The fee for the 2026 Examination of Added Competence in Emergency Medicine (EM) examination is $6,324 per candidate.

When determining the amount, the CFPC Board approved a strategy and mathematical formula in 2023 to calculate the cost of the emergency medicine exam annually. This is to make sure we deliver a high-quality exam and be transparent of the method used to determine the fee. The fee now includes all costs, including the centralized and shared services needed to design, develop, and deliver the exam as well as critical services needed to support the full spectrum of exam operations.

The table below summarizes costs related to the exam, including the subsidy:

View the detailed mathematical formula.

Note: Candidates who withdraw from the examination more than 60 days before the examination date will be refunded their examination fee less $500. Candidates who cancel 60 days or less before the exam will be charged a fee based on when their application was withdrawn. See our Cancellation Policy for more information.

Providing a high-quality exam is important to the CFPC. However, to continue administering and optimizing an exam that is valued by the emergency community and adapts to evolving education standards, periodic fee adjustments are necessary based on the mathematical formula approved by the Board of Directors.

Using the mathematical formula, the fee reflects all costs including the centralized and shared services needed to design, develop, and deliver the exam as well as critical services needed to support the full spectrum of exam operations. This will enable us to continue delivering the exam and improve on key areas such as:

• Continuous member service for candidates before, during, and after the exam. We are always here to help.
• High-quality, cutting-edge technology to improve the user experience, minimizing unnecessary stress on exam day
• Upgrades to privacy and security systems to continue keeping candidates’ information safe
• High levels of quality assurance, making sure exam content responds to and reflects the changing and more complex needs of patients in all our communities

Candidates who take the examination will continue to receive a tax-deductible receipt.

An in-person model versus a virtual delivery format requires different resources, which come with different expenses. The digital platforms used exceed the costs of securing facilities for in-person exams but result in minimizing travel expenses for examiners and candidates.

Previously, all candidates and examiners had to travel to Toronto to be examined. The costs of travel, accommodation, and food were indirect costs to candidates before, but no longer need to be accounted for.

Understanding the importance of keeping fees down, the CFPC’s Board of Directors  is committed to keeping exam fee increases limited to the Consumer Price Index (CPI) annually.

The fee increase will help the CFPC sustain its commitment to supporting candidates and administering a high-quality, reliable exam. The strategy and mathematical formula will be reviewed annually by staff to make certain it is meeting its goals, and every three years by the Finance and Audit Committee and the Board of Directors, which may result in a change to the fee. At a minimum the exam fee may be adjusted for inflation forecasts annually.
 

The number of candidates impacts the number of examiners, SO coordinators, and markers required to support exam delivery activities. The CFPC staff support candidates, examiners, SO coordinators, markers, subject matter experts (SMEs), the Board of Examinations and Certification, related CFPC committees, and vendors.

There is a direct correlation between the number of candidates sitting the exam and the total number of examiners, SO coordinators, and markers needed to support the candidates’ exam experience.

There is both a direct and an indirect correlation between the number of candidates and the number of staff needed to effectively design, develop, and deliver the exam.

We set the number of permanent staff full-time-equivalents (FTEs) and examiners, SO coordinators, and markers required based on the number of candidates. As the number of candidates rises so will the number of FTEs and examiners, SO Leads, and markers but the ratio should stay the same or become slightly more positive due to efficiencies. This is unique to FTEs providing direct member (in this case candidate) support for any College activity. We have noted an increase in support requested due to expectations of candidates and the examiners, SO coordinators, and markers.

At this time there is no separate equation for the CFPC cost related to determining if an applicant qualifies to sit the exam. Further work will be done to adjust future exam fees once these cost determinations are completed.

There are several aspects to this consideration:

• Communicating with candidates is crucial—we need:
  • General information such as web pages, social media, and instructions in various formats to be continually refreshed and presented in easy to find formats
  • Responses to specific concerns from individuals and key stakeholders
  • Information to flow in both predicted and responsive situations (e.g., emails with login details as one example)

The communication needs to be more than information sharing—rather a form of relationship building, and becoming and staying connected to the CFPC.

• Attending to communication and relationship building when working with members as they act in various roles, especially as SO coordinators. It requires ongoing work to manage recruitment, and train, show appreciation, and nurture a community of members with similar interests in being connected to the CFPC through examining in emergency medicine.
• Addressing legal actions: These are rare and unique, but when they occur, they require significant time commitment and input from staff.

As staff support commitments change over time, with changing candidate expectations, we will make sure we have adequate resources to support these services. As complexity, needs, and challenges grow, we need to add to our permanent/contract resources to meet demand. This will increase costs and recovery would then be either:

• Shared by all candidates
• Attract a specific fee (e.g., appeals, remarking)

At this time there is no separate equation related to the needs described above.

