Working as a Doctor in Germany: Approbation Guide for IMGs 2026

Germany is one of the largest employers of internationally trained doctors in Europe. According to the German Medical Association's physician statistics, about 446,000 doctors were working in Germany on 31 December 2025, and 16 percent of working doctors do not hold German citizenship. The route to practice runs through the Approbation, the permanent licence to practise, and for most non-EU graduates through two exams: the Fachsprachprüfung (medical German) and the Kenntnisprüfung (knowledge test). A German version is available at /de/countries/working-as-a-doctor-in-germany/.

Key facts

The German healthcare system

Germany has a statutory health insurance system covering most of the population, plus private insurance. Care is split into the inpatient sector (hospitals run by municipal, non-profit and private owners) and the outpatient sector (office-based doctors, mostly working with statutory health insurance accreditation). The physician statistics show that foreign doctors work predominantly in hospitals, which is where most international doctors start, usually as assistant doctors (Assistenzärztin/Assistenzarzt) in specialist training.

Authorities

• State licensing authorities (Approbationsbehörden) issue the Approbation and Berufserlaubnis and order the Kenntnisprüfung. Each federal state has its own authority, and you apply in the state where you intend to work.
• State medical chambers (Landesärztekammern) run the Fachsprachprüfung in most states on behalf of the authority, regulate specialist training and keep the membership register. The Bundesärztekammer is their umbrella organisation. See /councils/bundesaerztekammer-und-landesaerztekammern/.
• Gutachtenstelle für Gesundheitsberufe (GfG) can provide equivalence opinions for the states.

Recognition of foreign degrees

The route depends on where you earned your degree:

• EU, EEA and Swiss degrees are recognised under EU rules, often automatically; any compensation measure is called an aptitude test (Eignungsprüfung).
• Third-country degrees are checked for equivalence. If substantial differences exist, or if checking equivalence would require unreasonable effort, you must pass the Kenntnisprüfung.

Required documents include a CV, birth certificate, proof of identity, certificate of good conduct and a medical certificate (both no older than one month) and your degree, with certified translations. Authorities typically request additional evidence for foreign degrees, such as transcripts and proof of professional experience. For a detailed German-language walkthrough, read Approbation in Deutschland.

Exam process step by step

1. Choose a federal state and identify the responsible licensing authority.
2. Learn German to at least B2 general level, then prepare for medical German at C1.
3. Submit your application for the Approbation with all documents.
4. Pass the Fachsprachprüfung. It is typically structured in three parts of about 20 minutes each: a simulated doctor-patient conversation, written documentation and a doctor-doctor conversation. Read our Fachsprachprüfung guide.
5. Optional: work with a Berufserlaubnis while you prepare, if your state grants it.
6. Pass the Kenntnisprüfung if required. It is an oral-practical exam with patient presentation, focusing on internal medicine and surgery, plus emergency medicine, clinical pharmacology, imaging, radiation protection and legal aspects; it lasts 60–90 minutes per candidate. The result is pass or fail, and it may be repeated twice. See the Kenntnisprüfung guide.
7. Receive the Approbation and register with the state chamber.

Costs

Germany has no single national fee. Fees for the Approbation procedure, the Fachsprachprüfung and the Kenntnisprüfung are set by each federal state and its chamber and differ noticeably. Check the fee information of your licensing authority and chamber before applying. Budget also for certified translations, language courses, a possible equivalence opinion and visa costs.

Timeline

The only fixed deadline is the authority's decision: no later than four months after all documents are available, and within two months in the accelerated skilled-worker procedure. Total duration depends on:

• your German level when you start,
• waiting times for the Fachsprachprüfung and Kenntnisprüfung in your state,
• completeness of your documents and translations,
• whether you work with a Berufserlaubnis in the meantime (generally max. two years).

Language requirements

You need the German language skills necessary for practice. In 2014, the Conference of Health Ministers set medical German at CEFR level C1. Many states also require a general-language certificate at B2 before admission to the Fachsprachprüfung. Rules on retakes differ: Lower Saxony, for example, states the exam is repeated as a whole and the number of attempts is not limited. Check your chamber's information sheet.

Specialist training (Weiterbildung)

Specialist training is regulated by the state chambers on the basis of the Bundesärztekammer's model regulations, the (Muster-)Weiterbildungsordnung. You train as an employed doctor at an authorised training site and finish with a specialist exam at the chamber. Minimum training periods are defined for each specialty in the regulations. Training completed abroad can be credited on application if it is equivalent. With a Berufserlaubnis, whether training time counts depends on state rules, so ask your chamber in writing.

Working conditions

Hospital doctors are mostly employed under collective agreements, for example the TV-Ärzte/VKA for municipal hospitals, which define pay groups by experience and position and set working-time rules. The agreements are public; check the current tables rather than salary portals. Working time must stay within the legal limits and the agreements' on-call rules.

Document checklist

Licensing authorities typically ask for:

• CV in tabular form, signed.
• Birth certificate and proof of identity.
• Certificate of good conduct and medical certificate, both no older than one month at submission.
• Medical degree, transcript with subjects and hours, and internship certificate.
• Certificate of good standing from your previous regulator.
• Proof of German language skills.
• Certified German translations of all foreign-language documents.

Requirements differ slightly by state. Use your authority's checklist and send a complete file, because the four-month decision period only starts when everything is there.

Preparation strategy

For the Fachsprachprüfung, practise the three parts under exam conditions: take a history from a simulated patient, write a structured documentation within the time limit, and present the case to a colleague. Learn both medical terms and lay equivalents, because patients use everyday language.

For the Kenntnisprüfung, prepare for an oral-practical exam focused on internal medicine and surgery:

1. Revise the core subjects using German textbooks and guidelines, so you learn the terminology examiners use.
2. Practise patient presentations aloud, including differential diagnosis, diagnostics and therapy.
3. Cover the extra subjects that can be examined, including emergency medicine, pharmacology, radiation protection and legal aspects.
4. Use case-based questions to train clinical reasoning; see active recall and practice questions.

Choosing a federal state

Pick the state where you have a realistic job prospect and check its authority's guidance before you apply.

Visa basics

Doctors from outside the EU usually need a residence permit for skilled work or for recognition measures. The accelerated skilled-worker procedure can shorten the recognition decision to two months. Visa matters are handled by German missions abroad and local immigration offices; check the official "Make it in Germany" portal for current routes.

Typical mistakes

• Underestimating German. C1 medical German is a real exam, not a formality.
• Applying in one state and moving to another mid-process, which can restart steps.
• Incomplete documents, which stop the four-month clock from starting.
• Relying on the Berufserlaubnis too long; it is generally limited to two years.
• Preparing for the Kenntnisprüfung like a written exam. It is oral-practical with patient presentation.

Next steps

1. Pick your federal state and read its licensing authority's information.
2. Plan your German pathway to C1.
3. Practise clinical cases with the MediFlow Germany clinical track, with free test questions, or in the MediFlow app.
4. Compare with Austria and Switzerland.