English Language Proficiency Testing

Generally as part of licensing requirements and as part of the Visa Screen every foreign national must meet certain English language requirements unless otherwise exempted. English language Proficiency testing is in transition. The ETS (Educational Testing Service) has introduced a new program known as TOEFL iBT® (Internet-based Test of English as a Foreign Language™). This examination measures all four major English language skills, which include listening, reading, speaking, and writing.

Educational Testing Service first introduced the new TOEFL iBT® in phases began in 2005 in the United States and its Territories, Canada, Germany, Italy, and France. In the second phase that began on March 25, 2006, the selected cities in Africa, the Americas, Eurasia, Europe, the Middle East, and North Africa offered TOEFL iBT for the first time. Gradually, this examination will replace the TOEFL, TWE and TSE examinations in the US and other nations. To obtain a list of test locations and dates click here: (TOEFL iBT test locations)

Most licensing and visa screen requirements will continue to accept scores for TOEFL, TSE, and TWE, as well as for the new Internet-based TOEFL iBT examination. 

TOEFL, TSE and TWE:

Test of English as a Foreign Language (TOEFL) is a general test used to measure the proficiency in English for people for whom English is not their native language. The test is offered in a variety of formats depending on the location of a test taker. TOEFL is generally of Paper-based Test (PBT) and Computer-based Test (CBT), which are divided into four sections. Each section evaluates the applicant’s ability to do the following; Speaking, Listening, Reading, and Structure. 

Test of Spoken English (TSE) is the most commonly used test for assessing nonnative English speakers' proficiency in speaking English language.

Test of Written English (TWE) is a subtest of the TOEFL and measures writing ability. In general, TOEFL and TWE are currently administered together.

There are certain aliens who may be exempt from the English language proficiency testing if they meet the following criteria:

• Native language is English;
• Country of healthcare education was Canada (excluding Quebec), Australia, Ireland, New Zealand or the United Kingdom;
• Language of instruction was English; and
• Language of textbooks was English.

According to the USCIS site in April 2006, the following testing services are still approved:
1. Educational Testing Service (ETS)
2. Test of English in International Communication (TOEIC)
3. International English Language Testing System (IELTS)

What are the Acceptable English Language Test Scores for Healthcare Worker Certification:
The law vests the Secretary of Health and Human Services with the sole discretion to decide the minimum scores required for a Healthcare Worker Certification.

1. Occupational and physical therapists: A foreign national planning to work in the United States as an occupational or physical therapist must obtain the following scores on the English tests:  

ETS: Test Of English as a Foreign Language (TOEFL): Paper-Based 560, Computer-Based 220; Test of Written English (TWE): 4.5; Test of Spoken English (TSE): 50.

Note: The certifying organizations shall not accept the results of the TOEIC, or the IELTS for the jobs of occupational therapy or physical therapy.

2. Registered nurses (RNs) and other healthcare workers requiring the attainment of a baccalaureate degree: A foreign national planning to work in the United States as a registered nurse (other than a nurse presenting a certified statement under section 212(r) of the Act) or as a healthcare professional requiring the attainment of a baccalaureate degree (other than occupational or physical therapy) must obtain one of the following combinations of scores to obtain a certificate: 

ETS: TOEFL: Paper-Based 540, Computer-Based 207; Test of Written English (TWE): 4.0; Test of Spoken English (TSE): 50;
TOEIC Service International: TOEIC: 725; plus TWE: 4.0 and TSE: 50; or
IELTS: 6.5 overall with a spoken band score of 7.0. This would require the Academic module.

3. Occupations requiring less than a baccalaureate degree: A foreign national seeking to perform labor in the United States in a health care occupation that does not need a baccalaureate degree must obtain one of the following combinations of scores to obtain a certificate: