The Nine US Professions Section 343 Covers

Ask who needs an English test for a United States healthcare visa and most people say nurses.

The law names nine professions, and six of them are not nursing.

SpeakShark is free for the skill all nine are measured on hardest, three AI conversation sessions a day with no card.

In this guide: the nine · law not policy · one issuer · the education exemption · textbooks · 27 months · what it is not · limits · method · FAQ

Key takeaways

• Nine professions, named in Section 343 of the IIRIRA.
• The requirement is federal law, not one board's policy.
• One organisation is approved to certify all nine.
• Education exemption: six countries, Canada except Quebec, plus a textbook clause.
• Work exemption: 27 months, and only on renewal.

The nine professions

The professions covered are:

Two of those nine are nursing roles. The other seven are not, and several of them are rarely discussed in this context at all.

Audiologists and speech language pathologists are worth pausing on. Both work on the mechanics of hearing and speech, in English, with patients whose own speech or hearing is impaired. The UK's health professions regulator holds speech and language therapists to a higher English requirement than any other profession it regulates, covered in speech therapists against doctors. The American system does not single them out, but it does include them.

Clinical laboratory technicians and scientists sit at the other end of the patient-contact spectrum, and they are on the list too.

A law rather than a policy

HRSA states the requirement in a way most regulators do not. Applicants for VisaScreen must demonstrate oral and written competency of the English language as mandated by federal law.

That phrasing matters for three reasons.

It covers nine professions at once. Every other body in this series regulates one profession, or a family of them, and writes its own rule. This is one rule reaching across nine.

It does not move like a policy. A regulator can revise guidance. A federal requirement moves through federal process, which is why the current thresholds arrived via Federal Register comment requests in May 2019 and November 2024, and why the score list carries a hard effective date of 12 May 2026.

It is separate from licensure. Passing does not license anybody. That is done state by state, and the state boards have their own English rules, covered in MET for US nurse licensure.

The scores themselves are set out in every US healthcare English test now ranks speaking highest, and the direction the last revision took is covered in the US lowered every score except speaking.

One body covers all nine

TruMerit, formerly CGFNS, states that it is the only organisation approved by US Citizenship and Immigration Services to issue these certifications for all nine health professions named in Section 343.

Read the qualifier carefully. It is not claiming to be the only certifier of any of them. It is claiming to be the only one covering the full list, which implies others cover parts of it. Its own pages reference a route for applicants previously certified by a different body for physical therapy.

For a candidate the practical point is narrower: check which organisation certifies your specific profession before starting an application, because the answer is not the same for all nine.

The rename is worth knowing about too. The old CGFNS site remains online and states plainly that it is no longer updated and is maintained as a redirect pathway to the new site. Anybody working from an older bookmark is reading a page its owner has flagged as stale.

The education exemption, and Quebec

A VisaScreen applicant may be exempt from the English examination on the basis of English-based professional education. Both of these must be true:

• Entry-level professional education occurred in the United Kingdom, Australia, Canada except Quebec, New Zealand, Ireland or the United States; and
• English was the language of instruction, including the language of the textbooks.

Six countries. That is a much shorter list than the 43 the UK's health professions regulator maintains, covered in the 43 countries where the HCPC skips the test.

And there is that Quebec clause.

This is now the third way we have seen an authority handle the fact that Canada is not uniformly English-speaking, and it is the most precise of the three.

The UK rules exclude the entire country from one route rather than naming the province, which we set out in three regulators, three lists. The American version carves out the specific jurisdiction and leaves the rest of the country in.

Neither approach is wrong. One is blunter and easier to administer; the other is fairer to an anglophone graduate of a Canadian university outside Quebec.

The textbook clause

The second condition is the one that catches people, and it is unusually specific.

English must have been the language of instruction, including the language of the textbooks.

Every other regulator we have read asks about teaching and examination. This adds materials.

That closes a real gap. A programme can be lectured and examined in English while the core texts a student actually learned from are in another language, particularly in countries with strong domestic academic publishing. Under a teaching and examination test that programme qualifies. Under this one it does not.

It also raises an evidential problem the page does not solve. Nobody's transcript records what language the textbooks were in.

Compare the other versions of this same clause: the RCVS wants the university to confirm English was the sole language of instruction and to send the confirmation directly; the GPhC wants the course taught and examined in English and 75 per cent of in-service training conducted in English. We set the five variants out in five ways a degree taught in English is not enough.

