Written by: Kate Freeman and Ildiko Bors, SpanTran: The Evaluation Company
Unlike many countries, all health care professionals in the United States, from nursing assistants to medical doctors, are trained and educated at the post-secondary level. A high school diploma is the minimum entrance requirement for educational programs, except for programs of study that train medical doctors, dentists, and veterinarians. These programs require a bachelor’s degree with appropriate coursework for admission.
Licensure of health care professionals is the responsibility of the states and not the federal government. Each state has a separate licensing board for each profession, and each licensing board sets the educational and examination requirements for licensure in that profession. Applicants for licensure must be a graduate of a program that is accredited by a recognized accrediting body. Once licensed, continuing professional education is required to maintain the license. Most states have license reciprocity; this means the state will recognize licenses awarded by other states. Some states, namely California and Florida, do not have license reciprocity and require applicants to go through the entire licensure process.
NURSES
Education
All first-level general nurses (RNs) in the United States are first trained as general nurses. There are many pathways to being an RN:
- Two-year programs leading to an Associate of Science in Nursing/ASN. 58% of RNs are trained in these programs. Most of these programs are offered at community colleges.
- Three-year programs, usually based in hospitals, that lead to a Diploma in Nursing. At one time, this was the most common pathway to becoming an RN, but the number of Diploma in Nursing program has steadily declined, and only 4% of RNs are currently trained in these programs.
- Four-year university programs leading to a Bachelor of Science in Nursing/BSN. 38% of RNs are trained in these programs.
- Two- to three-year “RN to BSN” programs for nurses who hold an Associate of Science in Nursing or a Diploma in Nursing who wish to earn a Bachelor of Science in Nursing.
- 18-month accelerated BSN programs for students who hold a bachelor’s degree outside of nursing.
Graduate programs in nursing are two to three years. These programs train students in nursing specialties such as nurse anesthetist, midwifery, and advanced clinical care. Doctoral programs in nursing focus on research and/or continued advanced study of a nursing specialty. Currently, 13% of RNs hold a master’s or doctoral degree in nursing.
Licensure of Nurses Educated in the USA
After graduating from an accredited nursing program, students sit for the National Council Licensing Examination/NCLEX. The NCLEX is the same for all nursing students no matter which educational pathway they have completed. Passing the NCLEX is required for nursing licensure in all states and territories of the USA. States and territories may have additional licensure requirements.
Licensure of Nurses Educated Outside of the USA
Nurses who have been educated outside of the USA and who wish to be licensed as a nurse in the USA must meet these standards:
- Trained as a first-level general nurse and not as a specialty nurse or a medical doctor
- Nursing program that was at least two years and at the post-secondary level
- Nursing programs must have included sufficient hours in the main areas of nursing: medical, surgical, maternity/obstetrics, pediatrics, psychiatric, and geriatrics
Foreign-educated nurses must pass the NCLEX to apply for nursing licensure, but each state has its own requirements before it will allow foreign-educated nurses to sit for the NCLEX. Some states will complete their own internal credentials evaluation, some will accept outside credentials evaluation, but most will require foreign-educated nurses to submit a certificate earned after going through the CGFNS Certification Program which includes a qualifying examination, credentials evaluation, and demonstration of English language proficiency.
PHYSICAL THERAPISTS
Education
Previously, the first professional degrees for physical therapists were four-year programs leading to a Bachelor of Science in Physical Therapy/BSPT that was last awarded in 2002, and until 2008, two-year Master of Science in Physical Therapy/MSPT programs for students who held a bachelor’s degree in a field outside of physical therapy. Currently, the only first professional degree is the Doctor of Physical Therapy/DPT. There are 3 pathways to a DPT:
- Three-year programs following a bachelor’s degree with the appropriate coursework
- Three-year programs following three years of undergraduate study
- Six-year programs that are a direct admission after high school
Licensure of Physical Therapists Educated in the USA
After graduating from an accredited physical therapy program, students sit for the National Physical Therapy Examination/NPTE. Passing the NPTE is required for physical therapy licensure in all states and territories of the USA, although there may be additional licensure requirements.
Licensure of Physical Therapists Educated Outside the USA
Eligibility of foreign-educated physical therapists to sit for the NPTE varies by state. However, all states will only consider applications for licensure from foreign-educated physical therapists who have been trained in post-secondary program that was at least four years in length. Some states complete their own internal credential evaluations, but most require foreign-educated physical therapists to submit a credentials evaluation using the National Association of State Boards of Physical Therapy Coursework Tool/CWT. The CWT has six versions which are based on the year diploma or degree was awarded; each version uses the physical curriculum that was in place in that timeframe. The CWT looks for sufficient hours in basic science and physical therapy coursework as well as sufficient clinical hours.
MEDICAL DOCTORS
Education
There are several academic pathways for doctors in the U.S. All are four-year programs that lead to a Doctor of Medicine (M.D.), Doctor of Osteopathy (O.D.), or a Doctor of Osteopathic Medicine (D.O.M.). All of these programs include basic medical sciences and clinical rotations. Although the minimum educational requirement for admission to medical programs is completion of three years of undergraduate study, nearly all medical schools require a bachelor’s degree and sufficient scores on the Medical College Admission Test (MCAT). There are a few six-year accelerated programs that admit students directly from high school. Following completion of medical school, new doctors complete a one-year general medical internship before beginning a multi-year residency in a medical specialty. These residency programs range from three years in the case of internal medicine to seven years in neurosurgery. The one-year general medical internship is declining and is being combined with the residency.
