1. HOW THE PROFESSION IS ORGANIZED IN CALIFORNIA OVERVIEW
This guide looks at what you as a foreign-educated physical therapist must do to become eligible for licensing in California. At the same time, it includes some background and tips on the larger physical therapy profession to give you an idea of the variety of opportunities available as you work to build your career.
REGULATION OF THE PHYSICAL THERAPY PROFESSION
The practice of physical therapy in California is regulated by the Department of Consumer Affairs and its Physical Therapy Board of California (PTBC). You must be licensed to practice as a physical therapist (PT) in California.
The guide assumes that you hold the equivalent of a U.S. degree in physical therapy and that your California license will be your first U.S. physical therapist license. As a foreign-educated PT, you are required to first have your physical therapy education evaluated by the Foreign Credentialing Commission on Physical Therapy (FCCPT). The FCCPT uses a course-work tool that is based on the year you graduated to determine if your degree was equivalent to a U.S. physical therapist degree. The FCCPT also verifies that you have passed the Test of English as a Foreign Language (TOEFL) examination.
You will become a Physical Therapist through Licensure by Examination. The Federation of State Boards of Physical Therapy (FSBPT) administers the National Physical Therapy Examination (NPTE), which is required to become licensed as a PT in California. There is also a California Law Exam covering the physical therapy laws and rules for licensure in California. Once you have passed the NPTE, foreign-trained PTs are required to complete a nine-month clinical practice period under the supervision of a California Board-licensed PT.
The Job Market for Physical therapists
Physical Therapy is a growing field in the U.S. and the job outlook is excellent. The PT profession is projected to experience faster growth, through 2020, than other occupations requiring at least a master’s degree. In 2010, PTs held about 199,000 jobs in the U.S. Most PTs worked full-time, but about 25% held part-time positions. The Bureau of Labor Statistics reports that the majority of PTs are employed in the offices of other health practitioners or in hospitals. Home health care agencies, outpatient care facilities, and nursing and residential care homes also employ many PTs. In 2011 the median annual salary for PTs was $78,270.
THE JOB SEARCH
Qualified PTs are in high demand and employers will compete for their skills. The American Academy of Physical Medicine and Rehabilitation forecasts that the demand for PT services will outpace the supply of PTs in all 50 states through 2030. Bilingual and bicultural PTs can be even more attractive to employers who serve diverse communities. Because of this demand, even part-time employment can include attractive benefits such as health insurance, childcare, and tuition fees for continued education.
2. ELIGIBILITY FOR LICENSING
Internationally educated Physical Therapists need to meet several requirements to receive Licensure by Examination as a PT in California.
I. EVALUATE YOUR FOREIGN DEGREE AND FOREIGN LICENSE WITH FCCPT
The Physical Therapy Board of California requires that you have your foreign physical therapy degree evaluated using the FCCPT Coursework Evaluation Tool (CWT) that was in effect on the date you received your physical therapy degree.
The FCCPT instructs you on the steps necessary to evaluate your foreign degree and licensure. These include:
- Apply and pay online for the Educational Credentials Review Service
- Make sure that you ask for your report to be prepared for the Physical Therapy Board of California as this will make your record available to the State electronically
- Send academic and licensing request forms from the FCCPT application to the appropriate educational or licensing institutions
- Submit a notarized attestation page from the FCCPT application with a photo to FCCPT
- Provide translations for any documents received by FCCPT that are not in English. FCCPT requires that you contact a certified translator who will then send a notarized copy of the documents directly to FCCPT
- If your physical therapy education was not taught in English, your FCCPT report will include a determination of English language proficiency as tested on the TOEFL examination.
If your degree is not deemed equivalent to a U.S. degree, you will be provided information about the courses or subject areas in which you are deficient. If the Educational Credentials Review results in your education being found “not equivalent”, you may apply to FCCPT for a re-evaluation of your educational credentials after submitting additional information about your education. You must work directly with FCCPT in correcting any deficiencies in your report; the Physical Therapy Board of California has no role in the re-evaluation process or in counseling you in how to meet your education deficiency.
There are three additional companies who can use the CWT to evaluate your education. The FCCPT procedures are outlined here as they are representative of the credential evaluation process and FCCPT is the entity that developed the CWT. The other companies that may be used for evaluations in the state of California are International Consultants of Delaware, Inc (ICD), International Education Research Foundation (IERF), International Credential Associates, Inc. (ICA).
II. GET FINGERPRINTED VIA A CALIFORNIA-APPROVED VENDOR FOR A CRIMINAL RECORD CHECK
If you live in California you must do a LiveScan digital fingerprint process. If you cannot come to California, you can prepare an ink card and pay an additional $49 processing fee. Do not prepare your fingerprint card until your application is ready, since PTBC will only hold the prints for 60 days.
