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For Healthcare Professionals

1.  How can I find out about the TOEFL tests?

2.  I'm a Physical Therapist (or a Registered Nurse), and have filed my Adjustment of Status.

3.  I'm an Occupational Therapist or Speech Language Pathologist, and have filed my Adjustment of Status

4.  With state licensing laws changing so much, employers seem to be hesitant to bring therapists into the U.S. now on a temporary license. Why? How can I get a permanent license when the exam is not offered in my country?

5.  Why are some employers so reluctant to hire a therapist who has only a temporary permit to practice?

6.  What is the interim rule regarding Healthcare Workers?

7.  Why can't Registered Nurses come into the U.S. on an H-1B visa?


For more information on issues affecting healthcare professional:  Email info@therakare.com

1.  How can I find out about the TOEFL tests?
The TOEFL tests are given in many different locations worldwide. You may obtain information regarding dates and locations for the English language proficiency examinations by contacting:

Educational Testing Services
PO Box 6151
Princeton, NJ 08541-6151

Phone: (609) 771-7100
Fax: (609) 771-7500
E-Mail: TOEFL@ETS.org

2.  I'm a Physical Therapist (or a Registered Nurse), and have filed my Adjustment of Status. Since my adjustment is pending the certification requirements (in connection with Section 343), can I change employers without affecting the adjustment? How?
We usually encourage everyone to stay with the employer who sponsored their I-140 until the completion of the Adjustment of Status. However, since the certification requirement has caused such a backlog of processing time, many PTs and RNs are changing jobs while their Adjustment of Status is pending. This is possible only for PTs and RNs because of the Schedule A status of their occupation.

If you do find yourself in a position where you cannot wait to change employers until the completion of the adjustment, we have found the following steps are the best to take:

1. You must obtain an Employment Authorization Document first!
2. Find a new employer willing to sponsor your I-140, and begin processing the paperwork…do not go to work for them yet, however!
3. When the new I-140 has been filed and a Receipt Notice of Action has been received, you may give notice to your current company that you are leaving.
4. Upon receipt of the new I-140 Approval Notice of Action, you should send a copy of it to the INS Service Center that has your Adjustment of Status on file, along with an employment authorization letter from the new employer, and a letter from you verifying that the new employer is now sponsoring the I-140 Petition for Immigrant Worker.

Again, we caution you…change employers only if working conditions are unbearable and/or a new offer of employment includes a better opportunity for advancement in your career and an increase in salary! Do not be tempted to jump from employer to employer just because you are in a Schedule A occupation. And we would never encourage you to change employers more than once before the completion of the Adjustment of Status…INS may begin to think that a record of (several) job changes during the pending adjustment indicates a fraudulent intent to obtain the Green Card altogether!

3.  I'm an Occupational Therapist or Speech Language Pathologist, and have filed my Adjustment of Status. Since my adjustment is pending the certification requirements (in connection with Section 343), can I change employers without affecting the adjustment?
PROBABLY NOT...Not unless you are willing to give up all the time it has taken to get you that far along in the process!  

HOWEVER...If you are currently working for the employer who sponsored your Labor Certification and I-140, you could leave for a temporary period to work for another company, if you have a valid EAD, but we would suggest doing so, ONLY if your current employer agrees:
    1.  NOT TO WITHDRAW THEIR I-140 PETITION.
    2.  TO TAKE YOU BACK FOR FULL TIME PERMANENT EMPLOYMENT AT THE TIME THE ADJUSTMENT IS APPROVED, COMPLETED, AND THE IMMIGRANT VISA IS ISSUED.

FOR OBVIOUS REASONS...MOST EMPLOYERS WILL NOT BE WILLING TO DO THAT!  So you're back to "staying put!"

OTs and SLPs are in the group called Non-Schedule A occupations. The Labor Certification, including the recruitment process, is very job and employer specific...it's done only for the job you will be performing (which is usually the same job you are performing now) upon completion of the Adjustment of Status. It's also done specifically for the employer who is offering the job (usually the employer you are working for when the process begins).

So, if you change jobs & employers, the labor certification cannot be "transferred"…you'll have to begin all over again. If you do decide to give it up and start over, be sure to consider how much more time you have on your H-1B visa (6 year limit)…will there be enough time to get you to the adjustment of status phase before the 6 years runs out?

This is the reason we always say to a person beginning the Green Card: Make very sure you are satisfied with the job and employer sponsoring you…it may be a good long time before you're able to change!

4.  With state licensing laws changing so much, employers seem to be hesitant to bring therapists into the U.S. now on a temporary license. Why? How can I get a permanent license when the exam is not offered in my country?
State licensing laws have changed so much in the past few years. If you have a friend working in the U.S., the course of action he/she took to get here may have been very different from the one you will have to take. The best way to find out exactly what the licensing laws are for the state you wish to work in is to write the particular state board and request an application with rules and regulations. (See Below for helpful websites to link into!)

If your profession and/or country does not offer the license in a location convenient for you, you may enter the U.S. specifically to sit for the exam. Here are some helpful guidelines to follow if this is what you would like to do:

1. Find an employer who is willing to help you through the process and also willing to hire you once you obtain permanent licensure. This can be done by attending various job fairs in your area, contacting your university for companies hiring in the U.S. or by contacting your friends in the U.S. for suggestions on employers.
2. Once you are approved and registered to sit for the exam, you should obtain a Tourist Visa, specifically to come to the U.S. to sit for an exam. (If you are from a country that has Visa Waivers available, you may enter on those!) Contact us for information on the Visa Waivers.

