Visas for Allied Health Care Workers: Nurses, Occupational Therapists, Physical Therapists and Others

Certification of Certain Health Care Professionals

What is a Health Care Worker Certification?

A health care worker certification identifies and documents that a foreign health care worker has met minimum requirements for training, licensure, and English proficiency in order to be able to fulfill their professional role as a:

• Licensed practical nurse, licensed vocational nurse, or registered nurse
• Occupational therapist
• Physical therapist
• Speech language pathologist and audiologist
• Medical technologist (clinical laboratory scientist)
• Physician assistant
• Medical technician (clinical laboratory technician)

Who Must Obtain a Health Care Worker Certification?

Any non-U.S. citizen coming to the United States for employment as a health care worker (other than a physician) cannot be admitted unless he or she presents a certificate from either the Commission on Graduates of Foreign Nursing Schools (CGFNS) or a certificate of equal standing from an organization with equivalent credentials. These requirements apply to both immigrant and nonimmigrant applicants. Health care workers in occupations covered by the health care certification requirement are not exempt from the requirement even if they possess a U.S. state license or receive their health care education in the United States. Regarding visa classification, nonimmigrant health care workers will most likely be in H-1C, H-1B, J, O, or TN non-immigrant categories. Any non-immigrants coming to receive training in a health care occupation will not be required to obtain certification. Such health care workers will most likely be in F-1, J-1 (aliens coming to undertake a training program in a medical field) and H-3 nonimmigrant classifications. Please note that each of these visa classifications has additional requirements. Please go to our Nonimmigrant Visa or our Immigrant Visa Classification pages for more information on visa categories.

Are Nonimmigrants Subject to the Health Care Worker Certification Requirements?

A nonimmigrant seeking to be admitted to the United States, is changing status, and/or is requesting an extension of stay, s/he must provide evidence of health care worker certification if the primary purpose for coming to or remaining in the United States is employment in one of the above designated occupations.

Which Organizations Are Currently Authorized to Issue Health Care Worker Certificates?

The following organizations are authorized to issue certificates for the following health care occupations:

• The Commission on Graduates of Foreign Nursing Schools - (CGFNS) is authorized to issue certificates to all 7 health care occupations.
• The National Board for Certification in Occupational Therapy - is authorized to issue certificates for occupational therapists.
• The Foreign Credentialing Commission on Physical Therapy - is authorized to issue certificates for physical therapists.

Which English Language Testing Organizations Are Approved for Purposes of Health Care Worker Certification?

Every alien must meet certain English language requirements in order to obtain a certificate unless otherwise exempted. The following testing services have been approved:

• Educational Testing Service - (ETS)
• Test of English in International Communication - (TOEIC)
• International English Language Testing System - (IELTS)

Questions and Answers about Exemptions for Certain Health Care Workers

Q: Are foreign health care workers - trained in the United States or in possession of a valid state license - subject to the health care certification requirement?

A: Yes. While Congress provided certain nurses with a less rigorous, alternative certification process, it did not provide a less rigorous alternative certification option to state-licensed foreign health care workers. Possession of a state license does not exempt a foreign health care worker from compliance with the certification requirement. Similarly, health care workers who have been trained in the United States are not exempt from the certification requirement.

Q: Are there any accommodations for foreign health care workers who have been trained in the United States?

A: Yes. Foreign health care workers may be automatically deemed to have met the English language and/or educational comparability requirements if they have graduated from certain programs or from programs in certain countries. The following groups may be deemed to have met the English language requirements:

• Graduates of health professional programs in Australia, Canada (except Quebec), Ireland, New Zealand, the United Kingdom, and the United States;
• Alien nurses who are presenting the alternate certified statement under section 212(r) of the Act;
• For nurses, graduation from an entry-level program accredited by the National League for Nursing Accreditation Commission (NLNAC) or the Commission on Collegiate Nursing Education (CCNE);
• For occupational therapists, graduation from a program accredited by the Accreditation Council for Occupational Therapy Education (ACOTE) of the American Occupational Therapy Association (AOTA);
• For physical therapists, graduation from a program accredited by the Commission on Accreditation in Physical Therapy Education (CAPTE) of the American Physical Therapy Association (APTA); and
• For speech language pathologists and audiologists, graduation from a program accredited by the Council on Academic Accreditation in Audiology and Speech Language Pathology (CAA) of the American Speech-Language-Hearing Association (ASHA).

