Every US Healthcare English Test Now Ranks Speaking Highest

The United States government publishes a table of English tests its healthcare visa applicants may sit, with the minimum score for each.

On the list published as of 12 May 2026, all six accepted tests set speaking above everything else in the row.

SpeakShark is free for the skill six separate exams now rank first, three AI conversation sessions a day with no card.

In this guide: the table · six for six · three levels · who it covers · what changed · one discrepancy · what to do · limits · method · FAQ

Key takeaways

• Six accepted tests, and speaking is the highest bar on all six.
• IELTS 6.5 overall, 7 speaking, for nurses and bachelor's level workers.
• PTE 55 overall, 76 speaking, a gap of 21 points.
• The speaking minimum does not change between professional levels.
• TOEIC and paper TOEFL do not appear on the updated list.

The current federal table

HRSA publishes the requirement in three columns, one per professional level. Here is the middle column, for registered nurses and other bachelor's level health care workers.

Speaking tops every row

Read down the speaking column and then across each row.

Cambridge: 169 overall against 194 speaking, a gap of 25 points on the Cambridge English Scale.

IELTS: 6.5 overall against 7 in speaking, half a band higher than the average the candidate is allowed.

Michigan: 58 overall against 59 speaking.

PTE: 55 overall against 76 speaking, and 62 in reading, writing and listening. Speaking sits 21 points above the overall and 14 above the other sections.

TOEFL: 4.5 overall and 4.5 in speaking, with 3.5 in reading, listening and writing. Equal to the overall and a full band above the other three sections.

OET: 360 in speaking against 350 writing, 340 reading and 320 listening. Highest of the four.

Six tests, built by six organisations on six different scales, and in every single row the number that stands out is the same one.

That is not a coincidence in the tests. It is a decision by the body setting the thresholds, applied six times.

Three professional levels, one speaking bar

Here is the finding that makes the intent unarguable. HRSA sets three columns: occupational and physical therapists, registered nurses and other bachelor's level workers, and workers below bachelor's level.

Watch what moves and what does not.

Every overall requirement falls. Every reading, writing and listening requirement falls or holds. The speaking requirement is identical in all six tests, at every level.

A clinical laboratory technician and a physical therapist are asked for different amounts of written English and exactly the same amount of spoken English.

You can read that as a statement about what the requirement is protecting. Written and academic English scale with the qualification. Talking to a patient does not.

The nine professions

The requirement applies to the professions named in Section 343 of the Illegal Immigration Reform and Immigrant Responsibility Act:

• Registered nurses
• Licensed practical and vocational nurses
• Physical therapists
• Occupational therapists
• Physician assistants
• Audiologists
• Speech language pathologists
• Clinical laboratory technicians
• Clinical laboratory scientists

TruMerit, formerly CGFNS, states it is the only organisation approved by the US Citizenship and Immigration Services to issue these certifications for all nine.

This is why the requirement matters more than a regulator's rule. It is not one profession's licensing body. It is federal law reaching across nine professions at once, and we set out how much wider that is than most people assume in the nine professions Section 343 covers.

What changed on 12 May 2026

The previous list ran from 24 May 2022 to 12 May 2026, and comparing the two is where the direction becomes explicit. We work through that comparison in the US lowered every score except speaking.

The short version: overall requirements came down or held, speaking requirements went up, and two tests left the list. TOEIC and the paper-delivered TOEFL do not appear on the updated table.

TruMerit's own account of the process says the recommendations submitted to HRSA emphasised implementing a speaking subtest score for exams that previously lacked one, as well as strengthening the minimum required speaking subtest scores overall. The published table is what that produced.

For anyone holding an older certificate, the rule is dated rather than graded: exams taken before 12 May 2026 are certified against the previous criteria, and exams taken on or after that date against the new ones.

One number worth checking twice

Here is a discrepancy worth knowing about, described as what it is rather than resolved.

TruMerit's VisaScreen page carries a note stating that effective 1 December 2024, applicants using PTE Academic must achieve 63 on the speaking section, with the overall of 55 and the minimum of 50 on other sections unchanged.

The HRSA list published as of 12 May 2026 gives PTE as 55 overall, 76 speaking, 62 in reading, writing and listening.

Both statements sit on published pages today. The most likely reading is that the December 2024 figure was an earlier step and the May 2026 table supersedes it, but we have not found a page that says so.

If PTE is your route, that is a 13 point difference in what you need, and the safe move is to plan for the higher number and confirm with the certifying body before booking.