It's important to note that if you are obtaining a Tourist Visa to come to sit for the exam, you should be sure to follow these suggestions when going to the embassy for the visa:

A. Take all your educational documents
B. Take a copy of the licensure application, and the letter verifying you have been approved to sit for the exam, showing the date of the exam.
C. Be sure to be honest about the reason for your trip…that you are going expressly to sit for an exam, and plan to return within 10 days or so.
D. The officer will want you to provide proof that you are returning: a round trip ticket, and verification that you have a reason to return to your country of origin, i.e. real estate owned, automobile owned, bank accounts, and maybe a job you are currently working (a letter from the employer would be sufficient, verifying the employment).

For more information outlining the procedure for obtaining a Tourist Visa, you may go to: http://travel.state.gov/visa;visitors.html

For more information on the U.S. Embassy / Consulate nearest you, go to: http://travel.state.gov/links.html

 One thought: Employers who are willing to sponsor your H-1B visa and help you get licensed may depend on you to pay the up-front costs involved with licensing (including airfare to take the exam). Most employers will, however, reimburse you the costs once you arrive with a permanent license in hand, ready to go to work.

Helpful information regarding licensure, etc. for PT / OT / SLP:

Physical Therapy:
American Physical Therapy Association (APTA): http://www.apta.org/
Federation of State Boards of Physical Therapy (FSBPT): http://www.fsbpt.org/

Occupational Therapy:
American Occupational Therapy Association (AOTA): http://www.aota.org/
National Board for Certification in Occupational Therapy (NBCOT): http://www.nbcot.org/

Speech / Language Pathology:
American Speech and Hearing Association (ASHA): http://www.asha.org/
Miscellaneous information on Speech and Hearing, including licensure: http://www.mankato.msus.edu/dept/comdis/kuster2/welcome.html

5.  Why are some employers so reluctant to hire a therapist who has only a temporary permit to practice?
Not every U.S. employer feels this way! But…many employers are reluctant to hire (foreign) therapists with temporary licenses, simply because they have had a bad experience in the past, and aren't willing to go to the expense of trying it again! The best way to avoid the experience is, obviously, to hire therapists who are already in the U.S., those who have passed the national board exam and have a permanent license to practice.

What does the "experience" refer to?
If the therapist has not passed the national board exam, depending on the state, they can enter the U.S. and practice on a temporary license until they can take the national board exam. Many states now have a rule that says if they do not pass the exam on the first try, the therapist is then ineligible to work in that state.

If possible, the employer can help the therapist apply for a temporary license in another state and move the therapist (if the employer has locations or assignments in other states). However, only a few states even offer temporary licenses anymore, so moving to another state is becoming less and less viable.

If the therapist is not able to pass the exam on the first try, the employer goes to great expense to relocate the therapist to another state to work (if a new temporary license is obtained). Most (reputable) employers will feel a sense of responsibility to do anything possible to keep from having to terminate the foreign worker and send them back home. However, if all opportunities are exhausted, there may be no other option.

In the past, many therapists would "go underground", live with friends, study for and take the exam until they pass. This, of course, meant they went "out of status". After they passed and obtained their permanent license, the employer could process a new H-1B visa and, after a trip to a U.S. Consulate outside the U.S. for a visa stamp and new I-94 card, could come back and go to work! Simple, huh?

Things have changed! In addition to the states tightening up on their licensing rules, the immigration laws have changed! Now, if a person stays in the U.S. "out of status" for 6 months or longer, they will be banned from the U.S. for a Long Time!

So, as mentioned earlier, you can no longer compare your experience coming to the U.S. with that of your friend who came here a few years ago!

If you would like to ask specific questions about this subject, please send us an e-mail and we will respond just as quickly as possible!

6.  What is the interim rule regarding Healthcare Workers?
It gives authorization to the Commission on Graduates of Foreign Nursing Schools (CGFNS) to issue certificates to foreign health care workers in the occupations of occupational therapy and physical therapy. It also grants the Foreign Credentialing Commission on Physical Therapy (FCCPT) the authority to issue certificates to foreign-trained physical therapists. The rule is written in response to formal requests by CGFNS and FCCPT to obtain permission to issue certificates to foreign-trained workers coming to the United States in the occupations of occupational therapy and physical therapy on a permanent basis. This rule ensures that foreign-trained occupational therapists and physical therapists have the same training, education, and licensure as similarly employed United States workers.  Read the full text of the rule.

7.  Why can't Registered Nurses come into the U.S. on an H-1B visa?
The H-1B visa requires that the job in question REQUIRES at least the equivalent of a U.S. Bachelor's degree.  You may be saying..."But I have a Bachelor's degree."  In the U.S., a Registered Nurse is not required to have a Bachelor's degree to practice nursing.  Therefore, a normal, staff Registered Nurse position could not REQUIRE a Bachelor's degree just for the purposes of an H-1B visa.  

If the position is a specialized position, or a management position (such a Director of Nurses), which does require a Bachelor's Degree, you would most certainly qualify for an H-1B visa.

Keep in mind that Registered Nurses are included on the list of occupations known as Schedule A, Precertified...which refers to the Immigrant Visa (Permanent Residence), and may enter on a "Green Card" if you find an employer willing to sponsor it and wait for the process to be completed (usually one year or more).

Remember that nurses from Canada may come to work in the U.S. on the TN (Trade NAFTA) visa.