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United States

Work in the USA as a foreign doctor, nurse or AHP (2026)

In the US you are licensed by a state, credentialed by a national body and sponsored by an employer. Here is how those three pieces fit together, in order.

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Overview

To work in the United States as a health professional trained abroad, you need two things that are decided separately: a license from the state where you will work, and immigration status that allows you to work.

Licensing is state by state, so a nurse licensed in Texas is not automatically licensed in New York. National bodies sit in between: they run the licensing exams and evaluate foreign credentials, and the state boards rely on their results.

This page is for doctors, nurses, pharmacists and allied health professionals who qualified outside the US. It gives the big picture; the regulator and profession pages go into the detail. The main national bodies are ECFMG, part of Intealth, for international medical graduates; NCSBN, which develops the NCLEX used by every state board of nursing; NABP for foreign pharmacy graduates; and TruMerit (formerly CGFNS) for credentials evaluation and the VisaScreen certificate.

The route usually runs in this order: credentials evaluation, English test, licensing exams, state license (or eligibility for one), then an employer who sponsors you for a green card or a temporary work visa. For nurses, the most common path is an employer-sponsored immigrant petition in the EB-3 category, where registered nurses are a Schedule A occupation, followed by a wait for a visa number under the State Department's monthly Visa Bulletin. Doctors usually enter residency training first.

What makes the US different is scale and variation. Pay is set by employers, not a national scale, and differs widely by state and setting; the Bureau of Labor Statistics put the median registered nurse wage at $97,550 in May 2025. Rules differ by state, by profession and by visa category, and immigration queues depend on your country of birth. This page describes routes as USCIS and the State Department state them; it is not legal advice, and an immigration attorney should advise on your own case.

Profession guides

The route for your profession in the United States: regulator, exams, fees and pay.

The health system

US health care is delivered mainly by private nonprofit and for-profit hospital systems, physician groups, clinics, long-term care facilities and home health agencies, alongside federal (for example Veterans Affairs), state and county facilities.

Each state, plus the District of Columbia and the territories, licenses health professionals through its own boards: boards of nursing, medical boards, pharmacy boards and allied health boards. Requirements, fees and processing times differ by state.

National organizations support the boards: NCSBN (the NCLEX for nurses), the Federation of State Medical Boards and NBME (the USMLE with ECFMG), NABP (the NAPLEX and MPJE for pharmacists) and profession-specific bodies such as FSBPT for physical therapists, NBCOT for occupational therapists and ASCP for laboratory professionals.

The Nurse Licensure Compact lets nurses whose primary state of residence is a member state hold one multistate license; its website lists 43 jurisdictions. Moving your primary residence to another compact state means applying there within 60 days.

There is no national pay scale. Employers set pay, often by unit, shift and experience, and some unionized hospitals publish pay in their contracts. Federal BLS data give medians by occupation and state.

Employers who sponsor immigrants must meet Department of Labor wage rules: a prevailing wage determination for green card petitions and a labor condition application for H-1B workers.

Hospitals in the United States

Careers, pay and how to apply at hospitals that hire internationally trained staff.

Regulators in the United States

The route, step by step

  1. 1. Choose your profession's route and a target state

    Find the national body and state board for your profession and read their rules for applicants educated abroad. Nurses apply to a state board of nursing; doctors go through ECFMG certification and residency; pharmacists go through NABP's FPGEC certification. Choose a state early, because the board sets the documents, English scores and extra steps you need.

  2. 2. Have your credentials evaluated

    Most boards require an evaluation of your education and licenses by an approved agency, with documents sent directly by your school and regulator. Nurses usually use TruMerit's CES report or another agency the board accepts; pharmacists use Educational Credential Evaluators (ECE) through NABP. Missing or non-direct documents are the main cause of delay.

  3. 3. Prove your English

    Boards and credentialing bodies set their own tests and scores, and immigration has a separate requirement through VisaScreen for nine health occupations. Choose one test and score that meets every requirement you face. Education in the UK, Australia, Canada (except Quebec), New Zealand, Ireland or the US usually exempts you from the VisaScreen test.

