Germany urgently needs doctors — particularly in rural and underserved regions. Yet for physicians with foreign medical degrees, the path to practicing medicine can be long, complex, and bureaucratic. How can international doctors successfully navigate the system? Here’s an overview.

Many Clinics Remain Empty

Although the number of practicing physicians in Germany continues to rise, access to care remains uneven. By the end of 2023, the German Medical Association recorded around 428,000 active physicians — a record high. Yet this figure hides deep structural imbalances.

Shortages are especially acute in rural regions and in specialties such as psychiatry, pediatrics, and anesthesiology. The problem is not the total number of doctors but rather the unequal distribution of physicians across regions and disciplines.

According to forecasts from the Robert Bosch Foundation, Germany could face a shortage of around 11,000 general practitioners by 2035. In economically weaker districts, up to 40% may experience serious underprovision of care. The German Advisory Council on Health and Care similarly warned in its 2024 report that without intervention, roughly 11% of all physician positions could remain unfilled by 2035.

Foreign Doctors: An Increasingly Vital Workforce

The shortages are driven by several trends: an aging medical workforce, the rise of part-time employment, increasing treatment demands, and greater subspecialization. While large cities often face a surplus of physicians, rural practices and hospitals struggle to recruit and retain staff.

To fill these gaps, international recruitment has become an essential part of Germany’s healthcare strategy. Today, about 1 in 7 doctors in Germany received their medical education abroad — and that share continues to grow. Yet for many internationally trained physicians, entering the German healthcare system remains a time-consuming and paperwork-heavy process.

Licensure: The Gateway to Practicing Medicine in Germany

In Germany, doctors can only practice independently after obtaining an approbation — the official medical license to practice. This is issued by the licensing authorities of the individual federal states.

To qualify, applicants must meet several requirements (see also the overview in the box at the end of the article):

• Verification of medical qualifications
• Proof of personal reliability (no criminal record and legal compliance)
• Evidence of medical fitness
• Demonstrated language proficiency

The process is governed by the Federal Medical Practitioners’ Act and the Licensing Regulations for Physicians. The specific steps depend on where the medical degree was earned.

Different Procedures for EU and Non-EU Degrees

Doctors who obtained their medical degree in an EU or European Economic Area country, or in Switzerland, benefit from the European Professional Qualifications Directive. This law provides for automatic recognition of medical qualifications earned after a country’s accession to the EU framework. As a result, their applications are typically processed within 2-6 months.

Physicians trained in non-EU countries (so-called third countries) face a more demanding recognition process. Authorities must compare the duration, structure, and content of the applicant’s medical education with that of a German medical program.

If significant differences are identified, applicants must pass a knowledge examination to prove their expertise is equivalent to that of German graduates. Without this exam, the recognition process usually takes 6-12 months; with it, preparation and approval can take up to 2 years.

Bureaucracy and Documentation

Applicants must submit an extensive set of documents to the relevant licensing authority, including:

• Diplomas and certificates of medical education
• Detailed transcripts of subjects and clinical hours
• Evidence of prior professional experience
• Proof of identity
• A recent certificate of good conduct (police clearance)
• A medical certificate confirming fitness to practice 

All documents must be submitted in certified German translations, which can significantly add to processing times.

The medical certificate must be issued by a licensed physician in Germany and dated no more than 3 months before submission. Typically, a short consultation and basic physical exam are sufficient; complex diagnostic tests are not required.

The certificate of good conduct confirms that the applicant has no criminal record incompatible with medical practice. Applicants already residing in Germany can obtain it from the local registration office. Those living abroad generally need an additional police clearance from their home country, which must also be translated and authenticated.

Language Competence: A Decisive Factor

Proving sufficient language proficiency is one of the most critical requirements for obtaining medical licensure in Germany. The standard benchmark is B2-level fluency in general German and C1-level proficiency in medical terminology.

While the B2 certificate can usually be obtained through accredited language schools or official testing centers, proof of medical-language competence must be demonstrated through a specialized exam administered by the relevant State Chamber of Physicians.

This medical German language exam is widely regarded as challenging. It replicates real-life clinical situations — such as taking a detailed patient history, conducting informed-consent discussions, or writing a medical report or discharge summary. Many candidates fail on their first attempt — not because of insufficient medical knowledge, but due to linguistic uncertainty or nervousness during the exam.

Thorough preparation is therefore essential. Specialized medical-language courses, online learning platforms, tandem programs, and mock exams can help international doctors gain confidence, refine their professional vocabulary, and build fluency in German medical communication.

The Knowledge Test: Both a Hurdle and an Opportunity

The knowledge test is broad and clinically focused. In the oral-practical section, candidates examine a patient, present a preliminary diagnosis, and propose a treatment plan. The exam also tests skills in diagnostic reasoning, differential diagnosis, pharmacology, and emergency medicine.

The primary focus is on internal medicine and surgery, with additional questions on hygiene, medical law, and doctor-patient communication. Successful candidates must demonstrate not only factual knowledge but also clinical reasoning and the ability to apply evidence-based medicine in practice.

Long Waits for Recognition

Despite the complexity, the process is often worth the effort. Obtaining approbation opens the door to a stable medical career and access to continuing education opportunities in Germany.

According to the Federal Statistical Office, the number of foreign-trained doctors in Germany increased by over 60% between 2013 and 2023. Many come from Syria, Romania, Russia, and Egypt.

However, recognition procedures can take far too long. A 2024 report by the German newspaper Die Welt found that for applicants from countries such as Ukraine or Arab third states, processing times of 15 months to 3 years are not uncommon. These delays are frustrating both for applicants and for hospitals and clinics urgently seeking staff.

To speed up the process, professional associations are calling for greater digitalization and nationwide standardization. Currently, Germany’s federal system means that each state sets its own requirements, deadlines, and exam formats. A national digital platform could simplify procedures, improve transparency, and eliminate duplicate assessments.

No Stable Healthcare Without International Professionals

While Germany’s physician workforce continues to grow, one fact is clear: without targeted immigration and faster recognition procedures, the looming doctor shortage cannot be resolved.

For international physicians, obtaining approbation remains a crucial but challenging step. Those who start early, submit complete documentation, acquire strong language skills, and prepare carefully for the knowledge or specialty exam significantly improve their chances of success.

For the German healthcare system as a whole, only greater transparency, digital efficiency, and consistency across states will ensure the smooth integration of foreign-trained doctors — and help safeguard access to quality medical care across the country.

This story was translated from Medscape’s German edition.