Legal framework

(Status as of spring 2020)

Professional recognition

If you want to work as a medical doctor in Germany, you need a state licence, a “professional permit” (“Berufserlaubnis”) – a temporary licence to practise – or a so-called “Approbation” – a full licence to practise. The Approbation is an unrestricted professional permit.

To grant the full licence to practise [Approbation], the Medical Associations review the equivalency of the medical training. As long as medical doctors are awaiting the equivalency, a temporary and geographically limited temporary licence to practise can be issued.

The training as a specialist also requires recognition.

Temporary licence to practise (Berufserlaubnis)

Up to the time the review for equivalency of medical training (granting the full licence to practise [Approbation] – which can sometimes extend over several years) – it is possible to practise as a medical doctor in a restricted way with a temporary licence to practise [Berufserlaubnis]. It is necessary to apply for the temporary licence to practise [Berufserlaubnis] each time at the relevant authority (differs depending on the federal state) and it is usually issued for a maximum of two years (Section 10 Federal Medical Practitioners’ Act [Bundesärzteordnung (BÄO)]. It is limited to the state where it was issued. To be granted a temporary licence to practise [Berufserlaubnis], the prerequisite is that the applicant has completed a medical degree and can provide evidence of this. Details on the application for and the grant of a temporary licence to practise [Berufserlaubnis] vary from state to state; the responsible State Medical Association issues this information.

Frequently it is not possible to count the medical activity to be practised within the time frame of a temporary licence to practise [Berufserlaubnis] towards postgraduate training as a specialist – this is also a political decision for the federal state and differs depending on the state.

For everyday professional work, the temporary licence [Berufserlaubnis] means that practising medicine may be limited to certain activities and employment positions (Section 10 (2) Federal Medical Practitioners’ Act [Bundesärzteordnung (BÄO)] and that certain activities can only be performed under the supervision of someone with a full licence to practise [Approbation].

With a temporary licence to practise [Berufserlaubnis], it is possible to submit an application for a full licence to practise [Approbation]. The temporary licence to practise [Berufserlaubnis] does not preclude the grant of a full licence to practise [Approbation] (Section 10 (1a) Federal Medical Practitioners’ Act [Bundesärzteordnung (BÄO)]) and the time can be used to prepare for a possible full licence to practise [Approbation] or equivalency review

Full licence to practise (Approbation)

In contrast to a temporary licence to practise [Berufserlaubnis], a full licence to practise [Approbation] allows practising medicine without restrictions, has an unlimited term and is valid nationwide. Applicants who have completed a medical degree can apply for a German full licence to practise [Approbation].

For this purpose, however, it is necessary to determine equivalency to a German degree. Equivalency and medical expertise can be demonstrated in the context of a documentation review or by a personal examination (knowledge examination).

The equivalency review is uncomplicated for medical doctors from EU countries, as medical studies from an EU country are classified as equivalent (cf. Federal Medical Practitioners’ Act [Bundesärzteordnung (BÄO)]). For medical doctors who have completed their medical studies in a third country, the State Medical Association reviews the equivalency of the training completed abroad. It also takes into account professional experience gained in Germany or abroad and assesses whether this can compensate for significant differences resulting from the training (Section 3 (2) (2) in conjunction with Section 4 (1) Federal Medical Practitioners’ Act [Bundesärzteordnung (BÄO)]).

Should it not be possible to demonstrate equivalency by formal criteria, medical doctors must pass a knowledge examination (in colloquial terms: equivalency examination).

Should it not be possible to demonstrate equivalency by formal criteria, medical doctors must pass a knowledge examination (in colloquial terms: equivalency examination).

“Knowledge examination” (or equivalency examination)”

As already mentioned, there must be a knowledge examination if the completed medical degree is not formally recognised as equivalent. Good preparation is important because it can only be repeated twice (Section 4 (4) Federal Medical Practitioners’ Act [Bundesärzteordnung (BÄO)]). It cannot be repeated a third time (ibid.).

