Ontario Opens Doors to U.S. Health-Care Professionals—But Federal Immigration Rules Still Apply

In a major development aimed at easing Ontario’s healthcare staffing crisis, the province has announced that American-trained health professionals can now begin working immediately—without waiting for full registration. Doctors, nurse practitioners, registered nurses, and registered practical nurses who are licensed in the U.S. and have a clean record can start working in Ontario for up to six months before registering with the province’s regulatory bodies.

The new policy, unveiled by the Ford government, applies to work in hospitals, long-term care homes, community care facilities, clinics, and labs. It follows similar moves Ontario made in 2023 to allow health workers from other Canadian provinces to begin work while completing registration processes. With growing interest from U.S. health workers and over 2 million Ontarians lacking access to a family physician, the province hopes this streamlined approach will bring faster relief.

However, while Ontario’s new rules simplify the licensing timeline, they don’t eliminate the need for Federal immigration authorization.

CUSMA: A Streamlined Path for Nurses and Doctors—With a Caveat

For many U.S. health-care professionals, the Canada-United States-Mexico Agreement (CUSMA) offers a relatively smooth immigration pathway through the TN (Trade NAFTA) work permit category. Professions like Registered Nurse and Nurse Practitioner are explicitly listed in CUSMA’s Appendix 2, making qualified individuals eligible for a work permit without the need for a Labour Market Impact Assessment (LMIA).

To qualify for a TN work permit under CUSMA as a Registered Nurse, an applicant must typically provide:

• Proof of U.S. citizenship
• A degree or diploma in nursing
• A job offer in Canada matching the profession
• Proof of provincial licensure or eligibility to be licensed in the province of work

For doctors, the situation is more complex. The TN category only allows physicians to enter Canada for roles that do not involve direct patient care, unless they are participating in a training program like a clinical fellowship. As a result, most practicing physicians must apply through other immigration streams, such as:

• LMIA-exempt work permits under R205(a) (significant benefit to Canada)
• Provincial Nominee Programs (PNPs)
• Standard LMIA-based work permits where applicable

The Catch-22: Ontario Licensure vs. CUSMA Immigration Rules

Despite Ontario’s announcement that U.S.-licensed nurses can work for six months without first registering, this policy introduces a legal conflict with immigration rules. CBSA officers still require some CUSMA applicants to show they are either licensed or eligible to be licensed in their destination province. Registered nurses fall into this category.

This creates a Catch-22:

• Ontario says you don’t need a license to start working
• Immigration law says registered nurses need proof of licensure or eligibility before they can get a work permit

To navigate this contradiction, professionals and their employers should:

1. Obtain proof of eligibility: A letter from the College of Nurses of Ontario (CNO) or College of Physicians and Surgeons of Ontario (CPSO) confirming the applicant is eligible for licensure—even if not yet licensed—might help satisfy immigration officers.
2. Draft strong employer letters: Job offers should reference Ontario’s six-month grace period for licensing and confirm support for the applicant’s registration process.
3. Consider alternative immigration strategies: If the CUSMA TN category proves too narrow, other LMIA-exempt work permits, such as R205(a) (Significant Benefit), may be suitable depending on the nature of the work and the applicant’s credentials.
4. Examine provincial programs for occupations in demand.

Ontario’s move to reduce regulatory delays is a positive step, but it doesn’t override the federal requirement to meet immigration laws. Health professionals from the U.S. still need a valid Canadian work permit—so consulting immigration counsel is strongly recommended to avoid delays or refusals at the border.

If you’re a U.S.-trained doctor or nurse looking to work in Ontario, or a hospital trying to hire cross-border professionals, our firm can help you navigate both the provincial and immigration requirements. Contact us today to get started.