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Photo by Camila Cortés Pasasin

A graduate of a veterinary school in Colombia, Dr. Lina Cortés has been striving toward licensure in the United States since 2022. For the last three years, she’s been working as a veterinary assistant in Virginia while she waits for a chance to take the hands-on clinical skills exam that is the last step in the credentialing process.

Dr. Lina Cortés became a veterinarian more than a decade ago and has, for most of that time, had her eye on practicing in the United States — she hoped in large animal medicine, an area that happens to be perennially considered short of doctors.

As someone trained in the South American country of Colombia, Cortés knew she would need to pass a variety of exams before qualifying for a veterinary license.

What she didn't anticipate was that the quest would stretch out for an indeterminate, and seemingly interminable, number of years, strewn with a variety of process-related obstacles.

In the latest detour, Cortés successfully pressed for a new law in her state, Virginia, to enable foreign-trained veterinarians to work temporarily under a "traineeship." But days before the law took effect last week, she learned that Virginia's procedure for setting up the permit could take as long as two years.

Calling news of the delay heartbreaking, Cortés lamented, "It honestly feels like the light at the end of the tunnel keeps getting pushed farther away."

Virginia is not the first state to tackle the issue of getting foreign-trained veterinarians into the clinical workforce, although its process for doing so may be uniquely protracted. This year, Connecticut, too, authorized a temporary pathway to practice for those stuck in the bogged-down process required for full U.S. licensure. At least nine other states have established provisional permits or the like for graduates of foreign veterinary schools who are well along in an education-equivalency credentialing program. These are Delaware, Georgia, Kentucky, Massachusetts, Michigan, Minnesota, Nevada, New Hampshire and Utah.

Foreign equivalency credentialing explained

In the U.S. and around the world, 58 schools are accredited by the American Veterinary Medical Association Council on Education. Graduates of AVMA-accredited schools are eligible to take the North American Veterinary Licensing Exam. Graduates of schools that do not have AVMA accreditation must complete one of two programs in order to qualify to take the NAVLE. One is a four-step program administered by the AVMA, called the Educational Commission for Foreign Veterinary Graduates, or ECFVG. The other option is a three-step program administered by the American Association of Veterinary State Boards, called the International Pathway for Veterinarians, or PAVE.

Both programs can take years to complete — a period that's been lengthened by a surge in applications in recent years. In the case of the ECFVG, the more heavily subscribed of the two programs, the increased numbers have resulted in years-long waits to obtain a slot for the clinical proficiency examination. Known as the CPE, the three-day, seven-part exam, which includes performing surgery on live patients, is given multiple times a year at two locations in the U.S.

For years, ECFVG registrants have complained, on social media and through an online petition, about being stuck in CPE limbo. According to Dr. Jim Weisman, chief of academic affairs, research and accreditation for the AVMA, the backlog originated with the suspension of CPE testing during the Covid-19 pandemic in 2020 and has been compounded by sustained growth in the number of candidates seeking ECFVG certification. An AVMA spokesperson provided Weisman's responses via email.  

In May, lawmakers in Connecticut approved a temporary permit for doctors in the ECFVG or PAVE programs to practice in the state under the direct supervision of a licensed veterinarian. The permit is good for up to two years, with one opportunity to renew for two more years if the permit-holder hasn't yet completed ECFVG or PAVE certification. The law goes into effect on Oct. 1.

The Virginia measure, which passed in April, builds on legislation approved in 2024 that established a veterinary traineeship for graduates of U.S. veterinary schools waiting to take or re-take the NAVLE. The new measure extends the traineeship to ECFVG registrants who have completed all steps except the CPE.

Neither Virginia measure creates a conditional license, according to Susan Seward, lobbyist for the Virginia Veterinary Medical Association, which supported both measures.

"The traineeship statute and regulations achieve the same purpose — allowing vet school graduates waiting on final licensing exams — to gain experience in a limited practice setting without a license," Seward said in an email to VIN News.

She also emphasized that under the traineeship, candidates "have to have a Virginia licensee willing to bring you into the practice. It's the employing veterinarian's license that is on the line."

The law took effect on July 1, but veterinary regulators need to establish rules, such as how long traineeships run and under what circumstances.

