Imagine driving your vehicle into another country, only to have the manufacturer remotely disable access to it once you cross the border. Your keys or push-button start won’t respond. It’s not because the car is malfunctioning; it is because the system does not recognize you as a licensed driver. Your only option is to park your vehicle. 

Dr. Khalil’s journey 

Dr. Ahmad Khalil can attest to this. He arrived in Montréal, Quebec, in 1990. He had a medical degree and almost five years of general surgery experience. Despite this, his road to becoming licensed for full independent practice was long and anything but smooth. 

Since he couldn’t practice medicine, he turned to another way he could contribute to medicine. He pursued an M.Sc., in cardiovascular pathology, cardiac ischemia reperfusion injury, and a PhD in immunosuppression treatment and its impact on post-heart transplant coronary artery disease. He earned both degrees at the University of Montréal and Montréal Heart Institute and concluded with publishing results in leading North American journals, including the American Heart Journal and Circulation. 

Both postgraduate degrees were followed by a postdoctoral period at the Montréal Clinical Research Institute’s immunology department, where he acquired skills in molecular biology and HIV management. 

Following his PhD, he prepared for the Medical Council of Canada (MCC) Evaluating Exam, which was required (prior to 2018) before he could take the MCC Qualifying Exam Parts 1 and 2. 

A fourth exam, the Licentiate of the Medical Council of Canada (LMCC), while not a direct license to practice, was also mandatory. 

This is a process that IMGs/​ITPs have had to go through, adding years and financial burdens as barriers to practicing. 

The role and limits of clinical assistants

While this pathway is cumbersome, it is one that hundreds of IMGs/​ITPs who relocated to Manitoba have gone through. Despite completing this requirement, many never achieve independent practice. Others work as clinical assistants. A clinical assistant’s scope of practice is defined by provincial regulation and a supervision agreement with a physician. 

To be a clinical assistant, a medical degree from an accredited institution is required, but they are restricted from using ​“doctor” or ​“physician” as titles. 

Despite the long pathway to prove his qualifications, practicing as a clinical assistant was an opportunity Dr. Khalil could not pass up. In 2006, he moved to Manitoba and registered as a clinical assistant, a position he held for 18 years. 

With his background in cardiovascular pathology, he quickly became an asset to the cardiac surgery unit at St. Boniface Hospital, where he practiced until 2025. 

He is fond of his time at St. Boniface; he was treated well by the surgeons and other colleagues. He organized seminars and teaching sessions for nurses and taught at the University of St. Boniface. 

He did this despite his medical degree not being recognized, and his PhD, earned at a Canadian institution, did not change his clinical licensing status. This wasn’t just about pride; it had major financial implications for him. He was compensated as a resident, but his love of working in a surgical department kept him motivated. 

The weight of a title 

Unlike clinical assistants, residents who have earned a medical degree and are receiving post-graduate training use the title of doctor. Earning a medical degree in Canada means you can be called a doctor immediately, but someone like Dr. Khalil, who also earned a medical degree, has years of experience — and often other training and degrees — cannot use the same doctor title. 

“I was responsible for teaching other clinical assistants, physician assistants, residents, caring for patients and in the end, I received a fourth of the recognition because I couldn’t be called a ​‘doctor’,” he recalls. 

He tried to get creative, requesting that his medical degree be recognized only within the department. He also raised his concerns to the College of Physicians and Surgeons of Manitoba (CPSM). Neither resulted in any solution. 

This year, the changes he called for are finally happening. 

A milestone shift

Recognizing that clinical assistants have a critical role in the delivery of health care in Manitoba and that using the title of ​“Dr” is an academic achievement, in 2025, CPSM held a public consultation to modify the CPSM General Regulation, allowing clinical assistants to use the title of doctor. In May 2025, Council reviewed and discussed the varied feedback collected during the consultation and approved the amendment, with implementation scheduled for June 2026. 

Use of the title must be paired with ​“clinical assistant” to clarify their role to patients. This is consistent with how residents are called ​“resident doctors.” 

CPSM recognizes the change is complex and plans to educate both CPSM registrants and the public about the role of clinical assistants. 

“A medical degree and the title doctor represent the successful completion of medical education —basic sciences, clinical training, and are independent of the jurisdiction where the degree was earned,” said Dr. Ainslie Mihalchuk, CPSM Registrar and CEO. 

Dr. Khalil supports the change and believes it will make it more attractive for CAs to work in rural areas. 

“In retrospect, I am so thankful,” he says of his own journey. He completed the Manitoba Licensure Program for International Medical Graduates and as of July 2025, he is practicing as a full-time family physician in Ste. Anne. His knowledge of French, one of five languages he is fluent in, is an asset to the community. He also works in the ER, where he confidently practices independently, thanks to the experience he gained as a clinical assistant. 

Day and night difference 

He admits that once he began full practice as a family physician and could use the title ​“doctor,” he noticed an immediate difference. ​“It was day and night the recognition I received from patients, colleagues and staff.” 

Dr. Khalil’s journey is a reminder that medical care is stronger when we recognize the skill, dedication, and humanity that IMGs/​ITPs bring. 

Medical degrees are earned; they recognize completion of necessary training. Their legitimacy does not stop at a border, just as a physician’s jurisdiction does not diminish the value of their medical degree or their title.