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Medical Matters: A behind-the-scenes look at our Registration processes

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February Messenger 2023, Medical Matters | Posted February 9, 2023
Read time: 2 minutes

By Dr. Michael Caffaro, Assistant Registrar, Registration

As a regulated member of CPSA, you have first-hand experience with our Registration processes. What you may not be as familiar with is the ongoing work behind the scenes to make sure these processes support patient safety and access to high-quality care for all Albertans.

To practise medicine in Alberta, all physicians must receive a practice permit from CPSA. Once a physician or physician assistant (PA) applies for independent practice, our Registration team guides them through each step, from confirming their eligibility, to receiving their practice permits and ultimately seeing patients independently.

The first step a physician takes in this process is to verify they meet CPSA’s eligibility requirements, which apply to all applicants, including locums, physicians with Canadian credentials and international medical graduates (IMGs). These are designed with patient safety and quality care in mind, and are largely congruent with requirements across Canadian jurisdictions. Physicians who were trained outside of Canada may need to take additional steps to confirm they meet CPSA’s eligibility requirements.

We are sometimes asked about the reasons a candidate may be rejected after an eligibility review. In some cases, the candidate’s English Language Proficiency scores do not meet required minimums. In other cases, the candidate may have insufficient post-graduate training, or training that is not equivalent to Canadian standards. Currency of practice is a factor if a candidate has not been in practice or in accredited training within the past three years. For specialists, they may not have certification in specialty training. When our Registration team notifies a candidate that they are ineligible for registration, they also provide guidance to help the candidate understand actions they may take to help them succeed if they apply again in the future.

For IMGs, the final step to independent practice in Alberta is CPSA’s six-month practice readiness assessment (PRA). As I shared last September, we have been working to improve the PRA process to meet physician recruitment needs. This process continues to evolve, and this year, we launched a five-year pilot project that condenses the PRA timeframe for certain eligible IMGs. For those with training comparable to that obtained in Canadian universities, this accelerated registration route means certain requirements will be waived, including clinical review exams and the first three-month assessment. These physicians will now go directly to communities where they have been sponsored and begin practising independently while completing their three-month Supervised Practice Assessment (SPA). We have also implemented safeguards, such as enhanced Competence assessments and practice reviews, that will be in place once the physician has successfully completed their SPA. The goal of this pilot is to evaluate whether IMGs may begin seeing patients independently within their communities faster, while maintaining our focus on patient safety.

For Albertans, there are few things more important than having access to high-quality, community-based health care. That’s why we are committed to ensuring our Registration processes meet the needs of patients, our regulated members and communities across the province.


A man smiling for a portrait photo. He has brown hair and is wearing a white and blue striped shirt. Dr. Michael Caffaro has been a CPSA team member since 2015 and is currently the Assistant Registrar, Registration at CPSA. Prior to this role, Dr. Caffaro worked in CPSA’s Professional Conduct department for six years as Complaints Director and Assistant Registrar, Professional Conduct. Dr. Caffaro is a University of Alberta graduate and, before joining CPSA, spent 22 years as a family physician in Hinton, Alta.

10 Responses

  1. Tashfeen Sadiq says:

    Great work, hope we can hire a few doctors in our clinics as there is dire shortage of doctors. Can we as a clinic , now sponsor doctors as well ..?

    • Dr. Michael Caffaro says:

      Thanks for reading The Messenger! Sponsorship is still the sole purview of AHS. CPSA Council will be considering a proposal to open sponsorship to other organizations and entities in the near future—please follow upcoming CPSA Council meetings and The Messenger for updates. Take care!

  2. Nawal says:

    Thanks! Dr Caffaro for excellent description of pathway towards independent practice. However, those IMGs, who have been working as clinical assistants for years and years and providing the health care services with high standards of safety to Albertans in teaching hospitals over the nights are deprived of the pathway towards practice ready assessment. The CAs are considered out of practice while they are running the emergencies over nights and MRP is sleeping at home.What a dilemma.
    Please look into it and try to evolve some pathway for CAs.

  3. Dr. Michael Caffaro says:

    Thank you for reaching out and providing your perspective. Clinical assistants are valued members of the health care team and we appreciate their continued dedication to patients in Alberta. Upon registration with CPSA, clinical assistants are made aware that this is not a suitable pathway to independent practice. Clinical assistants may have training in a specific area, such as pediatrics, but be employed in another area, such as cardiology, which may also differ from their independent practice environment (general practice). A formal residency program, on the other hand, ensures training is directly aligned with future practice environments. As a result, participation in a formal residency program is the greatest predictor of both success in independent practice and safety for patients, and the preferred pathway to independent practice. We are aware of the need to expand residency positions, but unfortunately that is beyond CPSA’s scope as Alberta’s medical regulator.