Further work will be done to adjust the individual fees and/or exam fees at a future date.

Note that there are additional services sometimes required, each with its own fee. They include:

• Review of marks
• Reconsideration of awarded standing
• Appeal a Board of Examinations and Certification (BEC) reconsideration decision

The current exam is made up of two components: short answer management problems (SAMPs) and structured orals (SOs). These components impact the cost of the examination as follows:

• Costs related to the maintenance (and initial top up) of content banks for both SAMPs and SOs
• Costs related to the number of SOs included in the examination

We anticipate that to reach an adequate number of items in our exam content banks, we need to invest in funding from the certification and assessment reserves. Staff will develop a plan to identify the optimum number of questions in the SAMP and SO banks, along with the estimated time and honorarium needed to secure the required number of SMEs to produce this content.

Annual amortization and maintenance costs for the question bank are a fixed cost, which is included as a per anticipated candidate cost.

An investment cost will be added to the exam fee at a later date, once we can better determine the impact of current activities on the reserves and an appropriate replenishment rate to guarantee that funds are available to carry out all development activities related to the exam.

There are three projects under way that will improve the examination delivery:

• New Examination Administration Tool (NEAT)
• Re-Envisioning the Future of Assessment, Certification, and Examinations (ReFACE)
• Question Updating for Excellent Standardized Testing (QUEST)

The capital costs for the NEAT project are approximately $1.8M and will be amortized over a three-year period starting with the 2024/25 fiscal year. This would be equivalent to approximately $300 per candidate on an annual basis adjusted by CPI.

This is not the end of continuous improvements, but if we use these as a baseline and we assume that this level of expenditure would occur in some manner every three to five years, it makes sense to set up an average amount to be included in the exam costs as a contribution to the Certification and Assessment Reserve for future projects. This will make certain that projects can continue to be funded through this reserve without seeing sharp increases/decreases in the examination fee. This cost will be developed once we examine plans and can provide reasonable replenishment costs. Using current improvement initiatives, an average amount of approximately $300 per candidate is likely and would be included as a step adjustment. The amount in 2025 was $102 and will be kept the same in 2026.

Both components of the exam are  administered electronically, pandemic proofing exam delivery. This benefits both the exam candidate and the CFPC.

A candidate is not required to travel to an exam site. The exam will not fall victim to physical risks such as weather-related travel cancellations or the site experiencing an interruption of service. In addition, this delivery method significantly reduces the carbon footprint that resulted from many candidates, examiners, and CFPC staff travelling to the in-person exam site. Plus, our paper and printing consumption has fallen dramatically—two areas of planetary health that the CFPC is supporting.

We now rely heavily on technological processes to enable remote delivery, and we must consider investments in those processes that can impact our overall cost. These will be seen as per candidate direct costs and will be estimated to remain steady, with the exception of increases resulting from inflation and other business factors that could impact our suppliers.

Other operating costs include:

These costs, with the exception of the impacts of inflation, remain relatively stable and will be introduced as a flat fee using past cost trends.

There are many departments that support exam design, development, and delivery. As a result, the CFPC has developed full cost budgets as a practice, whereby centralized and shared service costs are allocated to each department using those services. Currently this practice captures allocated costs from:

• Membership Services
• Marketing and Communications
• Executive Leadership
• Governance
• Strategic Planning
• Finance
• Facilities
• Human Resources
• Meetings Support
• Information Technology Services

All of the costs combined represent the total direct cost per candidate for the exam. Such costs are allocated based on a ratio of the exam direct expenses against the total direct expenses for all CFPC programs.

Exam fees are set one year in advance of the exam taking place. We will be using historical forecasts for the prior year when setting all of the per candidate costs. A general inflation amount will be added to set the fee using the Consumer Price Index (CPI). Six months prior to the exam date the CPI will be reviewed and, if a lower percentage exists than the estimate used initially, the exam fee will be lowered accordingly. If the CPI is higher than the estimate, the exam fee will remain unchanged and in-year budget adjustments will be made if required.

Initially in 2023, the Board decided to remove subsidization completely from the Examination of Added Competence in Emergency Medicine fee. The voluntary nature of the exam, with only one-tenth of eligible candidates choosing to participate, significantly impacts the College’s ability to cover the costs using the past fee structure. The examination fee in 2026 will continue to be subsidized at approximately the same rate as in 2025. The Board has yet to make a determination of what, if any, subsidy will be applied in 2027.