The following groups may be deemed to have met the educational comparability requirements:

• For nurses, graduation from an entry-level program accredited by the National League for Nursing Accreditation Commission (NLNAC) or the Commission on Collegiate Nursing Education (CCNE);
• For occupational therapists, graduation from a program accredited by the Accreditation Council for Occupational Therapy Education (ACOTE) of the American Occupational Therapy Association (AOTA);
• For physical therapists, graduation from a program accredited by the Commission on Accreditation in Physical Therapy Education (CAPTE) of the American Physical Therapy Association (APTA); and
• For speech language pathologists and audiologists, graduation from a program accredited by the Council on Academic Accreditation in Audiology and Speech Language Pathology (CAA) of the American Speech-Language-Hearing Association (ASHA).

Q: Are dependents subject to the health care worker certification requirement?

A: No. For example, if you are here as an L-2 nonimmigrant, your primary purpose for entering the United States is to join your spouse. Since an L-2 nonimmigrant spouse is authorized employment, you may engage in employment as a health care worker without obtaining the certification. This will also apply to other dependents who are accompanying a principal alien and who are employment authorized within their dependent status.

Validity of a Health Care Certificate

The health care certificate must be used within five years of its issue date. Otherwise a new health care certificate must be obtained. The final rule provides that the certification must be used for any admission into the United States, change of status within the United States, or adjustment of status within five years of the date that it was issued. The health care certificate is valid for visa issuance and admission to the United States more than five years after its issue date only if it was used at least once for admission to the United States, change of status, or adjustment of status during the initial five-year period. Using it to apply for a visa is insufficient.

A. H-1B Nonimmigrant Temporary Employment Visa Eligibilities

The H-1B "Specialty Occupation" visa is available to individuals who can demonstrate qualification in a "specialty occupation" and who are sponsored by a U.S. employer to work temporarily in the U.S. in a "specialty occupation". The INA defines a "specialty occupation" as an occupation that requires:

• A theoretical and practical application of a body of highly specialized knowledge; and,
• A bachelor's or higher degree in the specific specialty (or its equivalent) as a minimum for entry into the occupation in the United States.
• Only 65,000 H-1Bs are granted each year. The cap was reached less than two months into fiscal year 2007 this past May; H-1B visas, for non-cap exempt employers, will not be available until FYT 2008 begins on October 1, 2008. [Non cap exempt employers may include many nurse employment opportunities, if the nurse meets the degree eligibility, including university employees and employees of non-profit and government research institutions, including numerous university and research-oriented hospitals around the country.

B. H-1B Pharmacists Nonimmigrant Temporary Employment Visas

Pharmacists are eligible for a professional visa to work in the US, referred to as an H-1B1. This visa, with extensions, is valid for a period of up to six (6) years. This visa is in high demand for professionals as it is efficient, well tested and, with premium processing can result in a decision within fifteen (15) days. Pharmacists are required to pass a number of exams before being admitted to the US on a temporary visa.

Licensure is regulated by the National Association of Boards of Pharmacy (NABP). NABP represents the State Boards of Pharmacy in every state, as well as the District of Columbia, Guam, Puerto Rico, the Virgin Islands, New Zealand, eight Canadian Provinces, three Australian states, and South Africa.

NABP provides the FPGEC Certification program as a means of documenting the educational equivalency of a candidate's foreign pharmacy education, as well as the license and/or registration. In the process of FPGEC Certification, candidates provide documents that verify their educational backgrounds and licensure and/or registration. Candidates are also required to pass the FPGEE, the Test of English as a Foreign Language (TOEFL), and the Test of Spoken English (TSE). The FPGEC Certificate allows foreign graduates to partially fulfill eligibility requirements for licensure in the states that consider the Certification.

The FPGEC Certificate is not a license to practice pharmacy. Applicants who receive the FPGEC Certificate may be qualified by the state boards to take the pharmacy licensing examination in those jurisdictions that accept this certification. Because the licensure requirements vary from state to state, applicants are advised to directly contact the board(s) of pharmacy of the state(s) in which they desire licensure.

It is the applicant's responsibility to confirm with state boards all requirements regarding FPGEC Certification as eligibility for licensure. The FPGEE Certificate allows foreign graduates to partially fulfill eligibility requirements for licensure, followed by the issuance of a temporary permit.

Upon passing the NABP examination, the applicant will receive an unrestricted permanent license to practice pharmacy.

While in H status, pharmacists are allowed to start the permanent resident ("green card") application process.

