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Professionals who move to the United States almost always run into the same question: does a degree obtained abroad automatically hold valid on American soil? The short answer is no. Unlike other national systems where a diploma from an accredited institution authorizes the professional to practice throughout the country, in the U.S. the practice of most professions is regulated by state boards and, in some categories, by national organizations. Each profession has its own path, specific exams, fees, and timelines that can range from months to several years.
This guide details the complete process — from initial academic evaluation to final licensure — with updated figures and requirements for 2026, covering the main fields in which foreign professionals seek recognition in the U.S.
Step 1: Credential Evaluation
The first step is submitting your transcripts and diplomas to a credential evaluation, a process that translates and converts your academic background into U.S. standards. The evaluation produces a report indicating the U.S. equivalent of your degree (associate, bachelor’s, master’s, or doctorate) and, in some cases, provides a course-by-course evaluation required by boards and universities.
The most widely accepted agencies are members of NACES (National Association of Credential Evaluation Services) or AICE. Among the most commonly used:
- WES (World Education Services) — the reference for immigration, corporate HR, and admissions. Full course-by-course evaluations cost, in 2026, approximately US$ 200 to US$ 250, with an average turnaround of 7 to 20 business days after document receipt.
- ECE (Educational Credential Evaluators) — widely used by academic programs and engineering boards. Fees similar to WES.
- Josef Silny & Associates — a traditional choice for evaluations in medicine, law, and higher education.
For health professions, there are specialized agencies: the ECFMG evaluates physicians trained outside the U.S., and CGFNS International verifies credentials for nurses and other healthcare professionals — a nearly universal requirement for state licensing.
Step 2: Licensing by Field
Once the evaluation is complete, the most critical — and most variable — stage begins: professional licensing. Each field has its own path.
Medicine
Physicians trained outside the U.S. (IMGs) must obtain ECFMG certification, which requires passing the USMLE Step 1, Step 2 CK, and Step 3. In 2026, each step costs approximately US$ 1,045 (international fee for Step 1 and Step 2 CK). After ECFMG certification, candidates must complete a U.S. medical residency through the Match (NRMP), regardless of how many years they practiced in their home country. Residency lasts between 3 and 7 years depending on the specialty. Only after completing residency can a physician apply for a license from a state medical board and fully practice.
Nursing
Nurses must obtain a CGFNS evaluation, demonstrate English proficiency (TOEFL or IELTS, depending on the state), and pass the NCLEX-RN. The NCLEX registration fee is US$ 200, and state board of nursing registration typically adds between US$ 100 and US$ 300. Some states require the CGFNS Qualifying Exam before the NCLEX.
Engineering
The traditional path to becoming a Professional Engineer (PE) involves two NCEES exams: the FE (Fundamentals of Engineering), with a fee of US$ 175 in 2026, typically taken shortly after graduation, and the PE Exam, with a fee starting at US$ 375, taken after four years of supervised experience. PE registration is done through the state engineering board where the professional intends to practice and authorizes signing off on projects. While PE licensure is not required for many private-sector positions, it is mandatory for public works, consulting, and stamp-required activities.
Architecture
Architects go through NCARB, which evaluates credentials via the Education Evaluation Services for Architects (EESA). Candidates must complete the AXP (Architectural Experience Program) and pass the ARE 5.0, which consists of six divisions. Each division costs US$ 235 in 2026, and the NCARB annual fee is US$ 100.
Law
Foreign-trained attorneys must pass the Bar Exam in the state where they wish to practice. Many states require an LL.M. (Master of Laws) from an ABA-accredited law school before allowing candidates to sit for the exam. New York and California are the most common destinations because both permit registration with an LL.M. or through a case-by-case evaluation of foreign legal education. Thirty-nine jurisdictions have already adopted the NextGen Bar Exam or UBE; fees range from US$ 250 to US$ 1,500 depending on the state, in addition to Character and Fitness, MPRE, and administrative fees.
Education
Foreign teachers must demonstrate equivalent academic credentials, pass a background check, and in many states take the Praxis (teacher competency tests). States such as Florida, Texas, and California have specific pathways for foreign-trained teachers, often requiring supplemental coursework in American education.
Dentistry, Physical Therapy, and Pharmacy
Dentists generally must complete a DDS/DMD advanced standing program of 2–3 years at a CODA-accredited U.S. institution, in addition to passing the INBDE Parts I and II. Physical therapists must submit credentials to the FCCPT, pass the NPTE, and meet state board requirements. Pharmacists go through the FPGEC process, then take the NAPLEX and MPJE.
Step 3: English Proficiency
Virtually all boards require proof of English proficiency. The most widely accepted tests are TOEFL iBT (fee: US$ 200–300) and IELTS Academic. In healthcare fields, the OET (Occupational English Test), which uses medical terminology, is also accepted by many state nursing boards and is increasingly recognized for medical licensing.
In technical exams, professional vocabulary matters as much as general fluency: legal terminology on the Bar Exam, clinical terminology on the USMLE, and engineering terminology on the FE/PE. Specialized preparation courses may prove more effective than generic English-language programs.
Step 4: Supervised Practical Experience
Several boards require locally obtained practical experience before issuing a full license. Physicians complete residency; engineers need four years of supervised practice under a licensed PE; architects complete the AXP; teachers do student teaching; nurses may need hospital residency transition programs. This period must be planned both financially and in terms of immigration status, as many of these positions pay less than what the professional earned in their home country.
Alternative Path: Entrepreneurship
For professionals whose credential validation process is especially lengthy or costly, launching a business in their area of expertise — without performing acts reserved exclusively for licensed practitioners — is a legitimate alternative. Physicians can operate non-invasive aesthetic clinics by hiring licensed professionals; foreign attorneys can found international law consulting firms without signing U.S. legal pleadings; architects can work as interior designers or project consultants under the technical supervision of a licensed architect.
This route pairs well with investment and entrepreneurship visas, such as the EB-5, the E-2 (available to nationals of treaty countries, which does not currently include Brazil for this category), the L-1A for executives, and the O-1 for professionals with demonstrated extraordinary ability.
Financial and Timeline Planning
The total cost of credential validation varies widely by field. A nurse can reach licensure with an investment of US$ 1,500 to US$ 3,000 and a timeline of 6 to 12 months. An engineer may spend between US$ 1,000 and US$ 2,500 in fees and complete the full cycle in 4 to 6 years including supervised experience. A physician — factoring in ECFMG, USMLE, residency application fees (ERAS), interviews, and relocation — typically invests between US$ 15,000 and US$ 30,000 over 3 to 5 years before even starting residency. Attorneys pursuing an LL.M. at a top law school may spend US$ 60,000 to US$ 90,000 in tuition alone, not counting Bar-related costs.
Before packing your bags, it is worth building a realistic spreadsheet covering all these costs and timelines, aligned with your immigration visa schedule. Professional recognition and immigration status are parallel processes that must be synchronized — one without the other does not allow you to legally work in a regulated profession.
Victoria Harper
Editor-in-Chief
Leading journalism and editorial content at Visto n’ Visa, Victoria helps make immigration topics clear, trustworthy, and easy to understand. Her focus is on delivering useful, human, and relevant content for people exploring new paths abroad.
