Work and training in Germany
In order to practise medicine or carry out specialty training in Germany, all physicians must be in possession of a valid full or temporary licence to practise. The full licence to practise (Approbation) is valid across the country for an unlimited period of time. The temporary licence to practise (Berufserlaubnis) is limited to a certain time period and is valid only within the federal state in which it was issued. In certain cases, a temporary licence may be limited to one position.
The Federal Government’s Recognition Act (Anerkennungsgesetz) came into effect on 1 April 2012. It improves the procedure for assessing and recognising professional and vocational qualifications obtained abroad. It allows individuals to have the equivalence of their professional qualifications assessed, regardless of nationality.
The state health authorities (Approbationsbehörden) of the respective federal state (Land) are responsible for issuing full and temporary licences to practise.
The prerequisites for becoming a member of the medical profession in Germany are set out in the Medical Practitioners’ Act (Bundesärzteordnung) and the Licensing Regulations for Physicians (Approbationsordnung).
Physicians wishing to practise in Germany must also become a member of one of the 17 State Chambers of Physicians (Landesärztekammer). Each of the 16 federal states of Germany has a State Chamber of Physicians (there are two in North Rhine-Westphalia). As corporations under public law, these bodies are responsible for the administration of all matters related to specialty training in Germany. The state laws governing the healthcare profession and the activities of the Chambers (Heilberufekammergesetz) set out the responsibilities of the State Chambers of Physicians with respect to physicians professionally active, or residing, within their area of jurisdiction.
Basic medical training in Germany
The principles governing medical training in Germany are set out in the Licensing Regulations for Physicians (Approbationsordnung) of 27/06/2002 (last amended by Art. 5 B from 18/04/2016 I 886).
According to Article 1, Paragraph 2, medical training comprises:
- undergraduate medical studies of no fewer than six years at a university or equivalent academic institution which, subject to section 3, paragraph 3, sentence 2, must include 48 consecutive weeks of practical training (practical year)
- first aid training
- three months of nursing experience
- a four-month clinical elective
- a medical examination in three stages
- with respect to section 10, paragraph 2 of the framework laws on further education (Hochschulrahmengesetz), the regular length of study, including time required for the third stage of the medical examination, should, according to section 16, paragraph 1, sentence 2, amount to six years and three months.
According to Paragraph 2, Nr. 5, the medical examination is administered as follows:
- the first stage of the medical examination takes place after two years of study in the field of medicine
- the second stage of the medical examination takes place three years after successful completion of the first stage ( following a total of five years of study in the field of medicine)
- the third stage of the medical examination takes place one year after successful completion of the second stage (following a total of six years of study in the field of medicine)
A period of practical training takes place following successful completion of the second stage of the medical examination, according to article 1, paragraph 2, sentence 1. Training begins either in mid-May or mid-November and consists of three 16-week work placements in:
- internal medicine
- either general practice or in another clinical/practical specialty, with the exception of those already listed in points 1 and 2
Proof of completion of training in first aid must be presented in order to register for the first stage of the medical examination (Approbationsordnung §10 paragraph 4).
The three months of nursing experience must be completed at a hospital or in a rehabilitation facility with a comparable level of required care either before university or during one of the semester breaks prior to the first stage of the medical examination. The aim of this is to give students or prospective students an insight into the operations and organisation of a hospital, and to familiarise them with the day-to-day activities of the nursing profession. The compulsory nursing experience can also be completed in three one-month segments.
The four-month clinical elective takes place outside of teaching periods between the first stage and the second stage of the medical examination. Proof of completion of a clinical elective must be presented in order to register for the second stage of the medical examination.
Further information about this may be found under "Ausbildung" on the website of the German Medical Association.
The website of the Institute für medizinische und pharmazeutische Prüfungsfragen (IMPP) (Institute for Medical and Pharmaceutical Examination Questions) is also a good source of information for queries related to medical studies in Germany. It also contains the contact details of the Landesprüfungsämter(State Examination Authorities), which are responsible, among other things, for assessing the eligibility of periods of study carried out abroad.
The Hochschulrektorenkonferenz (HRK) (Conference of University Rectors) is the voluntary association of state and state recognised higher educational institutions in Germany.
Specialty training in Germany
Specialty training in Germany takes place exclusively within the framework of medical practise, and junior physicians receive remuneration for their work. A prerequisite for beginning specialty training is the acquisition of a full or temporary licence to practise medicine (Approbation or Berufserlaubnis). Physicians who have completed their basic medical training and are in possession of a valid full or temporary licence to practise are entitled to apply for a position as a junior physician at an institution licensed for medical training in the relevant area of specialisation.
