Imagine an engineering manager in Austin whose English tests well on paper. In real meetings, say defending a budget when someone pushes back, he freezes. He has the words. Under pressure, he can't reach them.
For a professional like this, the gap is often confidence rather than vocabulary. Regular practice with a tutor, rehearsing the kind of meetings he actually has and getting honest feedback, could help him hesitate less and say what he means.
Over time, a learner like this might walk into a tough meeting feeling prepared instead of anxious. How long that takes depends on the person, but steady practice in realistic situations is what tends to help.