All foreign physicians who want to work in Germany as physicians must contact the competent Federal State registration authority to have their medical diplomas (basic medical training) recognised. In some Federal States there is only one registration authority (Approbationsbehörde), whereas other Federal States have several registration authorities for different regions. Competent is the registration authority in which area the physician wants to work (see list: Addresses of Registration Authorities).
The State Chambers of Physicians (Landesärztekammern) are responsible for the recognition of specialist qualifications. The recognition of the specialist diploma is incumbent to the State Chamber of Physicians in which area the physician wants to work (see list: State Chambers of Physicians). Furthermore, in most states a membership in the State Chamber of Physicians is necessary.
You can apply for limited or full registration even though you have not found a position yet and you reside outside Germany. You should submit your application to the registration authority in which area you would like to work (see § 3 General Administrative Law Acts and § 12(3) Federal Medical Code).
Physicians who have completed their basic medical training outside Germany, have a right to get, upon application, an official notice regarding the equivalence of their basic medical training. The proof of German language skills is not a prerequisite for this notice. However, the physician will only be granted full registration (Approbation) once he/she meets the German language requirements and fulfills all other requirements.
No! You must decide where you would like to work as a physician and submit then your application to the registration authority in which area you plan to take up a job.
The competent registration authority (Approbationsbehörde) provides the information which documents must be submitted for the recognition of the medical diploma (see list: Addresses of Registration Authorities).
The competent State Chamber of Physicians provides the information which documents must be submitted for the recognition of the medical specialist diploma (see list: State Chambers of Physicians).
Since the taking effect of the so-called recognition law (1 April 2012) the citizenship is irrelevant for getting full registration in Germany.
A basic medical training completed successfully in a member state of the European Union will, on request, be automatically recognised in Germany provided that the qualification is listed in the European Directive on the Recognition of Professional Qualifications (2005/36/EC, Annex V No.
5.1.1), that the minimum criteria of the directive are met and that the basic medical training had been started after the specified reference date. Once the registration authority received all necessary documents it has to decide upon the application within a time limit of three months.
As the EU has passed corresponding treaties with Norway, Iceland, Liechtenstein and Switzerland, similar rules apply for diplomas from these countries.
If all the other requirements (knowledge of the German language, health requirements, no criminal record, etc.) are met, the applicant obtains full registration.
Medical diplomas from EU countries certifying that the basic medical training was begun before the reference date will be recognised in Germany if the applicant submits in addition to his/her diploma a certificate of conformity. Herewith, the relevant authority of the country of training confirms that the basic medical training of the applicant corresponds to the minimum standards of the European Directive on the Recognition of Professional Qualifications. Alternatively the applicant can submit a certificate from the relevant authority of the country of training (or another EU member state) stating that he/she has been full-time, effectively and lawfully engaged in his profession for at least three consecutive years during the five years preceding the award of the certificate.
Such a diploma will only be recognised in Germany if the relevant authority of the EU member state confirms that the diploma has the same legal validity regarding the access to the profession and to its practice as the diplomas issued currently in the present member state. Additionally there must be an attestation presented that the applicant has been working during the past five years at least for three consecutive years full-time, effectively and lawfully as a physician in the territory of the present member state.
The European Directive on the Recognition of Professional Qualifications (2005/36/EC) can be downloaded under the following link: http://ec.europa.eu/growth/single-market/services/free-movement-professionals/policy/legislation/
The competent registration authority (see list: Addresses of Registration Authorities) will assess the equivalence of medical diplomas obtained outside of the European Economic Area/Switzerland compared to medical diplomas from Germany. If the competent registration authority confirms the equivalence of the foreign diploma or concludes that potential differences in the basic medical training can be compensated by pertinent work experience or other recognised skills and competences (lifelong learning) and if all the other requirements are met (knowledge of the German language, health requirements, no criminal record, etc.), the applicant is granted full registration.
If the competent registration authority finds that there are significant differences between the basic medical training of the applicant’s country of training and the basic medical training in Germany it may insist on the taking of a knowledge test (see question 15-18) provided that the differences in basic medical training cannot be compensated by pertinent professional experience or other recognised skills and competences. The professional experience, skills and competences may be obtained around the world.
In rare cases, the registration authority may conclude that the basic medical training is not equivalent at all and the differences in the basic medical training done abroad are so big that it will not be possible to sit the knowledge test. In such cases (approximately 1% of all applications) the physician cannot work in Germany.
The assessment of equivalence and the evaluation of professional experience and other recognised skills and competences is a case-by-case review conducted by the competent registration authority. Once the registration authority received all necessary documents it has to decide upon the application within a time limit of four months. Unfortunately, this time limit is often exceeded.
No! The competent registration authority (see list: Addresses of Registration Authorities) will assess the equivalence of all medical diplomas obtained outside of the European Economic Area/Switzerland compared to medical diplomas from Germany (see question 11). The fact that a physician got his qualification recognised in another EU member state does not change this rule. The assessment will also take place if, in addition to the recognition of the diploma, the physician has worked for a minimum of three years in another EU member state.