What to do with this

• Plan around speaking first. It is the highest bar on all six tests.
• Do not assume a lower-level role means a lower speaking score. It does not.
• Check which side of 12 May 2026 your exam date falls on.
• Do not book TOEIC for this purpose.
• If you are using PTE, confirm the speaking number before booking.
• Remember what the certificate is not. HRSA says it does not establish visa eligibility or authorisation to practise.

Six tests agreeing that speaking is the binding constraint is about as clear a signal as this field produces, and speaking is the skill that does not improve by reading quietly. Role play scenarios and a daily speaking partner are the practical routes, speaking practice for nurses covers the clinical register, and testing your speaking level free shows where you stand. CEFR levels for speaking explains the scale, MET for US nurse licensure covers the state boards behind the visa, and TOEFL's new 1 to 6 scale explains the bands in the TOEFL row. For how examiners mark spoken English, Cambridge speaking criteria by level works from real scored candidates.

What we could not verify

We did not resolve the PTE discrepancy. Two published pages give different speaking numbers and we have flagged it rather than choosing one.

We did not read the Federal Register comment rounds. HRSA states it relied on requests for comments published in May 2019 and November 2024, and we have not read those.

We did not verify the equivalence of the six tests to each other. The columns sit side by side; nothing here claims 194 on Cambridge equals 76 on PTE.

We did not check state licensing requirements. These are the federal visa screening thresholds. State boards set their own rules for licensure.

We did not read Section 343 itself. The list of nine professions is as TruMerit states it.

This is not immigration or licensing advice. It is a reading of a published federal table and a certifying body's statements, all linked below.

How we researched this guide

We came for a per-profession score table we had been missing for weeks and found something better, which is a fair summary of how this series works.

The table is arranged by test, so the obvious way to read it is one row at a time, checking the exam you intend to sit. Reading it as a column instead is what produces the finding. Speaking is the highest number in every row, on six scales that have nothing to do with each other.

The three-column structure is what turns an observation into an argument. If the speaking bar were simply high, it would move with the rest when the professional level changes. It does not move at all, in any of the six tests, while every other figure falls. That is a deliberate design and it is visible only by comparing columns rather than rows.

We then checked the previous list, still published on the same page, to see the direction of travel. Overall requirements down, speaking up, two tests removed. TruMerit's own statement about the process confirms the intent in words, and the words and the table say the same thing.

The PTE discrepancy we left open. Two published pages disagree by 13 points, and inventing a reconciliation would be worse than telling a candidate to ring the certifying body.

Practise speaking, from SpeakShark

SpeakShark is an AI English speaking practice app, and this is the strongest external evidence we have come across for the thing we exist to do.

This is not a marketing claim about the importance of speaking. It is a federal agency, six exam boards, and three professional levels, all arriving at the same conclusion: reading and writing requirements can flex with the role, and the ability to talk to a patient cannot.

You talk, the AI answers what you actually said, and you get speaking feedback while the conversation is still running. The free tier gives basic feedback; the detailed pronunciation and grammar breakdown is on Premium.

Being straight about the limits: a free session runs five minutes with four turns, we issue no certificates, and nothing here is accepted by HRSA, TruMerit or any exam board. We are practice, not proof.

Start free with three sessions a day and no card. Paid sessions run ten minutes with unlimited turns. Limits are on the pricing page, and how it works walks through a session. Sign up here if speaking is the number deciding your application.

We are a speaking improvement tool. We are not an exam preparation provider, and we are not affiliated with Cambridge English, the IELTS partners, Pearson or any exam board. For test format, booking and official practice material, go to the exam body directly. Use SpeakShark to make your spoken English stronger, and use official material to learn the test.

• Site: speakshark.com
• Support: speaksharksupport@gmail.com
• Free tier: 3 AI conversation sessions per day, no card

Sources

• HRSA, updated list of tests and scores for foreign health care workers as of 12 May 2026: the six accepted tests and their minimum scores across the three professional level columns, the previous list covering 24 May 2022 to 12 May 2026, the reliance on Federal Register comment requests in May 2019 and November 2024, and the statement that holding a certificate does not establish eligibility to enter the United States or authorisation to practise
• TruMerit, VisaScreen visa credentials assessment: the approved exam list, the statement that at-home versions are not accepted, the December 2024 PTE speaking note, and the exemption routes
• TruMerit, updated ELP exams and score requirements by HRSA: the 12 May 2026 effective date and the before and after certification rule, the removal of TOEIC, the nine professions named in Section 343 of the Illegal Immigration Reform and Immigrant Responsibility Act, and the statement that recommendations emphasised implementing and strengthening speaking subtest scores
• Council of Europe, CEFR Table 1, common reference levels global scale: the level scale several of these exams report against

FAQ