Specialty medical training usually takes between five and six years to complete, depending upon the specific training regulations for the specialty. Training is supervised by a clinical tutor authorised by the State Chamber of Physicians and takes place in a university hospital, clinic or other approved medical institution. This may include an outpatient unit under the supervision of a practise-based physician. Lists of authorised institutions may be found on the websites of the relevant State Chambers of Physicians under “Weiterbildung”.
Whereas the regulations regarding basic medical training and the granting of licences to practise are standardised at a national level through the Medical Practitioners’ Act (Bundesärzteordnung) and the Licensing Regulations for Physicians (Approbationsordnung), regulations on the content and configuration of specialty training are laid out in state by-laws and the autonomous statutes of the State Chambers of Physicians. These are largely based upon the Guideline Regulations on Specialty Training of the German Medical Association. These define the areas, focus and competencies covered during specialty training, as well as additional designations. The up-to-date specialty training regulations of each State Chamber of Physicians, which set out the content and duration of the specialty training for each area of specialisation, are available on their websites.
During their period of training, junior physicians must fulfil the points stipulated in the specialty training regulations and guidelines on the content of specialty training. Only then may they apply to the State Chamber of Physicians to be assessed. This takes the form of an oral examination with a committee of three physicians, two of whom will be qualified specialists in the area to be examined, who decide whether the specialty training has been completed successfully. Upon successful completion of the examination, the physician will be awarded a specialist diploma (Facharztdiplom) by the State Chamber of Physicians.
Further information about specialty training may be found under "Weiterbildung" on the website of the German Medical Association.
Scholarship holders (Stipendiaten)
Many countries have programmes which offer financial support or scholarships for physicians to come to Germany to conduct specialty training.
In order to avoid any misunderstandings about the requirements for specialty training in Germany and possible problems resulting from this, the German Medical Association has developed an Information Sheet for foreign physicians on the recognition of specialty training conducted within the framework of a scholarship or other funding programme. This sets out the formal and professional requirements which must be fulfilled by anyone conducting specialty training in Germany.
Each individual federal state has its own regulations on specialty training, the details of which can vary from state to state. The German Medical Association therefore recommends that physicians coming to Germany to carry out specialty training always seek advice from the State Chamber of Physicians responsible for the state in which they will work before training begins.
Recognition of specialty training carried out abroad
The competent authorities responsible for issuing the licence to practise medicine (Approbationsbehörden) assess the equivalence of training qualifications obtained abroad. The Medical Practitioners’ Act (Bundesärzteordnung) and the latest version of the Licensing Regulations for Physicians (Approbationsordnung) form the legal basis for the practise of medicine in Germany. EU diplomas are also subject to the principles of Directive 2005/36/EC of the European Parliament and the European Council on the recognition of professional qualifications. The recognition of specialty training carried out within the European Union is regulated by the EU Directive 2005/36/EC.
The State Chambers of Physicians (Landesärztekammer) are the main authorities responsible for all aspects of specialty training and for issuing binding decisions with regards to specialty training issues for their members. The specialty training regulations (Weiterbildungsordnung) of the State Chambers of Physicians contain legally binding provisions for the recognition of periods of specialty training carried out or completed abroad by members. The German Medical Association, representing the joint association of the State Chambers of Physicians, is not authorised to regulate or recognise periods of specialty training completed abroad. The State Chambers of Physicians, as corporations under public law, are the only bodies in Germany authorised to do so.
A physician must be a member of a State Chamber of Physicians before his or her specialist qualifications or periods of specialty training abroad may be assessed for equivalence. For information concerning membership of the State Chambers of Physicians (compulsory or voluntary) please contact them directly.
According to the specialty training regulations (Weiterbildungsordnung) of the relevant State Chamber of Physicians, periods of specialty training or other professional activity abroad can, as a general rule, only be accredited if they have taken place for a minimum duration of 6 months at an institution licensed for specialty medical training. Upon completion of training abroad, physicians should obtain a detailed certificate containing information about the size of the hospital at which training took place, the activities of the department in which he or she was employed, as well as any activities carried out independently. The certificate should reflect the content of the specialty training regulations of the relevant State Chamber of Physicians.
For further information for citizens of the European Union, the European Economic Area and Switzerland, as well as for citizens of other countries not members of the above, please see the links below.
- Physicians who completed their basic medical training in the EU, EEA or Switzerland
- Physicians who completed their basic medical training outside the EU, EEA or Switzerland
Information concerning vacancies for physicians at hospitals, institutes or other health facilities in Germany may be found on the website of the Federal Employment Agency.
The German Medical Journal (Deutsches Ärzteblatt), published weekly by the German Medical Association and the National Association of Statutory Health Insurance Physicians (Kassenärztliche Bundesvereinigung), contains a large jobs section.
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