Practicing as A Doctor in Germany

This catalogue of questions and answers is only a recommendation and legally not binding. It is not meant to replace counselling by the relevant regional association of the Marburger Bund or the Federal Association  Bundesärztekammer/Bundeszahnärztekammer

1. Which organisation is competent for the recognition of foreign medical diplomas?

All foreign physicians who want to work in Germany as physicians must go to the competent Federal State authority to have their medical diplomas (medical training) recognised.  In some Federal States there is only one medical license agency (Approbationsbehörde), whereas other Federal States have several medical license agencies (Approbationsbehörden) for different regions. But only one agency is relevant for the area where the physician wants to work (see list:Approbationsbehörden).

Concerning the recognition of specialist qualifications only the State Chambers of Physicians (Landesärztekammern) are competent.  The recognition of the specialist diploma is incumbent to the State Chamber of Physicians responsible for the area where the physician wants to work (see list: Ärztekammern).

2. What are the documents to be submitted for the recognition?

The competent medical license agency (Approbationsbehörde) provides the information as to which documents must be submitted for the recognition of the medical diploma (see list: Approbationsbehörden).

The competent State Chamber of Physicians provides the information as to which documents must be submitted for the recognition of the medical specialist diploma (see list: Ärztekammern).

3. What role does the citizenship play regarding the granting of the medical license?

Since the taking effect of the so-called recognition law (April 1, 2012) the citizenship is totally irrelevant in the granting of the medical license.

4. I have successfully completed my medical formation in a member country of the European Union (EU), in Norway, Iceland, Liechtenstein or Switzerland. Will my medical diploma be recognized?

A medical education completed successfully in a member country of the European Union will, on request, be automatically recognized in Germany provided that the qualification is listed in the EU Directive on the Recognition of Professional Qualifications (2005/36/EC, Annex V.1.1), that the minimum criteria of the directive are met and that the formation had been started after the specified reference date.

As the EU has passed the corresponding treaties with Norway, Iceland, Liechtenstein and Switzerland, a successfully completed medical education in these countries is equivalent to the graduation in EU countries.

If all the other requirements are met (knowledge of the German language, health requirements, no criminal record, etc.), the applicant obtains the medical license.

5. I have started my medical education in an EU country before the specified reference date (before the EU-entry of the country). Will my medical diploma be recognised?

Medical diplomas from EU countries certifying that the education 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 home member state confirms that the 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 home member state (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.

6. I have started my medical education at a time when the territory of the current EU country (e.g. Lithuania) belonged to the territory of another state (e.g. the Sovjet Union). Will my diploma be recognised?

Such a diploma will only be recognised in Germany if the relevant authority of the home country confirms that the diploma has the same legal validity regarding the access to the profession and to its practice as the diplomas issued in the present member state. Additionally there must be an attestation that the applicant has been working medically during the past five years at least for three consecutive years full-time, effectively and lawfully in the territory of the present member state.

7. Where do I find the European Directive on the Recognition of Professional Qualifications on the Internet?

The European Directive on the Recognition of Professional Qualifications (2005/36/EC) can be downloaded under the following link:

http://ec.europa.eu/internal_market/qualifications/policy_developments/legislation/index_gb.htm

8. I have successfully completed my education in a country outside of the European Economic Area and Switzerland. Will my diploma be recognised?

Medical diplomas obtained outside of the European Economic Area and Switzerland will be submitted in Germany to an assessment of equivalence by the authority responsible for the granting of the medical licenses (see list: Approbationsbehörden, medical license agencies). If the relevant authority confirms the equivalence of the foreign diploma or that potential differences in the education may be compensated by pertinent work experience and if all the other requirements are met (knowledge of the German language, health requirements, no criminal record, etc.), the applicant is granted the medical license.

If the relevant medical license authority finds that there are significant differences between the medical education of the applicant’s home country and the medical education in Germany it may insist on the taking of an examination (assessment test) provided that the differences in education cannot be compensated by pertinent professional experience. The professional experience may be obtained around the world.

The assessment of equivalence and the evaluation of professional experience is a case-by-case review conducted by the relevant authority.

9. What is an assessment test?

The assessment test refers to the substance of the German medical training. The foreign physician is to demonstrate that he has the knowledge equivalent to the one required by German graduates of the medical universities. According to a new regulation, which will come into force on 1 January 2014, the emphasis of the assessment test will lay 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 relevant authority can inform the candidate in advance that another subject or cross-section will be part of the assessment test if the authority is of the opinion that there is a major difference in the medical curriculum in Germany and in the medical curriculum which the examinee attended.

The assessment 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.