Note: Pre-Foreign Pharmacy Graduate Equivalency Examination (Pre-FPGEE)

The Pre-FPGEE is a practice examination to help familiarize you with the FPGEE. The Pre-FPGEE is not intended for use as a study guide. This practice examination will benefit those who are preparing for the FPGEE by exhibiting the types of questions provided on the actual examination as well as providing a score estimate.

Since the full benefit of this experience requires that you complete the Pre-FPGEE on your own, the Pre-FPGEE should not be taken in a group or with study aids or reference materials on hand.

Each attempt at the Pre-FPGEE is $50. You may take the Pre-FPGEE up to two times, receiving a different form each time. To take another Pre-FPGEE test, you must complete the test you have already paid for and review its score report before paying for another test.

C. H-1B Occupational Therapists Nonimmigrant Temporary Employment Visas

Internationally-educated Occupational Therapists are eligible for a professional visa to work in the US, referred to as an H-1B1. This visa, with extensions, is valid for a period of up to six (6) years. This visa is in high demand for professionals as it is efficient, well tested and, with premium processing can result in a decision within fifteen (15) days. Occupational Therapists are required to pass a number of exams before being admitted to the US on a temporary visa.

The National Board for Certification in Occupational Therapy (NBCOT) certification is a U.S. nation-wide recognition, that an OT practitioner has met certain professional requirements.

Certification requirements for internationally-educated OT's include graduation from an entry-level occupational therapy program recognized by the World Federation of Occupational Therapy (WFOT) at the time of graduation, or graduation from an entry-level occupational therapy program not recognized by WFOT at the time of graduation, but determined by NBCOT to be professionally comparable to that of a US educated occupational therapist holding a Bachelor's degree in occupational therapy.

Candidates educated outside the US also must have completed at least 1,000 hours of fieldwork and passed three English tests, including the Test of English as a Foreign Language (TOEFL), the Test of Written English (TWE) and the Test of Spoken English (TSE). (Graduates of OT programs in Australia, Canada (except Quebec), Ireland, New Zealand and the United Kingdom are currently exempt from the English test requirements.) Finally, internationally-educated OT's must pass the NBCOT certification examination, and every third year, complete certification renewal requirements in order to maintain use of the OTR credential.

NBCOT works in partnership with state regulatory agencies to protect the public interest. State regulatory entities are an important component of the credentialing process in the field of occupational therapy, and all recognize NBCOT's occupational therapy certification examinations. A state license grants an occupational therapy practitioner permission to practice in that jurisdiction. State regulations vary.

D. H-1B Physical Therapists Nonimmigrant Temporary Employment Visas

Internationally-educated Physical Therapists are eligible for a professional visa to work in the US, referred to as an H-1B1. This visa, with extensions, is valid for a period of up to six years. This visa is in high demand for professionals as it is efficient, well tested and, with premium processing can result in a decision within 15 days. Physical Therapists are required to pass a number of exams before being admitted to the U.S. on a temporary visa.

FCCPT Comprehensive Credentials Evaluation (Type I Certificate)

This Credentials Evaluation is used primarily for the individual who has never been licensed in the U.S. This certificate combines both an educational credentials review and the requirements for the U.S. Citizenship and Immigration Services Visa Credentials Verification Certificate.

The FCCPT Comprehensive Credentials Evaluation (Type I Certificate) is a comprehensive evaluation of your credentials based on the approved guidelines of the FCCPT. These guidelines meet or exceed the minimum credential requirements for licensure in most U.S. jurisdictions.

The Type I Certificate can be used for both immigration and licensing, and it therefore represents a cost savings for the individual who may seek credentialing for immigration and licensing separately.

FCCPT Visa Credentials Evaluation (Type II Certificate)

This certificate is required by the U.S. Citizenship and Immigration Services for those individuals who are currently licensed in the U.S. and are seeking adjustment of visa status to that of a permanent immigrant. The review process focuses on the verification of education (certificates, diplomas and degrees), the verification of licenses and the demonstration of English language proficiency.

If you are currently licensed as a physical therapist, are residing in the U.S., and you want to change your status to become a permanent immigrant to the U.S., you should apply for an FCCPT Visa Credential Verification (Type II Certificate).

The Type II Certificate is not accepted by U.S. jurisdictions for licensing purposes.

Permanent Residence for Physical Therapists

Physical Therapists are included in Schedule A and have a streamlined process for permanent residence, similar to Nurses (RN's).