The 27 month renewal exemption

There is a second exemption and it is only available on renewal. Three conditions:

• Employment in the United States for at least 27 months, including nine months of employment before the date of the renewal order.
• The applicant must be employed in the profession the VisaScreen service is sought for.
• The US employer must sign and submit an employment summary on corporate letterhead.

Twenty seven months is an oddly precise number and no reason is published for it. What the structure does is clear enough: it asks for a long total and a recent portion, so somebody who worked in the United States years ago and stopped does not qualify.

The corporate letterhead condition belongs to a family we have seen repeatedly, where the regulator cares about the chain of custody of evidence as much as its content. The RCVS wants the university to email it directly, the GPhC wants results through the myOET portal, and the GDC wants an official work email rather than webmail, all covered in five ways a degree taught in English is not enough.

One more condition applies to every route here: TruMerit does not accept the at-home versions of English language proficiency exams.

What the certificate is not

HRSA closes its own page with a disclaimer worth repeating in full, because it manages an expectation that the rest of the process encourages.

Holding a certificate indicating that an individual meets these updated English proficiency standards does not establish an individual's eligibility to enter the United States for the purpose of performing health care, and does not constitute professional authorisation to practise in that health care occupation.

So the sequence is: pass the English exam, obtain the certificate, and then separately obtain a visa and separately obtain a state licence. Three processes, three authorities, and the English requirement is a precondition for one of them rather than a step towards all three.

Anybody planning around this should count all three timelines, and the English one is the only one they can start today.

The speaking bar is where that time is best spent, because it is the highest requirement on all six accepted tests and it 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, IELTS for UKVI by CEFR level maps bands to levels, and Cambridge speaking criteria by level shows how speaking is actually marked.

What we could not verify

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

We do not know why 27 months. No reason is published.

We did not establish which bodies certify which subset of the nine. TruMerit claims the only full coverage; we have not mapped the partial certifiers.

We did not verify how the textbook condition is evidenced. The requirement is stated; the proof is not described.

We did not check state licensing requirements. These are federal visa screening rules only.

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

How we researched this guide

We had CGFNS in our notes for weeks as the body behind the American healthcare English requirement, and the first useful thing we learned this time was that the name has changed.

The old site says so itself, at the very bottom of the page, in a block headed did you know. That is a good argument for reading to the end of a page you think you already know: everything above it was accurate and stale at the same time.

The nine professions came from a footnote. The main text says nine health professions and puts the list in a numbered note at the foot of the article. Footnotes are where lists go when the author considers them detail, and here the list is the whole scope of the law.

The Quebec clause we recognised immediately, because we had already seen the UK Immigration Rules exclude Canada by name from a degree route. Finding a second authority solving the same problem more precisely is what turns one odd carve-out into a pattern worth writing about.

The textbook clause we went looking for a second reading of, because it is unusual enough to suspect a misreading. It says what it says: including the language of the textbooks.

Practise speaking, from SpeakShark

SpeakShark is an AI English speaking practice app, and the reason this guide exists is that six of these nine professions rarely see themselves in coverage of this requirement.

If you are an audiologist, a physician assistant or a clinical laboratory scientist, the federal English requirement applies to you exactly as it applies to a nurse, and the speaking bar is the same one.

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 do not teach profession-specific clinical vocabulary either.

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 your profession turned out to be on the list.

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

• TruMerit, updated ELP exams and score requirements by HRSA: the nine health professions named in Section 343 of the Illegal Immigration Reform and Immigrant Responsibility Act, and the statement that TruMerit is the only organisation approved by USCIS to issue these certifications for all nine
• TruMerit, VisaScreen visa credentials assessment: the education exemption requiring entry-level professional education in the United Kingdom, Australia, Canada except Quebec, New Zealand, Ireland or the United States with English as the language of instruction including the language of the textbooks, the renewal exemption requiring 27 months of United States employment including nine months before the renewal order with an employment summary on corporate letterhead, and the statement that at-home versions of exams are not accepted
• HRSA, updated list of tests and scores for foreign health care workers as of 12 May 2026: the statement that competency is mandated by federal law, the score tables, and the disclaimer that holding a certificate does not establish eligibility to enter the United States or constitute professional authorisation to practise
• HCPC, certificate of English language proficiency: the list of 43 qualifying countries, used for comparison with the six here

FAQ