Licensure of Medical Doctors Educated in the USA
Medical students must pass the US Medical Licensing Examination/USMLE which is a three-step examination process. The Step 1 examination is usually completed after the 2nd year of medical school. The Step 2 examination has two parts – clinical skills and clinical knowledge – and is taken after the 4th year of medical school. Step 3 is usually taken during the 1st or 2nd year of the internship or residency. Most licensing jurisdictions require completion of all steps within 7 years of beginning medical school.
Licensure of Medical Doctors Educated Outside the USA
International medical graduates (IMGs) must also pass the USMLE and must also earn certification from the Educational Commission on Foreign Medical Graduates (ECFMG). ECFMG certification includes verification of the foreign educational credential(s), passing USMLE Step 1 examination, and the clinical knowledge portion of the Step 2 through online testing centers around the world. After passing these examinations, the IMG must take the clinical skills portion of USMLE Step 2 at one of four testing centers in USA. An ECFMG certificate allows the holder to apply to residency programs in the USA and sit for the USMLE Step 3 examination. Between 1991-2010, 60.7% of applicants earned ECFMG certification. It is interesting to note that ECFMG currently does not require an IMG to be a graduate of a recognized or accredited medical education program; the only requirement is that their medical school is listed in the World Directory of Medical Schools. However, beginning in 2023, ECFMG will require that applicants be graduates from a medical school that has been appropriately accredited or recognized in the country or region where the school is located. The accreditation or recognition authority will have to be accredited by an agency that has been recognized by the World Federation for Medical Education through its Programme for Recognition of Accrediting Agencies.
DENTISTS
Education
Dental education programs are four years and lead to either a Doctor of Dental Surgery (D.D.S.) or a Doctor of Dental Medicine (D.M.D.). Dental programs are accredited by the Commission of Dental Accreditation (CODA) of the American Dental Association (ADA). Admission to dental programs technically requires completion of three years of undergraduate study, but the vast majority of dental schools require a bachelor’s degree for admission. Dental programs consist of two years of basic medical and dental sciences and two years clinical training. Graduates of accredited U.S. and Canadian dental education programs are eligible for licensure in the United States. Dental specialties are offered as advanced dental education programs at the post-graduate level leading to a Master of Science.
Licensure of Dentists Educated in the USA
The National Dental Board Examination (NDBE) Part I is taken after the 2nd year of the dental program and Part II is taken after the 4th year. To apply for licensure a dentist, applicants must pass Parts I and II of the NDBE, and most licensing jurisdictions require applicants to pass a clinical examination which is offered at five regional testing agencies. Some states, including California, Colorado, Delaware, Minnesota, New York, Ohio and Washington have other specific requirements for licensure.
Licensure of Dentists Educated Outside the USA
Most states require that foreign-educated dentists first obtain a D.D.S./D.M.D. degree from a CODA-accredited program by attending an advanced standing program in the United States. The advanced standing program can be completed within two to three years and grants eligibility for the National Dental Board Examination (NDBE) and subsequent licensing procedures.
PHARMACISTS
Education
Previously, the United States had a five-year, post-secondary school Bachelor of Science in Pharmacy which was last awarded in 2002. Since January 1, 2003 the first professional degree in pharmacy is a Doctor of Pharmacy (Pharm.D.). The Pharm.D. is a four-year professional program that requires at least two years of specific undergraduate coursework or a Bachelor of Science in a non-pharmacy field for admission. Some institutions offer six-year accelerated Pharm.D. programs that admit students directly from high school.
Licensure of Pharmacists Educated in the USA
All pharmacy graduates must take and pass the North American Pharmacist Licensure Examination (NAPLEX), and all states require the Multistate Pharmacy Jurisprudence Examination (MPJE) or the state’s own jurisprudence examination. Each state may have additional licensing requirements.
Licensure of Pharmacists Educated Outside the USA
Graduates of pharmacy schools outside the USA must first earn Foreign Pharmacy Graduate Examination Committee (FPGEC) Certification from the National Association of Boards of Pharmacy before applying for licensure. Some states exempt graduates of Canadian pharmacy schools from this requirement. The certification process includes:
- Verification and evaluation of the foreign credential(s) by Educational Credential Evaluators (ECE)
- Graduation from an accredited or recognized post-secondary pharmacy program
- Program of study must be at least four years if the pharmacy degree was awarded December 31, 2002 and earlier, and at least five years if the pharmacy degree was awarded January 1, 2003 and after. Coursework and internships completed after the degree was awarded are not included when determining the length of the program of study.
- Applicants must be currently licensed or registered to practice pharmacy in a foreign country without restrictions.
- Once all of the steps listed above have been completed, the applicant is eligible to sit for the Foreign Pharmacy Graduate Equivalency Examination (FPGEE)
After passing the FPGEE and submitting sufficient TOEFL iBT scores, FPGEC Certification is awarded. Applicants are then eligible to apply for state licensure. States may have additional internship and licensing requirements.
Inside this edition:
President’s Welcome: November 2017 Newsletter
Committee Updates: November 2017 Newsletter
International Secondary Schools: Whose Education System Is it, Anyway? November 2017 Newsletter
Memoriam to Sandy Gault: November 2017 Newsletter
TAICEP Elections: November 2017 Newsletter
TAICEP Strategic Plan: November 2017 Newsletter
TAICEP News: November 2017 Newsletter
Add to Your Library: November 2017 Newsletter
Recent TAICEP Events: November 2017 Newsletter
Upcoming TAICEP Events: November 2017 Newsletter