III. SUBMIT YOUR LICENSURE APPLICATION, REQUIRED SUPPORTING DOCUMENTS, AND PAY APPLICATION FEE
Your application to the Physical Therapy Board of California should include:
- Licensure application from PTBC that can be downloaded from http://www.ptbc.ca.gov/forms/ftp_app.pdf
- Fee: $200 processing fee by a check or money order from a a U.S. financial institution payable to the PTBC
Other documentation that must be received to complete your license application and be made eligible to take the NPTE exam:
- Credential review in a sealed envelope from your chosen evaluator
- Fingerprint/Criminal Background Check report
IV. PASS THE NPTE
There are a few steps to passing NPTE:
- Register online with FSBPT for the NPTE: there are fixed examination dates for the NPTE that include strict deadlines for registration. As of 2013, the NPTE costs $370.
- Receive an Authorization to Test (ATT) from FSBPT: the ATT letter that will include instructions about how to schedule your exam at a Prometric testing site. You must sit for the examination on the date indicated in the ATT letter. There is a $70.60 scheduling fee that is paid to Prometric when you schedule your exam.
- Take and pass the National Physical Therapy Examination (NPTE) and receive a passage letter. Your NPTE scores should be available to PTBC within a week after testing.
IV. COMPLETE NINE-MONTH SUPERVISED CLINICAL PLACEMENT
You will receive detailed information on your clinical service requirements when you get the notice that you have passed the NPTE. There are multiple requirements about both the type of setting in which you must have your nine months of service, and about the areas of practice that will be evaluated by your supervisor, who must be a California-licensed Physical Therapist.
You will need to find your own placement and have it approved before starting. You will then be considered a Physical Therapist License Applicant or PTLA. More information is available online and in the Important Links section.
To become a licensed PT in California, you must pass both the California Law and NPTE examinations.
CALIFORNIA LAW EXAM
The California Law Exam is an hour-long multiple choice exam that covers the contents of the Physical Therapy Practice Act, Physical Therapy Regulations, and statutes outside the Physical Therapy Practice Act.
Study links are available in the Important Links section.
NATIONAL PHYSICAL THERAPY EXAMINATION (NPTE)
The National Physical Therapy Examination (NPTE) is a computer-based test that is designed to assess the basic entry-level competence of a physical therapist. This examination is required for licensure in every state in the U.S. You cannot bring reference materials or other testing aids to the exam.
NPTE CONTENT AREAS
The content of the NPTE focuses on the clinical application of knowledge, concepts, and principles necessary for the provision of safe and effective patient care. The current NPTE exam (January 2013 edition) is divided into five domains, some of which have subcategories. The percentages show the approximate percent of questions each test taker will receive in the category:
- Physical Therapy Examination (26.5%)
- Foundations for Evaluation, Differential Diagnosis, and Prognosis (32.5%)
- Interventions (28.5%)
- Non-System Domains (12.5%)
- Equipment & Devices; Therapeutic Modalities (6%)
- Safety & Protection; Professional Responsibilities; Research (6.5%)
NPTE SCHEDULING AND TESTING SITE PROCEDURES
Prometric administers the NPTE in testing centers across the U.S. You can register with Prometric, but you cannot schedule the exam until your California application has been processed and you have received an Authorization to Test (ATT) notice. The ATT includes detailed instructions for choosing a testing center and scheduling a date to take the NPTE.
On the day of the test, you must bring the ATT and two forms of acceptable identification. Acceptable ID is a currently valid, government-issued photo ID (passport, driver’s license, etc.), and another piece of identification pre-printed with your name and containing your signature. You will be fingerprinted, scanned with a metal detector wand, and photographed before your test and will be fingerprinted when you re-enter the testing area after breaks. You should arrive at least a half hour early; you will not be allowed to take the test if you arrive more than fifteen minutes late for your appointment. You will have up to 5 hours to complete the test, including time scheduled for optional breaks.
FAILING THE NPTE
If you fail the NPTE, you will be provided with a Score Report which shows the areas that need improvement. You can use the report to learn what areas to study before you retake the exam. You must register to retake the examination with FSBPT. You are allowed to take the examination no more than three times in any 12-month period.
PRACTICING FOR THE NPTE
There are many different resources that can help you prepare for the content and the computer-based testing technology. There are a variety of test preparation resources available for low cost. FSBPT offers a Practice Review Tool and a practice examination (PEAT) that are both available through their website for a fee. Consider investing in test preparation as it may save you money by not having to pay to retake the test and by entering the job market faster.
