Now, as IMGs applying to residency in Canada, Canadian DOs must compete with ~2300 other IMG applicants for 323 designated spots. The odds have become so challenging that we at COMSA now recommend pursuing an ACGME residency training program in the US after graduating DO school, and returning to Canada as a licensed, fully trained, and board-certified physician.


Further information can be found on the CaRMS website here:

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