Short answer: yes, it’s hard. Especially if you’re an international medical graduate.
But “hard” doesn’t mean impossible. Hundreds of IMGs match into Canadian residency programs every year. The real question isn’t whether it’s hard. It’s understanding exactly how hard, why, and what actually moves the needle for your application.
Let’s look at the real numbers.
The Match Numbers Recent Year
In the 2025 CaRMS first iteration, the gap between Canadian medical graduates (CMGs) and international medical graduates (IMGs) was significant.
| Applicant Type | Match Rate (First Iteration) |
| CMG, current-year graduate | 93.0% |
| CMG, previous-year graduate | 89.6% |
| IMG, current-year graduate | 77.2% |
| IMG, previous-year graduate | 43.2% |
That gap between current-year and previous-year IMGs matters a lot. If you don’t match in your first year of applying, your odds drop sharply with each additional attempt. This is one of the most overlooked facts in IMG residency planning.
When you combine all years of IMG applicants together, the overall picture is tougher. Studies looking at multi-year IMG cohorts have found that fewer than a quarter of all IMG applicants ever successfully match, even across multiple attempts.
Why It’s Harder for IMGs Specifically
It comes down to seats. Canadian medical schools produce a fixed number of CMGs every year, and the vast majority of residency seats are reserved for them. IMGs compete for a much smaller pool of designated IMG seats.
In Ontario, for example, the IMG applicant-to-position ratio is over 4 to 1. That means for every available seat, more than four IMGs are applying.
On top of that, IMGs are evaluated separately from CMGs in most provinces. You’re not directly competing against Canadian grads for the same seat. You’re competing against other IMGs, but for far fewer total spots.
The Ontario Policy Change You Should Know About
Starting with the 2026 CaRMS cycle, Ontario introduced a policy requiring IMG applicants for designated Ontario seats to have completed at least two years of high school in Ontario, if they’re Canadian citizens or permanent residents. This policy is currently under a court injunction, so implementation is uncertain, but it signals where provincial policy is heading.
This matters because it shows provinces actively shaping who gets priority access to IMG seats. If you’re applying from outside Canada with no Ontario educational ties, your strategy may need to lean more heavily on other provinces.
Which Provinces Are More IMG-Friendly
Not all provinces handle IMG applications the same way. Some have structured programs specifically built for IMGs:
- British Columbia: Runs a Practice-Ready Assessment (PRA) pathway for experienced physicians
- Alberta: Offers a competency-based IMG assessment route, limited to current Alberta residents
- Nova Scotia: Has historically supported IMG-specific residency initiatives
If you’re an experienced, already-licensed physician rather than a recent graduate, PRA pathways can be a faster route than the traditional CaRMS residency match. They typically require several years of independent practice experience and passing the MCCQE1 and NAC OSCE, but they let you skip repeating a full residency.
What Separates Matched IMGs From Unmatched Ones
This is the part most articles skip. Based on CaRMS data and consistent patterns across matched applicants, a few factors show up again and again:
Strong exam scores. A passing MCCQE1 score is 226. Competitive applicants often score 260 or higher. Program directors use exam scores as one of the few standardized ways to compare candidates with very different educational backgrounds.
Applying broadly. The average IMG applicant submits close to 20 program applications. Limiting yourself to one or two programs significantly lowers your odds.
Matching in your first attempt. As the numbers show, your match probability drops substantially after your first cycle. Treat your first application year as the one that matters most.
Specialty choice. Family Medicine, Psychiatry, and certain primary care fields tend to have comparatively higher IMG acceptance than competitive specialties like surgery or dermatology.
Strong letters and a clear narrative. A well-written letter of intent and reference letters from clinicians who’ve actually observed your work carry real weight, especially when program directors are comparing candidates from vastly different health systems.
The One Thing Within Your Control
You can’t control how many IMG seats a province offers. You can’t control policy changes. But you can control how well-prepared you are for your exams, and exam performance is one of the clearest signals program directors use to evaluate IMG candidates.
This is exactly where focused preparation makes a real difference. At Jallah Academy, the MCCQE1 Prep Course is built around the kind of high-yield, case-based learning that helps you move from a passing score toward a genuinely competitive one. With access to thousands of practice cases and live structured classes, you’re preparing the way that actually reflects how the exam tests you.
The same applies to your clinical skills. The NAC OSCE Prep Course focuses on the communication and station performance skills that examiners and, indirectly, program directors are evaluating. A strong NAC OSCE result doesn’t just get you through the exam. It builds the clinical confidence that shows up in your interviews and your overall candidacy.
Realistic Timeline Expectations
Most IMGs spend one to three years completing the full process: credential verification, MCCQE1, NAC OSCE, and the CaRMS application cycle itself. If you don’t match on your first attempt, plan for the possibility of reapplying, while also exploring PRA pathways if you have sufficient clinical experience.
Final Thoughts
Getting a residency in Canada as an IMG is genuinely difficult. The numbers don’t sugarcoat that. But difficulty isn’t the same as impossibility, and the applicants who do match usually share a pattern: strong exam scores, broad and strategic applications, and a first-attempt mindset.
You can’t change the system. You can control how prepared you walk into it. That’s where your time and effort are best spent.
