This is a reflective blog of the past 15 months and the journey I've been on since my husband and I decided to make the move to San Francisco. Some of you might be aware that the requalification process for Physical Therapy in the States is complex and lengthy. For California, it has felt like nearly impossible. As I have struggled to navigate the system and understand what tasks are required to achieve a licence, I have been horribly mislead, lost, discouraged and now, happily redirected onto the right path.

I was not able to find a single person to help me understand this process. My wish is to share with you what I have learnt in the hope that more Australian Physiotherapists may navigate this process more successfully. For other countries - I'm not sure how much this process differs but at least you'll know more about what the States require and expect from your education.

Where do I begin?

I began looking into gaining an American Licence in August 2014 and my initial knowledge was that it might take 9 months. At the time I definitely felt a knee-jerk-reaction to it taking that long. It is currently 15 months and I am still without a licence (some of that though is my choice).

Firstly, the Foreign Credentialing Commission on Physical Therapy (FCCPT) is a great resource for information and a great company to work with. I'm disappointed that I didn't begin working with this company originally and you will save yourself a huge amount of time if you pick them from the start. Before you begin the process you need to understand what the requirements for each state are. I was applying for a licence through the Physical Therapy Board of California. Start by reading the board website for your chosen State.

Step 1: Pick a company to review your credentials & Education.

Of the companies that are accepted by California to review your education and credentials, I originally chose the International Consultants of Delaware. I am not one to put negative feedback on my blog or criticise others but I would have to say not to select this company. My contact person was a ghost who never replied to a single email and was never in the office when I called. Waking up at 2am in the morning on 5 occasions to try get an update on my application - only to be told repeatedly to email 'my representative'. When I explained that he didn't reply there was no additional help.

This year in June I chose to go through the process again. After many months of reading online and speaking with people I started to question if I was accurately informed about my evaluation. This time I chose the FCCPT and they have been absolutely wonderful. Once you register online you are given an account where you can check your progress at any time. Their help desk replied to every email, promptly, with helpful solutions to my questions and they were extremely collaborative in helping me get together all the required paperwork.

Pick the Foreign Credentialing Commission on Physical Therapy to complete your credential evaluation. That is my number 1 recommendation.

Foreign Credentialing Commission on Physical Therapy
124 West Street, South, 3rd Floor
Alexandria, Virginia 22314-2825

Q: Why do you need a credential review?

To determine if your education is the equivalent of the American Physical Therapy Degree, which is structured as a Undergraduate Health Science Degree and a Post Graduate Doctorate of Physical Therapy. As I studied a Bachelor of Physiotherapy there were several issues comparing my degree to the American degree. I required a comprehensive credential evaluation review (type 1 certificate) and my education was compared against Coursework Tool 5. One thing I have come to learn is that if you studied in a similar format to the American model, many of the issues I am facing may not even apply.

Step 2: Gather all the required paperwork for your evaluation.

You will need:

Your current licence to be verified by the Registration Body, which for Australia is the Australian Health Practitioners Regulation Agency. You need the AHPRA to send a Certificate of Registration Status (CoRS) to the FCCPT. They complete a CoRS and this form depending on the agency you chose.
Request the following paperwork from your University to be sent via secure and tracked mail, to the credentialing agency you chose.
1. Official Transcript - which needs to be very detailed and contain the number of hours you completed during Clinics.
2. Course Syllabus.
3. Verification that you completed your degree and full Academic Records.

Q: How long will this take?

To gather all the documents takes around 3 months. The evaluation itself takes an additional 4-6 weeks. Both times it has taken just over four months to get my evaluation back.

If you are successful, you will gain a Certificate of Professional Equivalency.

I was not successful, on either occasion, and will go into further depth about this below. But first let's keep going through the steps.

Step 3: You need a Proof of English Proficiency

This means, for California and many other States, you need to prove that English is your first language and to do this, you need to sit the TOEFL test. The Test of English as a First Language is a 4-5 hour test, which is surprisingly hard. Once you complete the test, you nominate the FCCPT or Board of California as your contact person and get the results sent to them. Your test score has to be from the past 2 years to count towards the application.

Step 4: Get a VISA

The reason we moved to San Francisco is for my husband's job and therefore my visa is a spousal-visa. So I can't offer any advice on Visas.... sorry.

Step 5: Authorisation for employment.

Once you move to the States you submit a I-94, which is an Authorisation for Employment application. This takes 3 months to get back (nothing less) and once you have it you are allowed to be employed. You will require this to get a Social Security Number. You have to be in America for this to be processed which means there is no way you can work within the first 3 months of moving.

Step 6: get a Social Security Number

Which can only occur once you are in the States, with an active visa and a completed 1-94 form. In the mean time you can still complete the requalification process but you will need an alternative identification number. To do this you need a Notary to verify your identification and register it with the US. Its like a SSN for your application and only that.

