For International Medical Graduates (IMGs), pursuing a career in the United States or Canada involves not only meeting medical licensing and immigration requirements but also proving strong English communication skills. One of the most important steps is to learn how to navigate the English proficiency exam with confidence since the visa process for international medical graduates often includes demonstrating English fluency. To do this, candidates must take an English proficiency test recognized by U.S. or Canadian authorities and medical boards.

Required English proficiency tests

When applying for U.S. medical training or licensure, IMGs are typically required to prove their ability to communicate clearly in English. In the U.S., the Occupational English Test (OET) and the TOEFL iBT are the two most common exams recognized for this purpose. 

For Canada, the tests are known as the Canadian English Language Proficiency Index Program (CELPIP) and the International English Language Testing System (IELTS).  The CELPIP assesses listening, reading, writing and speaking skills in Canadian English while the IELTS (which is more commonly required for IMGs) evaluates English proficiency in both British and American English.

How long do the tests take?

The OET Medicine exam lasts about three hours, divided into listening, reading, writing and speaking sections tailored specifically to healthcare scenarios. TOEFL iBT takes just under three hours as well with similar sections but less medical-specific content. Both tests are designed to evaluate whether IMGs can handle real-world medical conversations and written documentation in English.

The Canadian IELTS test typically takes about two hours to complete. For international physicians, the American OET is generally considered harder than Canada’s IELTS. The OET is specifically designed for healthcare professionals, focusing on language skills relevant to their field. In contrast, the IELTS is more general. Even so, the IELTS may require more extensive vocabulary and preparation.

Where can IMGs take the exams?

English proficiency exams are available worldwide. The OET is offered in test centers across multiple countries and, in some cases, via a secure online format. TOEFL iBT and IELTS can be taken at thousands of authorized testing sites globally. There may also be online home editions available.

At what stage in the visa process do IMGs take the English proficiency test?

Most IMGs take their English exam before or during the early stages of the visa application. For physicians applying for U.S. visas through the Educational Commission for Foreign Medical Graduates (ECFMG), passing an English proficiency test is required before certification can be issued. Because ECFMG certification is needed to apply for U.S. residency programs and visas like the J-1, completing the test early ensures there are no delays in the immigration process.

The OET and IELTS are both valid for two calendar years from the date of the test. Specifically, the OET expires on January 1 of the second year after the test date. Therefore, if you take the OET in December 2025, it will be valid until January 2027.

IELTS has a full two-year cycle. If you take the IELTS on December 12, 2025, it will be valid until December 12, 2027. After this period, the certificate will no longer be accepted for most academic, work and immigration purposes.

Passing scores and requirements

Achieving the passing score is crucial for advancing in any U.S. or Canadian medical career pathway.

  • Which is reportedly harder: listening, reading or speaking?
    Among IMGs, the speaking section is often considered the most challenging. Medical professionals may be comfortable with reading or listening but can struggle to demonstrate fluency and confidence under exam conditions.
  • What accent is used on English proficiency tests?
    TOEFL, OET and IELTS use a variety of English accents. Candidates may hear American, British, Australian and Canadian speakers. This reflects the global nature of healthcare communication.
  • If the accent is difficult to understand, can I get a different test?
    Unfortunately, no. All candidates receive the same test versions, including the range of accents. Preparation materials can help you practice understanding different pronunciations to avoid surprises on test day.

What if I fail the English proficiency test but pass all other requirements?

Failing the English exam can delay your career progress, even if you have already passed licensing exams like the USMLE. Without proof of language proficiency, certification will not be issued, and visa applications cannot move forward. However, IMGs can retake the test as many times as needed, and scheduling is usually flexible. Early preparation and practice with sample tests significantly increase the chances of success.

How can I get an exemption?

Some IMGs may not need to take the exam at all depending on their background.

Which countries are exempt?
Physicians from countries where English is the native language, such as the United Kingdom, Canada, Australia, New Zealand and Ireland, may qualify for exemptions. U.S. immigration policies and ECFMG regulations outline specific national eligibility.

For Canadian visas, IMGs from Andorra, Australia, Bahamas, Austria and the
United Kingdom are exempt from English proficiency tests. 

What if I attended an accredited international school?
If you studied at a medical school where English was the official language of instruction, you may be eligible for a waiver. However, documentation is required, and approval is not guaranteed. Always confirm exemption eligibility directly with ECFMG or Canadian provincial authorities before relying on this pathway.

Visa and immigration advice for IMGs

Successfully passing an English exam is only one part of the larger immigration journey. IMGs applying to the U.S. must also navigate visa options such as the J-1 or H-1B and prepare for the demands of medical residency.

For detailed guidance, IMGs can explore resources like:

These resources provide step-by-step advice on residency applications, visa categories and immigration policies specific to international physicians.

Passing the OET, TOEFL iBT and IELTS is a crucial milestone for International Medical Graduates aiming to practice in the United States or Canada. By preparing early, understanding score requirements and knowing where the exam fits into the overall process, IMGs can move through the visa and licensing stages more smoothly.

If you’re an IMG preparing for your journey, make sure to explore PracticeLink’s Resource Center for comprehensive guidance. With the right preparation, you’ll be well on your way to building a successful U.S. or Canadian medical career.