If the competent registration authority finds that there are significant differences between the basic medical training of the applicant’s country of training and the basic medical training in Germany it may insist on the taking of an examination provided that the differences in the basic medical training cannot be compensated by pertinent professional experience or other recognised skills and competences. However, instead of the knowledge test the doctor has to sit an aptitude test.
Content of the aptitude test are those subjects were differences in the basic medical training were found.
If the basic medical training in the country of training consists of medical studies and an obligatory practical phase we highly recommend that you only come to Germany after you have completed this practical phase. Otherwise the competent registration authority will conclude that your basic medical training is incomplete. Please note that it is extremely difficult to integrate into the German system with an incomplete basic medical training.
Foreign physicians who reside in Germany for at least three months can get a subsidy of up to 600 Euro provided that they have only little financial means at their disposal and that the costs of the recognition process are not covered by the job agency or other governmental bodies. Furthermore, the application needs to be submitted before the start of the recognition process. The subsidy can be used for costs of translations, legalizations of diplomas, expert opinions, fees etc. Further information on the subsidy and the application form is posted on the information portal of the German government for the recognition of foreign professional qualifications under: www.anerkennungszuschuss.de. Questions can be addressed to the Research Institute for Vocational Education and Training (phone: 0371 4 33 11 222, mail: email@example.com, www.f-bb.de).
The knowledge test refers to the substance of basic medical training in Germany. The foreign physician is to demonstrate that he has the knowledge equivalent to the one required by graduates of the medical universities in Germany. According to a regulation, which came into force on 1 January 2014, the emphasis of the knowledge test lays on internal medicine and surgery. In addition questions from the following fields have to be expected: accident & emergency medicine, clinical pharmacology/pharmacotherapy, diagnostic imaging, radiation protection, law on professional practice. Furthermore, the competent authority can inform the candidate in advance that another subject or cross-section will be part of the knowledge test if the authority is of the opinion that there is a major difference in the basic medical training in Germany and in the basic medical training which the examinee underwent.
The knowledge test is a clinical-practical test with patient presentation. It takes between 60 and 90 minutes and can be repeated two times at the most. The registration authority must offer the applicant an examination date within six months after the decision was taken. Unfortunately, this time limit is quite often exceeded.
Since the taking effect of the so-called recognition law a limited registration is mainly granted in order to prepare for the knowledge test. However, it is not a prerequisite for the admission to the knowledge test.
Please note that working with a limited registration is not a guarantee to pass the knowledge test. Therefore, a thorough theoretical preparation of the test is highly recommended.
Besides working with a limited registration various institutes in Germany offer integration courses for foreign physicians and offer preparatory courses for the knowledge test. The following institutes are approved by the Federal Employment Agency and accept vouchers issued by employment agencies:
- berami-Akademie Frankfurt (www.berami-akademie.de)
- Freiburg International Academy (https://www.fia.academy)
- Gemeinnützige Gesellschaft für berufsbildende Maßnahmen mbH Berlin (www.gfbm.de)
- Interkulturelle Bildung Hamburg (www.ibhev.de)
- Kulturakademie Dresden (www.kulturakademie-dresden.de)
- maxQ.im bfw – Unternehmen für Bildung (www.maxq.net)
- medisim Köln (www.medisim.com)
- mibeg-Institut Medizin (www.mibeg.de)
- ProBildung Leipzig (https://probildung.org)
For some years the Marburger Bund co-operates trustfully with the mibeg-Institut Medizin in Cologne.
Furthermore, the IQ-Network offers courses which are sponsored e.g.:
- Charité International Academy (https://academy.charite.de/projekte/)
- mibeg-Institut (https://www.mibeg.de/medizin/iquamed/)
More courses are posted under:
(see Priority Area: Qualification)
The digital medical learning programme AMBOSS is a helpful tool for foreign physicians who need to pass the knowledge test. The vast majority of medical students use this text and reference book with plenty of multiple choice questions in order to prepare for their state exams. Moreover it can be used later at work as a reference guide with many supportive functions. Members of the Marburger Bund can profit from a special price. Further information can be found here.
The costs of the knowledge test vary between the German states. Currently you need to pay € 350 in Schleswig-Holstein and € 1,100 in Hesse or Rhineland-Palatinate
(see overview: Cost of Knowledge Test).
Please note that the costs are subject to change.
The Marburger Bund takes the view that the foreign physician is entitled to be remunerated according to our collective agreements as he is also medically active with a limited registration. De facto such remunerations are not always the case.
Since 1 April 2012 a limited registration can only be granted for a maximum period of 2 years. The granting or extension over this period of time is possible only in individual cases or for reasons of medical care for the population. And it is only admissible for reasons of medical care if the equivalent level of knowledge has been established. In this case the limited registration will be restricted to the particular speciality.