Step 7: Apply to sit the National Physical Therapy Exam

Everyone sits the NPTE and some States require a jurisprudence exam. For California you require both. Check with the specific state what is required. DO NOT GO THROUGH THIS PROCESS UNTIL YOU HAVE YOUR CERTIFICATE OF PROFESSIONAL EQUIVALENCY. I thought I could save time by starting this process early and without a certificate you will not qualify for the Authorisation to Test Letter.

Follow the step-by-step registration process below:

Find out what your jurisdiction requires.
Complete a State Application form - for this you need a SSN or AIN.
Register and pay for the Exam.
Obtain jurisdiction approval - known as an Authorisation to Test Letter (ATT). The ATT letter is sent when the licensing authority to which you are applying has notified us that you are eligible to sit for the exam.
To register for the exam first have to apply to Prometric.
Sit the Jurisprudence Exam
Sit the NPTE (which takes several months to study for).
After taking the exam it will be scored and the results send to the board within 5 business days. A copy of the results are sent to you within 10 business days. To pass you need >600/800 which will be standardised and processed into a pass/fail score.
The Course Manual and more information can be found here.

Step 8: Apply for a licence

Apply for a licence with Board of Physical Therapy California.
You also have to complete a Foreign Physical Therapist Application Fee Form

What happens if you don't get a certificate of professional equivalency?

As you can see from the stages above, if everything goes perfectly, you are looking easily at 9-12 months before you gain a license. If, like me, you don't get a certificate of professional equivalency, you need to choose whether you want to make up the educational deficiencies.

When I had my review completed by the ICD my score was 151. The minimum education requirements is 150 credit points, of which 60 are general education and 90 profession specific. As I mentioned, I made the cut off but had 90 points for Physio education and only 11 for science. This is due to the structure of my undergraduate degree. Despite being very educated in the subjects that relate to my profession, I was deficient in 49 points of science. When I approached the ICD about this, I was informed that I needed to make up 49 credit units before they would consider a re-evaluation. That is almost a 2-year full-time health science degree.

I weighed up the time and cost of full time science and decided not to pursue my licence. I was devastated to say the least. First you get over the idea that it takes a long time, lots of money and a huge amount of effort to get a licence. Then you are asked to study for a Physiotherapy exam and prove you speak English with a seperate exam. At all of these stages I thought 'seriously?' Then I found the strength and motivation to move forward. When I got the result from the ICD asking for 49 units, it broke my strength. I decided there were many things I could do with that time. I kept thinking "2 years of studying something I don't need only to land up in exactly the same place up am today". For me, it wasn't something I saw myself pursuing.

Then I wondered if it would be different with a different company? So I chose the FCCPT and began again. November 10th 2015, exactly 15 months after I first applied to the ICD, I got my second evaluation back. The result was the same. So disappointing.

This time however, the FCCPT offer a PLAN service which gives you access to a Physical Therapist who will review your evaluation, decide what deficiencies you need to make up, and direct you towards recognised institutions to make up these deficiencies. Seriously, I was over-joyed. I'd been trying to work this out for months and finally found someone who can help.

The 'PLAN' service through the FCCPT.

The were so prompt and helpful in answering all my questions and guiding me through the process. What a relief to have the answers about what I need to do. Essentially I don't need 49 credit units but I do need the following. One course in:

Chemistry with lab work
Biology
Mathematics
English Language
Basic lift support or Advanced Cardiopulmonary Care
Metabolic Disorders
Integumentary System
Screening and Delegation.

This seems achievable. I can complete the science subjects, except Chemistry, through CLEP exams. CLEP exams are essentially where you study independently and sit the exam to prove you know the material and gain credit points. The University of Phoenix will help me with my semester of Chemistry and CLEP exams and I will be studying the Physical Therapy Subjects through the University of St. Augustine in Florida (hopefully).

I have only just decided to go back to University and continue through this process and I am still waiting for confirmation that my application for enrolment has been accepted. All these subjects will take several months to complete and after that I can apply for a re-evaluation. Then if I get my certificate of professional equivalency, all the other steps are complete and I apply to sit the NPTE and Jurisprudence exam. Then, if I pass, I will apply for a licence. Realistically this will take almost a year.

If I had known to go with the FCCPT and known about the PLAN service they offer, I would probably be working already.

It was much easier to convert my sister's dog Chino to being a San Francisco giants fan :)

For the past year I have focussed heavily on developing this blog, which has continued to develop my knowledge as well as teach many others. I have continued to teach Clinical Pilates, studied 2 fantastic courses online through Coursera, recovered from a chronic hip injury and travelled. I'm very grateful for the experiences this year has given me.

I'm excited to see what I learn and hope things are a bit more smooth sailing from here. One thing that has been reinforced throughout this time is that I really love being a Physiotherapist and I'm not ready to walk away from my career or loose my skills.

Hopefully now, many other Physiotherapists will find this process easier to navigate and be more successful than I was. Looking back through this blog, the process doesn't seem so complicated but believe me, it has taken 15 months for me to learn about and endless scouring for information on the web. If you have any additional knowledge of recommendations please comment below so others might learn more.

With fingers crossed,
Sian