4. TIME AND COSTS
Evaluating your foreign degree and achieving licensure as a Physical Therapist in California depends on many factors. A few of these include:
- The completeness of your educational and professional records (the more documentation, the better)
- The efficiency of your home country’s system in compiling and transmitting your university records and verification of licensing
- Your performance on the National Physical Therapy Examination (NPTE)
- Your free time and how much money you have to spend
We provide two hypothetical scenarios below to show some of the variety in results that immigrant professionals may find when they seek to become registered as a physical therapist in California. Please consider these scenarios as two examples out of many possibilities. Your experience will vary.
Two Hypothetical Scenarios for Licensing as a Physical Therapist:
|Step||More Efficient Scenario|
Approximate Time and Cost
|Less Efficient Scenario|
Approximate Time and Cost
|1 Degree Evaluation||It takes you just 3 months to get your home country documents to a credentialing organization to complete your degree evaluation|
No translation is needed
3 months + $490
|Problems with your documents take 6 months to resolve and are expensive since you must pay others in your country to visit institutions for you|
Your documents must be translated
8 months + $1,100
|2 Fingerprints||You get a Live Scan fingerprint service|
1 month + $49
|You get a Live Scan fingerprint service|
1 month + $49
|3 Submit Licensure Application to Board||You assemble your licensing application packet relatively quickly|
6 months + $200
|Your licensing application is incomplete the first time and you must resubmit it|
9 months + $200
|4 NPTE||You register with Prometric for the NPTE right after receiving the Authorization to Test ($70.60 + $370)|
You begin a self-study course for the NPTE for $300
Your skills are fresh and you've been using a self-study program throughout the process; you pass the NPTE on the first try. Your license is received 3 months after you take the exam
5 months + $740.60
|You register with Prometric for the NPTE right after receiving the Authorization to Test ($70.60 + $370)|
It takes you 2 tries to pass the NPTE. In between tests, you enroll in a 4-month NPTE preparation class for $1,000. Your license is received 3 months after you take the second exam
8 months + $440.60
|5 Clinical Service||You find a clinical service site and receive approval in 2 months|
You complete your service in 9 months
|You have difficulty finding an acceptable placement. You receive approval after 6 months|
You complete your service in 9 months
|More Efficient Total|
About 2 1/2 years and $1,500
|Less Efficient Total|
About 3 1/4 years and $3,200
5. OTHER CAREERS AND CREDENTIALS
You may want to consider if taking a lower-level job in healthcare in the short-term can help you meet longer-term goals of licensing as a physical therapist.
- Preparing for the National Physical Therapy Examination (NPTE) can take time. Working in healthcare in a different way and with fewer responsibilities may offer you some advantages, such as:
- Employers paying for tuition and fees associated with the NPTE and licensing
- More energy to focus on studying
A chance to adapt to the U.S. healthcare system and workplace culture in a lower-pressure environment
You should be honest with your employer about your long-term plans and be sure that they have benefits such as tuition reimbursement or schedule flexibility that will support your goals.
PHYSICAL THERAPY ASSISTANT
There is a separate Physical Therapy Assistant (PTA) license that is required to work in California. This license also requires a credential review from FCCPT and passing the NPTE examination for PTAs. Foreign-trained PTs rarely have the required coursework to become a licensed PTA in California; instead they need to enroll in a local program.
PHYSICAL THERAPY AIDE/TECH
A physical therapy aide or tech can perform some general duties at a site providing physical therapy services. A physical therapy aide or tech cannot provide physical therapy services to a client and would work under the supervision of a licensed PT. A physical therapy aide or tech typically earns about $22,000 a year if working full time.
CERTIFIED NURSING ASSISTANT, CNA
CNAs are also commonly referred to as nurses’ aides or orderlies. CNAs have very limited responsibilities and work under nurse supervision. Additionally, you must complete a relatively short training program, pass a test and undergo a criminal background check before working as a CNA. Working as a CNA in the healthcare field will provide you with an opportunity to build a professional network, gain U.S. experience that is highly relevant to your profession, and possibly receive tuition reimbursement for relicensing purposes. CNAs typically earn approximately $12 per hour.
If you are bilingual and a strong communicator, you may want to research opportunities for work in hospitals as an interpreter. This type of role is not regulated in California, so standards for employment as well as pay and benefits may be very different depending on the employer. You are more likely to have benefits such as tuition reimbursement if you find work as a direct employee of a healthcare facility, instead of working for a company that provides interpretation services to hospitals. You may want to begin your research by directly contacting human resource departments at hospitals.
