A medical degree from abroad or a foreign license to practice medicine in your country of origin unfortunately is not sufficient to work as a doctor in Germany. In order to work as a doctor with a foreign qualification in Germany, a state licence is required. This can be a ‘licence to practise medicine’ (Approbation) or a ‘permit to practise the profession temporarily’ (professional licence; Berufserlaubnis).
The following overview explains the differences between the two:
- Condition for granting:
- Completed medical studies
- Sufficient German language skills (usually technical language at level C1)
- Worthiness and reliability and
- Health suitability for practising the profession
A professional license is limited to a maximum of 2 years and is tied to a specific position where professional supervision must be guaranteed. In most federal states, the language requirements for a professional license are somewhat lower (only B2, no C1). Foreign doctors often first go to Germany with a professional license, get to know the procedures in Germany and then register for the knowledge test and apply for their license to practice. Without preparation, the knowledge test is said to be difficult for foreign doctors to pass. You can either work as a doctor with a professional license (and earn money) or attend preparatory courses for the knowledge test at your own expense.
Due to the uniform standard for professional qualifications, the equivalence of degrees from these countries can be recognized automatically. However, you must pass a specialist language test at level C1 CEFR. This exam is usually administered by the relevant state medical association. In order to be able to register for this exam, general German language skills at level B2 CEFR are required as well.
However, in some cases it may be important when you began your studies. Bulgaria and Romania, for example, have only been EU member states since January 2007, while Croatia joined the Union in July 2013. Anyone who started their studies before this cut-off date will need additional documents. This can be, for example, a certificate of conformity, which must be issued by the competent authority in the country of study. Alternatively, you can prove that you have worked continuously as a doctor in an EU country for at least three years.
Doctors from third countries
Whether the university degree obtained in a third country is comparable to a German medical degree will be assessed individually. Significant differences in training can be compensated for by relevant professional experience or other knowledge and skills.
One way of proving the equivalence of a foreign degree is a document check. This involves checking whether the curriculum of the foreign university covers the same content as a German medical degree. If the curriculum is not available in German, it must be translated. The applicant has to cover the occurring costs.
Another way to determine the equivalence of the qualification is the knowledge test. This option can be chosen as an alternative to the document check - for example, to save the costs for the translation. You must also pass a specialist language test at level C1 CEFR. This exam is usually administered by the state medical associations. In order to be able to register for this exam, general German language skills at level B2 CEFR are required as well.
How does the knowledge test work?
The knowledge test is based on the examination of the German state examination (M3). It focuses on actual diagnosis and correct treatment of patients. The test concentrates on the subjects of internal medicine and surgery, but emergency medicine, clinical pharmacology and pharmacotherapy, imaging procedures, radiation protection and legal issues relating to the practice of medicine also play a role. Those who pass this examination can prove the equivalence of their professional qualifications and obtain a medical license to practice medicine in Germany if the other requirements are also met. In case one fails at the first attempt: the knowledge test may be taken twice. In order to prepare for the test, it is possible to work under the supervision of a licensed doctor for a limited period of two years. In addition, various institutes throughout Germany offer preparatory courses for it.
Recognition of training periods abroad
Both a specialist title acquired abroad and residency training periods completed abroad can theoretically be fully or partially recognized in Germany. However, this usually requires a medical license to practice medicine. The respective state medical association is responsible for the recognition of further specialist training or a period of further training, and the procedure depends on the respective federal state. In many cases, doctors must also be a member of the state medical association to which they wish to apply.
Further medical training completed in a EU Member State outside Germany is automatically recognized in Germany if it is listed in the European Professional Recognition Directive (2005/36/EC, Annex V No. 5.1.2 et seq.) for both countries and was started after the specified cut-off date. If the training began before the deadline, it is automatically recognized if the doctor has a certificate of conformity from the country of origin confirming that the training meets the minimum standards. Alternatively, the doctor can submit a certificate confirming that they have worked full-time as a specialist for at least three consecutive years in the last five years. It takes a maximum of three months for the specialist qualifications to be examined and recognized automatically, after all required documents have been received by the relevant state medical association.
The speciality is not listed in the Professional Recognition Directive for the country of origin and Germany.
If the specialty exists in Germany, the responsible state medical association carries out an individual equivalence assessment.
- If the further training is equivalent or significant differences can be compensated for by professional experience or other proven skills, recognition is granted.
- If significant differences are identified that cannot be compensated for, the applicant must take an aptitude test in the areas concerned.
It takes a maximum of four months to examine the recognition of specialist qualifications that are subject to the general recognition system, after the competent state medical association has received all necessary documents.
The regulations for the recognition of specialist qualifications from third countries are not the same in all federal states. However, the state medical associations are guided by the model training regulations of the German Medical Association. If the specialty exists in Germany, the competent state medical association will carry out an individual equivalence assessment upon application.
- If the further training is equivalent or significant differences can be compensated for by professional experience, recognition is granted.
- If there are significant differences that cannot be compensated for, the applicant must take a specialist examination. If the duration of further training is one year or more less than the duration specified in the further training regulations, this is generally regarded as a significant difference.
It takes a maximum of four months to examine the recognition of specialist qualifications that are subject to the general recognition system, after the competent state medical association has received all necessary documents. (According to experience, however, the procedure unfortunately takes much longer - up to even a year!) In some cases, additional periods of further training may be required before the specialist examination can be taken.
Important note
In the past, some state medical associations have refused to assess the equivalence of medical specialist diplomas from third countries if the applicant has proven their basic medical training by passing a knowledge test.
As at May 2024, the medical associations in Lower Saxony and Saxony refuse to check the equivalence of specialist diplomas if the level of training has been proven by a knowledge test.
On the webpage of the Federal Government's information portal on the recognition of foreign professional qualifications, you as a medical specialist can obtain information on your responsible federal state in German and English, depending on your speciality, place of residence or preferred place of work and current status.
Further detailed information on the procedure and the required documents can be found in the following list as links to the respective federal medical associations.
- Ärztekammer Berlin (Berlin)
- Ärztekammer Bremen (Bremen)
- Ärztekammer des Saarlandes (Saarbrücken)
- Ärztekammer Hamburg (Hamburg)
- Ärztekammer Mecklenburg-Vorpommern (Rostock)
- Ärztekammer Niedersachsen (Hannover)
- Ärztekammer Nordrhein (Düsseldorf)
- Ärztekammer Sachsen-Anhalt (Magdeburg)
- Ärztekammer Schleswig-Holstein (Bad Segeberg)
- Ärztekammer Westfalen-Lippe (Münster)
- Bayerische Landesärztekammer (München)
- Landesärztekammer Baden-Württemberg (Stuttgart)
- Landesärztekammer Brandenburg (Cottbus)
- Landesärztekammer Hessen (Frankfurt am Main)
- Landesärztekammer Rheinland-Pfalz (Mainz)
- Landesärztekammer Thüringen (Jena)
- Sächsische Landesärztekammer (Dresden)
Note: North Rhine-Westphalia has two state medical associations: the North Rhine Medical Association based in Düsseldorf and the Westphalia-Lippe Medical Association based in Münster. Therefore, there are 16 federal states and 17 medical associations.
The Association of privately and publicly employed doctors in Germany (Marburger Bund) has compiled a guideline for the employment of foreign-trained doctors as well as an extensive list of FAQs. You might find some relevant information for the recognition of your degree.