    Thanks again and take care!

  4. Satvik vasoya says:

    Dr. Caffaro, 24 months postgraduate training requirement was added around 2015 and onwards for PRA. Most of the Asian countries dont have 2 years post graduate internships but some countries do have 2 years post graduate internship which is accepted, while Doctors coming from Asian countries are merely rejected because of only this requirement in PRA.
    The provinces like Manitoba and Saskatchewan have made only 1 year Post graduate training requirement and rest they accept independent practice in lieu of the deficiency. Recently Newfoundland also approved just 1 year post graduate training for PRA program. In Alberta, there is a severe shortage of family doctors in rural areas. And also to become a licensed physician PRA assessments are there to check whether the selected candidate is competent or not.

    Then why can’t this 2 year postgraduate training requirement be reduced to 1 year which will provide many Doctors chance to be eligible for PRA like before 2015 and many Albertans will get a family doctor.
    If the candidate is not competent, they can be failed during assessments as many do fail even after having 2 year post-graduate training too.

    This step will help a lot of ALBERTANS to have a family doctor and AHS to reduce the shortage of doctors. It would be a win win situation for all three concerned parties namely ALBERTANS, AHS AND ASPIRING CANDIDATES. This will also remove any sort of discrimination felt by Asian and other country’s candidates who have 1 year post graduate internship compared to countries with 2 year internship.
    Just a thoughtful suggestion.

    • Dr. Michael Caffaro says:

      Thank you for providing your feedback Dr. Vasoya, and we apologize for the delayed response.

      CPSA has registration requirements in place to ensure physicians licensed in Alberta have the training and competencies to provide safe and high-quality medical care to patients in Alberta. As a result, internationally-trained physicians are expected to meet the same standards as domestically-trained physicians, regardless of their country of origin.

      Having said that, we appreciate your perspective and suggestion. We’re always looking at ways to ensure our processes are efficient and accessible, while still ensuring patient safety remains our top priority.

  5. Anselm Uche Onwugbolu says:

    Thanks Dr Caffaro for your passion and commitment towards the IMGs recruitment while ensuring access to high-quality, community-based health care services to Albertans.

    I am particularly attracted to your recent launch of a five-year pilot project that condenses the PRA timeframe for certain eligible IMGs.

    I am an Independent Practitioner, with an Independent practice registration with the Health Professions Council of South Africa, and a Fellow of the College of Paediatricians of South Africa.

    I am interested in the accelerated registration route, and I will be more than willing to relocate to Alberta to render the community-based health care services to the Albertans as a Pediatrician.

    Would you please throw more light on the process of the 3-month Supervised Practice Assessment (SPA) where the candidate practises independently in their identified community, providing medical services to Albertans.

    Thanks again for your time and dedication.

    God bless.

    • Dr. Michael Caffaro says:

      Hi Anselm, thank you for taking the time to read and provide feedback on The Messenger.

      During the three-month Supervised Practice Assessment (SPA), a CPSA-approved supervisor will observe the applicant in independent practice where they are the physician in charge. During this phase, they can bill Alberta Health for medical services. The supervisor will visit regularly to review charts and collect feedback from patients, colleagues and staff. CPSA does reserve the right to end the assessment at any point if there is enough evidence to determine the applicant has not passed.

      More information about the SPA and CPSA’s accelerated route to registration can be found on our website:

  6. Randall Sargent says:

    I appreciate the detail Dr. Caffaro’s statement offers and I think that the information is valuable to those of us in the medical profession.
    Counter to the statement is the common call to allow all the trained physicians knocking at Canada’s door to commence practice now. That shows an unfortunate lack of understanding of CPSA’s practices meant to protect the quality of medical care for Alberta patients. I’m sure there are many innovations we could adopt in thus area given finances and available preceptors.
    For now this message belongs not just in the Messenger but in our messages to patients, our communication avenues, and our funders’ agendas.
    Let’s get the details accurately into the minds of Albertans.

    • Dr. Michael Caffaro says:

      Thank you for taking the time to share your feedback, Dr. Sargent. You are correct in that CPSA’s registration requirements are in place to ensure Alberta’s physicians have the right training, knowledge and skills to give Albertans safe and high-quality medical care.