Kelly A. Smith, spokesperson for the Virginia Department of Health Professions, said that, due to other regulatory actions in the pipeline and procedural steps required by the state, the rules will not be in place for 18 months to two years.

'That's when the waiting started'

Like many graduates of foreign veterinary schools who seek to practice in the U.S., Cortés' career trajectory has been long and winding.

She earned her veterinary degree in Colombia in 2015 and practiced there for two years. In 2017, she moved to the U.S. to improve her English and get a master's degree.

Initially, she worked as an au pair before attending Virginia Tech on a scholarship, earning a master's in neuropharmacology and completing an internship at Virginia Tech Equine Medical Center. She had hoped to pursue a specialty in large animal surgery, but after failing to secure a residency, she turned her attention to becoming licensed in general practice in Virginia.

By then, Cortés was working at a clinic as a veterinary assistant, a position that requires no formal educational training. She decided to seek licensure through the ECFVG program. She thought the process would take two years.

She passed three of the four ECFVG steps: an English exam in 2022; the Basic Veterinary Science Exam in 2023, qualifying her for the CPE; and the NAVLE in 2024. 

At first, registration for the CPE was first come, first served. As Cortés described it, "Basically, you have to check the website every single day, multiple times a day, hoping that they release a spot, but you don't know when they're going to release a spot."

She checked three times a day — first thing in the morning, at lunchtime and at night. "I did that for two years. There was never an opening."

Then, last October, Cortés was able to stop that vigil. The AVMA released a revamped candidate portal that included, for the first time, a candidate waitlist for full CPE testing seats and a separate waitlist for exam retakes. (Seventy-five to 80% of first-time candidates fail one or more of the sections and must get on the waitlist for a retake.)

Cortés said she signed up the day the waitlist opened, but she doesn't know when she might be eligible to take the exam.

According to the AVMA, once a candidate registers for the waitlist, they get confirmation. The next time they will hear from ECFVG should be with news that they are eligible to sit for the exam.

Asked generally about the waitlist, AVMA's Weisman said, "We do not release waitlist data, specifically the number of candidates on the waitlist or a candidate's actual place on the waitlist. There are many factors which impact the scheduling of a candidate for either the full CPE or an exam retake; therefore, this data taken out of context can contribute to a candidate's misunderstandings of timing, resulting in increased uncertainty."

He also said the waitlist may be a step toward alleviating delays. "Implementation of the waitlist allows for a more accurate understanding of the CPE capacity need and candidate wait times, and offers ECFVG the opportunity to research sustainable solutions to minimize this wait for all candidates."

As the years rolled by, Cortés became concerned that she was losing the clinical skills she'll need to pass the exam. 

She researched conditional licenses in other states, hoping she could find work temporarily as a veterinarian elsewhere to hone her skills and "have more of a chance to actually pass this exam, so I don't go back to the pool, like many people, like a vicious cycle."

Then she discovered that New Hampshire offers a conditional license for ECFVG candidates. Would it be worth relocating? she wondered. She decided to take the steps to qualify.

"It was a hard choice, but I didn't even have to make that choice," Cortés said, "because I never got a job offer." She said the clinics she contacted told her they were seeking fully licensed practitioners.

New Hampshire's conditional license took effect in September 2024, and the first license was granted in April 2025. The state has issued 15 conditional licenses to foreign-trained veterinarians, according to Shaun Filiault, counsel to the state's Office of Professional Licensure and Certification.

Cortés turned her attention to practicing closer to home. Thus began, for the newly minted U.S. citizen (as of 2024), a new sphere of study: how a bill becomes a law. After learning that the state veterinary medical board couldn't create laws, she said she emailed every senator in Virginia's General Assembly. After a few months, Sen. Danica Roem responded. Roem helped draft and then sponsored the traineeship bill.

Cortés' plight evidently resonated with Roem. The lawmaker told VIN News in an email, "I think a traineeship is needed in order to cut red tape and get more qualified practitioners working in a high-demand field where a lot of animals could really use their expertise across the commonwealth right now."

Her colleagues appear to have agreed, considering the bill passed unanimously in both chambers.

Despite lawmaker support for a measure to get veterinarians like Cortés serving Virginia pet owners and pets as soon as possible, Cortés is pretty much in the same place she's been for three years. Only now, she sees a career deferred by exam delays and a regulatory process.