This can put a lot of pressure on medical doctors, as a young medical doctor explains:

This simply means very big pressure for everyone. If you fail there too, then you know that you have one more time; I have to do it this once. (Interview WD-06)

Examination requirements and contents with a description and sample evaluation form can be found on the websites of the State Medical Associations. 

Kenntnisprüfung (bzw. Gleichwertigkeitsprüfung)
Wie bereits erwähnt, muss eine Kenntnisprüfung erfolgen, wenn das absolvierte Medizinstudium nicht formal als gleichwertig anerkannt wird. Eine gute Vorbereitung ist wichtig, da sie nur zwei Mal wiederholt werden darf (§4 Abs.4 BÄO). Sie kann kein drittes Mal wiederholt werden (ebd.).

Dies kann bei Ärztinnen und Ärzten großen Druck ausüben, wie eine junge Ärztin erzählt:

Das ist für alle sehr großer Druck einfach. Wenn man da auch noch durchfällt, dann weiß man, dass man noch einmal hat, dieses einmal muss ich es schaffen. (Interview WD-06)

Prüfungsanforderungen und-inhalt mit Beschreibung und Musterbewertungsbogen können auf den Webseiten der Landesärztekammern gefunden werden.

Language test

Knowledge of technical terminology is a formal requirement to be able to practise as a medical doctor in Germany. Pursuant to Section 3 (1) No. 5 Federal Medical Practitioners’ Act [Bundesärzteordnung (BÄO)], in addition to the equivalent professional qualification (knowledge examination), medical doctors must have “the knowledge of the German language required for professional activity”.

Medical doctors must prove general language skills at level B2 and specialist language skills at level C1. No full licence to practise [Approbation] can be granted without this proof.

B2 and C1 German tests can be found on (


Obtaining a full licence to practise [Approbation] is associated with high costs; these include fees for the translation and recognition of certificates, processing fees, costs for language courses and tests as well as for the knowledge examination.

Medical doctors who are in the asylum process, are already recognised as refugees or so-called “ethnic German repatriates” [“Spätaussiedler”] (e.g., humanitarian residence pursuant to Section 25 Residence Act [Aufenthaltsgesetz (AufenthG)] can receive state financial support for the recognition of certificates, for the language courses, technical terminology test and knowledge examination (cf. German Social Code [Sozialgesetzbuch (SGB) III & Residence Act [Aufenthaltsgesetz (AufenthG)]). Medical doctors who come from an EU country, from a third country or arrive as a family member are not entitled to state support.

These language courses can be financed by the state for medical doctors who are entitled to social insurance benefits – such as persons with a humanitarian residence permit or ethnic German repatriates – (see Section 44 ff. Residence Act [Aufenthaltsgesetz (AufenthG)], Section 3 (2a) German Social Code [Sozialgesetzbuch (SGB) II, Section 421 German Social Code [Sozialgesetzbuch (SGB)] III).

Immigration counselling centres for adults

This complex process of educational recognition, limited residence permit, language courses, etc. is not a task that a hospital or a migrant medical doctor has to deal with on its or his/her own. Since 2005, the umbrella organisations of independent welfare services [Spitzenverbände der Freien Wohlfahrtspflege] have set up immigration counselling centres for adults that specialise in integration processes for immigrants. This counselling is free, confidential and focuses on the following:

  • Language promotion, such as support with language and integration courses;
  • Support with the recognition of professional qualifications and recognition of foreign degrees;
  • Advice on vocational training and postgraduate training;
  • Social counselling;
  • Searching for a flat;
  • Debt counselling;
  • Family matters such as Nursery school/child care;
  • Marriage, families and raising children;
  • Support in finding leisure and contact opportunities;
  • Questions about residence and asylum law;
  • Questions about social law;
  • Intercultural encounters and neighbourhood/district work;
  • Social integration;
  • Psychosocial needs
    and much more.

The immigration counselling centres for adults represent a professional service and can be found on the Internet (e.g., [Federal Office for Migration and Refugees [Bundesamt für Migration und Flüchtlinge (BAMF)]). The independent welfare services also provide information about where to find immigration counselling centres for adults.