Practicing as a Physician in germany

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Parent Category: Business Legalities

Created on Saturday, 29 January 2011 18:40

Last Updated on Wednesday, 10 April 2013 05:50

Practicing as a Physician in Germany

Is there a need for physicians in Germany? There is a shortage of physicians but this is only locally and generally in eastern states of Germany. 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 if you want to bill the statutory health insurance companies or your patients directly.

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What does 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 when it comes to 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 hazardous injury. Furthermore, you have to be physically and psychologically capable of working as a doctor. In order to work in a German speaking environment, the applicant will also have to show that he can sufficiently communicate in German. In general, this is shown by a B2 language certificate which can be obtained by taking exams at any language school in Germany or abroad - either already at home or here in Germany. It is currently being discussed whether you will alo have to show additional knowledge in the medical language.
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Doctors from outside the EU

But I am from outside the EU club! May I not practice here?

The possibilities for physicians from outside the Union have dramatically improved since April 1, 2012. 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. 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. In the case, equivalence lacks then you will initially only get a Berufserlaubnis, a restricted permission to work.
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How long will my license be temporary?

The intention of the new law is 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. In case the deciding body still comes to the conclusion 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 that are 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 granting are practicing in a needed discipline, integration into Germany (esp. language abilities), inconspicuous professional behavior, etc. First time to try will be after eight years of practicing in Germany.
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Aren't there any other exceptions? I heard that where I live there is a shortage of doctors.

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 do require that your medical qualification is equivalent ("gleichwertig") to the German qualification. You are expected to show studies in medicine of at least 6 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 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 proofs of medical education. They came back and told me that they are 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 still can enhance your details! Since your medical qualification seems not to be sufficient according to the requirements above, this is the time when 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 adequately assess the equivalence.
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Great! The office just ultimately denied me having shown 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)". Some states require the applicant to fulfill a period of adjustment ("Anpassungszeit") which usually takes 18 months and requires at least 6 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 while at home we use this beautiful Sanskrit. 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. Documents in languages other than German have to be translated by a court approved translator.
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Does it make sense to hire a lawyer?

Yes and no. Generally, at least an initial consultation is recommended to determine what the requirements are in the federal state you are planning a practice (but not necessarily living in). The office is required to give you general information on the application proceedings, they will not check your documents and tell what you is missing. Such is the job of an attorney. He will not only streamline the documents (what is necessary, irrelevant or helpful) but also advise on how to legally circumvent any black spots on your white overall - um slate. Understand the office as a "case decider", not an employment bureau.
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Which office do I have to address to obtain my license?

The Genehmigungsbehörde is usually the Bezirksregierung (municipality's administration) but sometimes also the Landesprüfungsamt (state examination board). It really depends on the federal state which body will issue the license.
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How long will the application proceedings 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 on this. 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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Content kindly provided by Rechtsanwältin Kristina Tewes