10. When do I have to take the assessment test?

The specific moment in time when the test can be taken varies between the different Federal States. Thus foreign physicians often obtain a provisional license to practice in preparation of the assessment test (6-24 months, depending on the Federal State) before the test must be taken. The completion of this preparatory period is however not a guarantee for the successful completion of the assessment test. Therefore a thorough theoretical preparation of the test is highly recommended.

The completion of a preparatory period is not a prerequisite for the admission to the assessment test.

11. How can I prepare for the assessment test?

Various institutes in Germany offer integration courses for foreign physicians and offer preparatory courses for the assessment test. The following institutes are approved by the Federal Employment Agency: Gemeinnützige Gesellschaft für berufsbildende Maßnahmen mbH Berlin (www.gfbm.de), Kulturakademie Dresden (www.kulturakademie-dresden.de), mibeg-Institut Medizin (www.mibeg.de), VIA-Institut Nürnberg (www.via-institut.de).

For many years the Marburger Bund co-operates trustfully with the VIA-Institut in Nuremberg.

12. How am I getting paid during the “preparatory period”?

The Marburger Bund takes the view that the foreign physician is entitled to a remuneration according to our collective agreements as he is also medically active with a professional permit.  De facto such remunerations are not always the case.

13. What is the maximum period of time such professional permits can be granted for?

Since 1 April 2012 a professional permit 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 professional permit will be limited to the particular speciality.

14. What language skills are required?

One of the basic requirements which must be met by foreign physicians intending to work in Germany is the attestation of adequate knowledge of the German language. The physician is to contact the medical license agency responsible for the area he wants to practice in (see list: license agencies). The relevant agency decides which certificates/attestations it recognises. Currently the requirements vary between the different Federal States.

In our experience most of the license agencies accept Goethe Certificate B.2 and TELC Certificate B.2. Some agencies (e.g. Baden-Wuerttemberg, North Rhine-Westphalia) require furthermore evidence of proficiency regarding the medical language. Other agencies expect moreover from the physician to appear in person. In Rhineland-Palatinate they actually accept only an attestation for medical terminology by the Medical Association. In Hesse they require Goethe Certificate B.2 or TELC Certificate B.2 for the granting of the professional permit, whereas for the application for the medical license  (Approbation) you need Goethe Certificate C.1 or TELC Certificate C.1.

The Ministers of Health of the Federal States have agreed in June 2013 that foreign physicians must have sufficient skills in colloquial language as well as in medical language and they aim as far as possible for uniform test procedures of language skills in the States. Presently they are elaborating the key points.

15. Which organisation is responsible for further medical training as a specialist?

For all matters regarding further medical training in view of obtaining the status of a specialist the State Chambers of Physicians as public bodies are responsible. For each physician only the “Regulations for further medical training” issued by the State Chamber where he is a member are legally binding.

16. Do I have to register with a State Chamber?

Definitely. All physicians working in Germany must be a member of the relevant State Chamber. This applies to physicians during further medical training as well as to specialists.

17. What are the income opportunities for physicians during further medical training and for specialists?

Marburger Bund as the only trade union for physicians in Germany has concluded specific wage agreements with the different hospital operators. Wages and other working conditions (e.g. working hours) slightly vary according to each wage agreement. In communal hospitals physicians in further medical training currently earn a monthly gross salary between 3,944.20 € (first year of further training) and 5,069.98 € (sixth year of further training).  Monthly gross salaries for specialists are from 5,205.70 € (1rst year) to 6,685.44 € (from 13th year onward). These salaries are for a 40-hour workweek. Additional services and overtime are paid extra.

The “Career Entry Brochure” by Marburger Bund offers a thorough overview of the physician wages at the different hospital operators.

These wage agreements don’t apply directly to physicians in further medical training (residents) or to employed specialists in outpatient services (medical practice, ambulatory healthcare centre, etc.); they should, however, serve as a basis while negotiating wages and other working conditions.  Here also, Marburger Bund can provide you with model employment contracts to be ordered from the regional association and/or from the Federal Association.

18. What does the job market look like and where do I look for vacancies?

In Germany there are many vacant positions for physicians. There is a lack of physicians particularly in the countryside and in small towns. Employment ads may be found e.g. in the following media:

• Deutsches Ärzteblatt: www.aerzteblatt.de
• Marburger Bund: http://www.marburger-bund.de/mbz/stellenmarkt
• Websites of hospitals

19. Which organisation can advise me in matters pertaining to labour law?

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 Marburger Bund reaches far beyond this offer. You’ll find more details on the advantages of a membership in Marburger Bund under:

http://www.marburger-bund.de/mitgliederservice#rechtsberatung