One of the basic requirements which must be met by foreign physicians intending to work in Germany is the proof of adequate knowledge of the German language. The physician is to contact the registration authority responsible for the geographic area in which he wants to work (see list: Addresses of Registration Authorities). The competent authority decides which certificates/attestations it recognises.
With the aim to establish a more coherent system the State Ministers of Health agreed on key points for the required German language skills in June 2014. Among other things they came to an understanding that foreign physicians should at least have completed level B2 of the Common
European Framework of Reference for Languages (CEFR) in general German. Additionally, they should also pass a specific medical German language exam (Level C1 of CEFR). It is worth noting, that the key points are legally not binding for the states. More information about this agreement (in German) can be found on the following websites:
In the meantime all German states ask for the level B2 (CEFR) in general German. Additionally, a medical German language exam level C1 (CEFR) has to be passed. An overview of the requirements in the different states is posted here: German language requirements for full registration. Please note that the requirements can change anytime. Therefore, the competent registration authority should be contacted before any decision is taken.
In most German states the language skills must be the same irrespective if you apply for full or limited registration (see question 21). Exceptions are made in the following states:
- Baden-Württemberg: B2 exam (CEFR) from a recognised language school. The medical German language exam of the State Chamber of Physicians Baden-Württemberg has to be passed soon afterwards.
- Berlin: B2 exam (CEFR) from telc, Goethe-Institute or TestDaF
- Bremen: B2 exam (CEFR) from a recognised language school and personal conversation with the registration authority
- Hamburg: B2 exam (CEFR) from a recognised language school (In case of a possible extension of the limited registration over one year the medical German language exam of the State Chamber of Physicians Hamburg Level C1 has to be passed.)
Please note that the requirements can change anytime. Furthermore, some registration authorities might consider exceptions form the rule in special cases. Therefore, the competent registration authority should be contacted beforehand.
The costs of the medical German language exam vary between the different providers. Currently you need to pay between € 300 for the medical German language exam of the State Chamber of Physicians Nordrhein and € 490 for the medical German language exam of berami-Academy (see overview: Costs of Medical German Language Exams).
As the costs may change anytime, please contact the relevant provider before you make a decision. Please be reminded that you cannot simply chose a provider but that you have to fulfill the language requirements of the competent registration authority (see question 21).
For all matters regarding postgraduate medical training the State Chambers of Physicians as public bodies are responsible. For each physician only the regulations for postgraduate medical training issued by the State Chamber of Physicians where he/she is a member are legally binding.
Limited registration will be granted to physicians whose basic medical training shows major differences compared to the German basic medical training or in cases where the assessment of the basic medical training is still in progress.
The directive 20013/55/EU had to be transposed in all the EU member states by 18 January 2016. This directive provides that admission to postgraduate medical training shall be contingent upon completion and validation of a basic medical training programme which consists of at least 5 years and 5,500 hours of theoretical and practical basic medical training. According to the legal interpretation of the Marburger Bund it is only possible to start postgraduate training in Germany once the doctor got his full registration in Germany as otherwise the EU directive 2013/55/EU is not transposed correctly.
For information about the transposition of the directive in the different states and possible transitional arrangements, please contact the competent State Medical Chamber of Physicians.
Definitely! All physicians working in Germany must be a member of the relevant State Chamber of Physicians. This applies to physicians during postgraduate medical training as well as to specialists.
Marburger Bund as the only trade union for physicians in Germany has concluded specific collective agreements with the different hospital operators. Wages and other working conditions (e.g. working hours) vary slightly according to each collective agreement. In communal hospitals physicians currently earn a monthly gross salary between 4,402.39 € (first year of professional experience) and 5,658.97 € (sixth year of professional experience). Monthly gross salaries for specialists are from 5,810.45 € (first year) to 7,462.09 € (from 13th year onwards). These salaries are for a weekly working time of 40 hours. Additional on-call services and overtime are paid extra.
The “Career Entry Brochure” by Marburger Bund offers a thorough overview of the physician working conditions at the different hospital operators.
The Marburger Bund has not yet concluded a collective agreement with practice based physicians (niedergelassene Ärzte) or Healthcare Centres (Medizinische Versorgungszentren). However, our collective agreements that apply in hospitals should serve as a basis while negotiating wages and other working conditions. The Marburger Bund can provide members with a model employment contract.
Whereas hospitals in big cities usually have no problems to fill their positions, there is a lack of physicians particularly in the countryside and in small towns. Employment ads may be found for example in the following media:
The Marburger Bund offers to all members an examination of their working contract free of charge and provides free counsel in all matters pertaining to labour law. However, the range of services of the Marburger Bund reaches far beyond this offer. You’ll find more details on the advantages of a membership in the Marburger Bund under: https://www.marburger-bund.de/bundesverband/service/der-marburger-bund-beraet
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