  4. 4. Pass the licensing exams

    Nurses sit the NCLEX-RN, which can be taken at Pearson VUE centers in the US and in listed countries such as India, the Philippines and Jordan. International medical graduates take USMLE Step 1 and Step 2 CK for ECFMG certification. Foreign pharmacy graduates take the FPGEE, then the NAPLEX and law exam their state requires.

  5. 5. Get licensed, or become eligible for a license

    The state board issues your license after it receives your exam result and completes its checks, including fingerprint-based background checks. For a nurse green card, USCIS accepts a full license in the state of intended employment, an NCLEX-RN pass or a TruMerit certificate as evidence for the Schedule A petition. Doctors are licensed after residency training under state rules.

  6. 6. Find a sponsoring employer

    Apply to hospitals, health systems and other employers that sponsor foreign workers. For a nurse green card, the employer files Form I-140 with USCIS with a prevailing wage determination and posted notice of filing. Read the contract closely: terms such as length of commitment and repayment if you leave early vary by employer.

  7. 7. Get your VisaScreen certificate

    Under INA 212(a)(5)(C) and 8 CFR 212.15, most foreign health care workers in nine occupations, including RNs, physical and occupational therapists and lab scientists, need a health care worker certificate before a visa is issued. TruMerit's VisaScreen checks your education, all your licenses and English, and for RNs an NCLEX-RN or Qualifying Exam pass. It costs $740 and is valid for five years.

  8. 8. Wait for a visa number and complete the immigrant visa or adjustment

    After the I-140 is approved, your place in line is set by your priority date. The State Department's monthly Visa Bulletin shows when you can move forward, and USCIS says you must use the Final Action Dates chart unless it says otherwise. You then complete consular processing abroad or, if you are already in the US in valid status, adjustment of status.

  9. 9. Arrive, transfer and keep your license

    Once you have your immigrant visa or work visa, you start with your employer, complete onboarding and keep your state license renewed. Working in another state usually means another license, unless you hold a multistate compact license and live in a compact state.

English tests

  • There is no single US English requirement. Each state board and national credentialing body sets its own accepted tests and scores, and immigration has a separate VisaScreen requirement.
  • VisaScreen for registered nurses and other bachelor's-level health care workers (TruMerit, May 12, 2026): IELTS 6.5 overall with 7 speaking; OET 360 speaking, 340 reading, 350 writing, 320 listening; TOEFL iBT 4.5 overall and 4.5 speaking with 3.5 in the other sections; PTE Academic 55 overall with 76 speaking; MET 58 overall with 59 speaking. At-home test versions are not accepted.
  • Physical and occupational therapists need the same VisaScreen scores as RNs; occupations below bachelor's level, such as LPN/VNs, have lower thresholds.
  • State boards of nursing set their own scores. Texas, for example, uses the same figures as VisaScreen for RN applicants whose nursing education was not in English.
  • Pharmacists: NABP requires the TOEFL iBT or OET for Pharmacy before you can be accepted for the FPGEE.
  • Exemption: VisaScreen does not require a test if your entry-level professional education was in the UK, Australia, Canada (except Quebec), New Zealand, Ireland or the US, taught in English with English textbooks.

Visas

  • EB-3 immigrant visa (green card) for nurses

    USCIS describes EB-3 as the third employment-based preference for skilled workers, professionals and other workers. Professional nurses and physical therapists are Schedule A occupations: the Department of Labor has already found there are not enough US workers, so the employer files an uncertified Form ETA-9089 with the Form I-140 at USCIS instead of first getting labor certification. Your spouse and unmarried children under 21 may be able to immigrate with you.

  • Priority dates and the Visa Bulletin

    Your priority date is your place in the queue. The State Department publishes the Visa Bulletin each month with Final Action Dates and Dates for Filing by category and country of birth. When demand is higher than the annual limit, the dates move slowly or go backward, so waits for EB-3 can be long and differ by country; check the current bulletin rather than relying on past estimates.

  • H-1B specialty occupation

    For jobs that normally require at least a bachelor's degree in a specific field. There is an annual cap of 65,000 plus 20,000 for holders of US master's degrees, but institutions of higher education, their affiliated nonprofits and some research organizations are cap-exempt. Stays are up to 3 years, extendable to 6. USCIS says a September 2025 proclamation requires a $100,000 payment with certain new petitions filed after September 21, 2025 for workers outside the US without a current H-1B visa, with rare exceptions. A nursing role qualifies only if the position itself requires the degree.

