Practicing as a Physician in Germany

There is a shortage of physicians, but this is only locally and generally either in the eastern states of Germany or rural areas. What is the employment situation in Germany for physicians in general? Physicians are needed! You will read here what is needed to practice as a physician in Germany – regardless of whether you want to bill the statutory health insurance companies or your patients directly. Law prohibits brokering an employment in the health industry for certain nationalities. This corresponds with WHO standards to prevent the "brain drain" of certain countries. Find out here which nationalities are restricted.

What does the law consider typical of a physician?

The physician serves the health of the individual and of the people (§1 I BÄO).
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I studied medicine back home and did well on the exam. Now I want to gain professional experience in Germany. How can I work in Germany as a physician?

The possibility for foreign doctors to work in their profession in Germany depends on their nationality and foreign qualifications. In general, there are two groups regarding the nationality of foreign doctors interested in working in Germany: Firstly, EU citizens and citizens with equal rights, and secondly, doctors from other countries. Further, there are two kinds of licenses: Approbation and Berufserlaubnis.
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What is the practical difference between a Berufserlaubnis and Approbation?

In general, the Berufserlaubnis is temporary and does not allow opening a private medical practice. It can be restricted to work under supervision by a doctor who has an Approbation and to jobs in the lower hierarchy (e.g., "Assistenzarzt"). The full medical license is not restricted in time or location. Whereas the Approbation permits practicing in all 16 German states, the Berufserlaubnis is issued by each state separately and is only valid in the issuing state. Rules for the issuance of this license, therefore, vary slightly from state to state.
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Requirements for EU-Citizens

So how do I get my license being a European?

EU citizens will receive a full medical license (so-called "Approbation") according to §3 I no. 1 BÄO if their medical studies are recognized as equivalent to the German medical studies. This is the case for medical studies completed in all EU countries if the medical studies were started after the accession date of the respective country and have been mentioned in appendix 2 to §3 I cl. 2 BÄO, or if the respective country acknowledges the equivalence according to art. 24 Directive 2005/36 (certificate of equivalence).
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Anything else that I have to be aware of?

In addition, you will have to show that you are not unreliable and not unworthy to work as a physician. A person will be unworthy when (s)he has been convicted of significant crimes. N.B. Don't worry about speeding tickets - especially not when hurrying to a patient with a life-threatening injury. Furthermore, you have to be physically and psychologically capable of working as a doctor. To work in a German-speaking environment, the applicant will also have to show that he can communicate in German sufficiently. In general, this is shown by a B2 language certificate. After taking exams at any language school in Germany or abroad, you will obtain this certificate. It is currently being discussed whether you will also have to show additional knowledge in the medical language.
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Doctors from outside the EU

I am from outside the EU club! So may I not practice here?

The possibilities for physicians from outside the Union have improved dramatically since April 1, 2012. Moreover, if your medical studies are considered equivalent, you will get the same license as German doctors.
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Okay, but I'm from outside the union. So what will be my license?

It all depends on whether your medical degree is equivalent to the German one. If the degree is equivalent, you will get an Approbation from the beginning – just like German doctors. On the other hand, if equivalence is lacking, you will initially only get a Berufserlaubnis, a restricted permission to work.
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How long will my license be temporary?

The new law intends to issue the Approbation to all doctors eventually. The initial Berufserlaubnis is therefore only valid for two years. After these two years, the assessment of professional equivalence will be re-assessed. This means that your experience in Germany will count towards your overall equivalence. If the deciding body still concludes that your medical degree is not yet equivalent, you will have the chance to take an exam and show that your knowledge is equivalent to German standards. The exam will be on all subjects required for the final German medical exam.
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Is there any chance that I might get this Approbation?

The issuance of an Approbation is imaginable, but it is discretionary (§3 III BÄO). The factor that will favor the granting is practicing in a needed discipline, integration into Germany (esp. language abilities), inconspicuous professional behavior, etc. The first time to try will be after eight years of practicing in Germany.
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Aren't there any other exceptions? For example, I heard that there is a shortage of doctors where I live.

If you have completed the initial two years with a Berufserlaubnis and your knowledge is not yet equivalent, you can get a further extension of this temporary permission.
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I applied as I was told, and the office is now asking me to show that my education is equivalent. What do they mean?

Some states require that your medical qualification be equivalent ("gleichwertig") to the German qualification. You are expected to show studies in medicine of at least six years and certain subjects during your studies and practical internships. The equivalence is generally assessed by certain lists which the federal states have agreed upon.
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But hey, I've been working for the last few years in France. Do I have to do it all over again? I got my French certificate of equivalence. Doesn't that count?

Mais oui! Yes, a French certificate is absolutely fine.
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Following the office's request, I submitted proof of medical education. They came back and told me that they were about to deny my application because I did not show the equivalence of my education. Is now all lost? Is there anything I can do?

Relax! Until you get the final decision, you can still enhance your details! Since your medical qualification seems insufficient according to the requirements above, this is the time to submit further documents to prove equivalence. New developments indicate that the personal experience as a doctor might have to be taken into consideration more effectively to assess the equivalence adequately.
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Great! The office just ultimately denied me. They do not see the equivalence of my education. Now what? Must I study medicine again?

Well, this is not the absolute end of the story. Even when the equivalence has been irrevocably rejected, you can prove it by passing an exam to show equivalence, a so-called "Kenntnisprüfung (test of knowledge)". However, some states require the applicant to fulfill a period of adjustment ("Anpassungszeit") which usually takes 18 months and requires at least six months in the area of internal medicine as well as surgery before being allowed to take the "Kenntnisprüfung".
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Knowing the Germans use this funny Latin alphabet, we use this beautiful Sanskrit at home. However, I don't believe that the office will really understand it. Do I have to translate the certificates?

Yup! All documents have to be either in original or be verified copies. In addition, documents in languages other than German have to be translated by a court-approved translator.
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How long will the application procedure take until I can work?

This can last from a few weeks to a few months - after all details have been submitted.
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How much will the application cost?

The license of a Berufserlaubnis will cost around € 300. The equivalence test will cost approximately just as much - extra.
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Is there any special treatment for foreign physicians in Germany?

Yes and no. In general professional life, you will be treated as all other physicians. One special thing is to be mentioned. When it comes to executing court orders, or when you are sued in court, or a criminal investigation against you has been initiated, you have to consider that the Ärztekammer (Physician's Chamber or regulatory body of physicians) will be informed. When this body considers it important, it will question you, seeking an explanation. Understand this questioning as testing your license. Depending on the seriousness of the matter, do get legal help! Only fools represent themselves, for it is a wise saying among attorneys that every lawyer who represents himself has a fool for a client.
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What applies if I am 45 or older?

If you are 45 years or older, you also have to receive a salary of at least € 4015 in western Germany resp. € 3905 for eastern Germany. If your salary will be lower than that threshold, you will have to show an adequate pension plan or other provisions for retirement. This coverage can be either the state pension plan from home, private savings, or closing a German pension plan or a mixture of all. The government wants to make sure that you will not be dependent on welfare upon retiring.

N.B. This is only relevant for the very first permit!
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What does a physician earn in Germany?

The overall average monthly salary for a physician in Germany is € 6,620. You will find more and fine-tuned information on the website of the Federal Labor Agency in their remuneration atlas.