6. BEYOND LICENSING
Physical Therapists must renew their license every 2 years. Your license will expire the last day of your birth month. The Board sends a notice reminding you to renew your license, so be certain to keep your contact information up-to-date with their office. You are responsible for renewing your license even if you do not receive a notice from the Board. You must renew online. The cost to renew on time is $200. If more than 30 days have passed since your license expired, there is a $100 delinquency fee. Be careful: if you continue to practice after your license has expired (lapsed), you could have disciplinary action taken against you. If your license is expired over 5 years you will be required to apply for relicensure to reactivate your license.
There are continuing education requirements for all California-licensed Physical Therapists. The requirements are different depending on how new you are to the profession and whether you complete the hours before or after your license needs renewal. Information is available in the Important Links section.
JOINING A PROFESSIONAL ASSOCIATION
State and national associations for physical therapists provide opportunities for professional development and networking. They also help set acceptable working conditions for physical therapists, and give information and opinions on policy in California and across the U.S. Their websites may offer useful information to physical therapy candidates about the licensing and examination process, including test preparation. They often provide Continuing Education to members as well.
- California Physical Therapy Association
- American Physical Therapy Association
LICENSING MOBILITY (RECIPROCITY)
The state of California does not have any shared agreement to honor the physical therapist licenses of other states. It grants licensing to physical therapists by either examination (the process described in this topic) or endorsement (where a physical therapist licensed in another state must meet all California requirements for licensing). Fortunately, since the National Physical Therapy Examination (NPTE) is accepted by all states, a physical therapist looking to relocate to California will not have to retake the NPTE.
7. IMPORTANT LINKS
- The Department of Consumer Affairs’ Physical Therapy Board of California issues licenses for Physical Therapists. Application packets (both by Examination and by Endorsement) can be downloaded on the homepage.
- Contact information for the Physical Therapy Board of California: 2005 Evergreen Street, Suite 1350, Sacramento, CA 95815; Phone: 916-561-8200; Fax: 916-263-2560
- The landing page for physical therapy licensing is http://www.ptb.ca.gov and it includes information regarding the boards, applications and frequently asked questions
- The law that regulates licensing for physical therapy can be read here
- Nine-month clinical practice information http://www.ptbc.ca.gov/applicants/clinical_service.shtml
- Continuing Competency requirements http://www.ptbc.ca.gov/licensees/cont_comp.shtml
- NPTE Exam Application – Federation of State Boards of Physical Therapy www.fsbpt.net/pt
- NPTE Exam Information www.fsbpt.org
- Prometric administers the National Physical Therapy Examination (NPTE) www.prometric.com
- California Law Exam study links http://www.ptbc.ca.gov/applicants/exam_reg_info.shtml
CREDENTIAL REVIEW AGENCIES
- Foreign Credentialing Commission on Physical Therapy (FPT) www.fccpt.org
- International Consultants of Delaware, Inc, (ICD) www.icdel.com
- International Education Research Foundation, Inc, www.ierf.org
- International Credentialing Associates, Inc. (ICA) www.icaworld.com/applications.html
- The Federation of State Boards of Physical Therapy (FSBPT) represents member Physical Therapy Boards for all 50 states. It develops the National Physical Therapy Examination (NPTE). www.fsbpt.org
- The American Physical Therapy Association (APTA) is a national organization that represents physical therapists and advocates for physical therapy issues. www.apta.org
PROVIDE COMPLETE DOCUMENTS
Physical Therapy foreign degree evaluation services require that your university and licensing authority send transcripts directly to them. Invest the time and money early to facilitate this process. Providing additional documentation about your program of study, such as syllabi or course descriptions, can make the most of your degree evaluation. Making an effort here can result in significant savings of time and money by minimizing the gaps in comparing your degree to its U.S. equivalent.
GET YOUR QUESTIONS ANSWERED
Be your own advocate throughout the licensing process. Seek clarification about questions and concerns directly from official sources. If you feel your degree has been misinterpreted or you do not understand a fine point about testing or state regulations, organize your questions and then contact FCCPT, Prometric, or the Physical Therapy Board of California and ask for assistance.
INVEST IN TEST PREPARATION
If you can afford it, invest some money in test preparation. There are online and in-person formats available, including a moderately priced Practice Review Tool by the makers of the National Physical Therapy Examination (NPTE). Investing money wisely now to make your licensing process a success will get you into a job that pays well that much faster! You should feel prepared to take the NPTE by the time your licensing by examination application is ready to submit because the events that follow are sensitive to deadlines and you will lose money if you delay.
BE FLEXIBLE IN YOUR JOB SEARCH
Build professional networks; consider employment in healthcare at a lower level, to give you a lower-stress job that allows you to study for licensing and open opportunities to meet employers. If you are overqualified for positions you are applying for, explain how your plans can bring long-term value to the employer.