  • Health care worker certification (VisaScreen)

    Section 212(a)(5)(C) of the Immigration and Nationality Act and 8 CFR 212.15 make most foreign health care workers in nine listed occupations inadmissible unless they present a certificate from an authorized organization. TruMerit's VisaScreen is that certificate for RNs, LPN/VNs, physical and occupational therapists, physician assistants, audiologists, speech-language pathologists and clinical lab technicians and scientists. Some RNs licensed in certain states can use a 212(r) Certified Statement instead.

    Read the guide

  • Doctors: J-1 and H-1B for residency

    International medical graduates entering US residency usually do so on a J-1 exchange visitor visa sponsored by ECFMG or on an H-1B where the training program supports it. Both have their own rules and conditions; check with ECFMG and your program before you match.

  • Not legal advice

    Immigration rules, fees and processing change often, and the right route depends on your profession, country of birth and family. Use USCIS and State Department pages as the source of truth, and ask a licensed immigration attorney about your own case. Employers normally have their own attorneys for the petitions they file.

Pay

There is no national pay scale in the US. These are national median annual wages from the Bureau of Labor Statistics Occupational Outlook Handbook, based on May 2025 data. Half of workers earn more and half less; pay varies widely by state, metro area, setting, shift and experience, and employers set it.

  • Registered nurses

    $97,550

    May 2025. Lowest 10% under $68,940, highest 10% over $137,470. Hospital median $100,220.

  • Licensed practical and vocational nurses

    $64,400

    May 2025.

  • Physicians and surgeons

    $275,930

    May 2025, all specialties. Residents are paid by their training program.

  • Pharmacists

    $140,910

    May 2025.

  • Physical therapists

    $102,760

    May 2025.

  • Occupational therapists

    $100,330

    May 2025.

  • Clinical laboratory technologists and technicians

    $62,930

    May 2025.

Pay for your profession: Doctors · Nurses · Dentists · Pharmacists · Physiotherapists · Occupational therapists

Key terms in the United States

The permits, numbers and bodies you will meet on the way, each explained in plain English.

Questions

No. Each state licenses its own professionals, so you apply to the board in the state where you will work. National bodies run the exams and evaluate credentials, and nurses in compact states can hold a multistate license.

Many foreign nurses come on an employer-sponsored green card in the EB-3 category. Registered nurses are a Schedule A occupation, so the employer files the uncertified labor certification with Form I-140 at USCIS. The wait then depends on the Visa Bulletin for your country of birth.

If you are an RN, LPN/VN, physical or occupational therapist, physician assistant, audiologist, speech-language pathologist or clinical lab professional seeking a US visa for that work, usually yes. Federal law requires a health care worker certificate, and TruMerit's VisaScreen is that certificate. It costs $740.

Only if the specific job is a specialty occupation that normally requires at least a bachelor's degree in nursing. Many staff nurse jobs do not meet that test. The H-1B cap, the cap exemptions for universities and the 2025 $100,000 payment rule also affect whether an employer will use it.

A monthly State Department publication showing which priority dates can move forward in each green card category and country. USCIS says you use the Final Action Dates chart to file adjustment of status unless it announces otherwise.

The BLS median for registered nurses was $97,550 a year in May 2025, with the lowest 10% under $68,940 and the highest 10% over $137,470. Pay depends heavily on state, city and setting.

On an EB-3 green card, USCIS says your spouse and unmarried children under 21 may be eligible to immigrate with you or after you. Temporary visas have their own dependant rules.

One that your state board and VisaScreen both accept at the scores you need. For RNs, IELTS 6.5 overall with 7 in speaking, or OET 360 speaking, 340 reading, 350 writing and 320 listening, meets VisaScreen and the Texas board, for example.

Through ECFMG certification, which includes passing USMLE Step 1 and Step 2 CK, and then a US residency program. USMLE says Step 3 needs ECFMG certification and at least some US postgraduate training.

No. It summarizes what USCIS, the State Department and the credentialing bodies publish. Ask a licensed immigration attorney about your own case.

Sources

Keep exploring

Registering and working in the United States