Work in Germany as a foreign doctor, dentist or pharmacist

• ApprobationState licensing authorities (Approbation)

  Doctors, dentists and pharmacists; nurses through professional recognition

  Read the registration guide

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   1. Check your qualification and choose a federal state

   Confirm that your degree is a completed medical, dental or pharmacy qualification that allows you to practise in the country where you trained. Then decide in which federal state you intend to work, because that state's authority will handle your case and must stay responsible throughout. If you have no job offer or address there yet, the ZSBA at the Federal Employment Agency can advise you and issue a location note that some authorities accept.
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   2. Learn German to B2 and beyond

   Authorities generally expect a general German certificate at level B2 of the Common European Framework of Reference (CEFR) from a recognised provider, and the Fachsprachprüfung is pitched at around C1 in a professional context. The Bezirksregierung Münster lists exemptions, for example if you qualified in German or completed school in German. Starting German early is the single biggest factor in how quickly you finish.
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   3. Prepare and submit your Approbation application

   Applications need, among other things, proof of identity, a CV listing your training and work, an officially certified copy of your diploma, proof of your licence to practise in your home country, a certificate of good standing and a medical certificate. The BÄO says the good standing and health documents must be no more than three months old when you submit them. In North Rhine-Westphalia, documents in a foreign language, including English, need a qualified translation, and foreign documents may need an apostille or legalisation.
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   4. Pass the Fachsprachprüfung

   The language test is usually run by the state medical, dental or pharmacists' chamber after the authority registers you. For doctors it is typically a one-hour test with three 20-minute parts: a history-taking conversation with a simulated patient, a written report and a doctor-to-doctor case presentation. Fees are set by each chamber; for example, the Ärztekammer Westfalen-Lippe charges €400 and the Ärztekammer Nordrhein €430.
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   5. Equivalence assessment or Kenntnisprüfung

   If you trained in the EU, EEA or Switzerland and your diploma is listed in the EU directive, recognition is largely automatic. If you trained elsewhere, the authority compares your training with German training. Where it finds substantial differences that your experience does not make up for, you must pass the Kenntnisprüfung, an oral-practical state exam based on the content of the German final exam. You can also go straight to the Kenntnisprüfung where documents cannot reasonably be produced, and the law requires the state to offer you a date within six months of its decision.
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   6. Consider a Berufserlaubnis while you wait

   A temporary licence to practise (Berufserlaubnis) lets you work in your profession under restrictions while you complete the route. The federal law limits it to a total of two years, and it can be restricted to specific activities and workplaces. In North Rhine-Westphalia it is normally granted for two years after you pass the Fachsprachprüfung and is limited to that state.
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   7. Get a job offer and your visa

   With a job offer, you apply for a national (D) visa at the German mission, increasingly through the Federal Foreign Office's Consular Services Portal. If you still need to complete recognition, the section 16d visa covers qualification measures and exams. Once you hold the Approbation or a Berufserlaubnis, an EU Blue Card or skilled worker residence permit is usually the right route. Your employer can also use the fast-track procedure for skilled workers.
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   8. Receive the Approbation and register with the chamber

   When all conditions are met the authority issues the Approbation, which is valid across Germany. The BÄO requires a decision on a third-country application's equivalence within four months of receiving the complete documents, and within two months under the fast-track procedure. You then register with the chamber in the state where you work.
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   9. Build towards specialist recognition and settlement

   Doctors who want a German specialist title or to complete specialist training apply to the state medical chamber. For residence, EU Blue Card holders can apply for a settlement permit after 27 months with A1 German, or 21 months with B1, and holders of skilled worker permits after three years, if the other conditions are met.

• Germany does not use IELTS or OET for licensing. The language requirement is German, and English test results do not count towards the Approbation.
• General German: the Bezirksregierung Münster says applicants should normally show a B2 certificate (CEFR) from a recognised language provider. The pharmacists' chamber Nordrhein also states that a B2 general German certificate is required.
• Professional German: the Fachsprachprüfung is run by the chambers in most states. The Ärztekammer Westfalen-Lippe says it expects professional language skills oriented to level C1, and the Apothekerkammer Nordrhein describes its test as based on C1.
• Exemptions listed by the Bezirksregierung Münster for the B2 certificate include a final exam taken in German, a passed Kenntnisprüfung or specialist exam, German as your mother tongue, a university entrance qualification from a German-language school, at least ten years of general schooling in German, or completed vocational training of at least three years in German.
• For visas, German is assessed separately: the section 16d recognition visa usually needs about A2, the recognition partnership needs A2, and settlement permits need A1 or B1 depending on the route, according to Make it in Germany.

• Visa for the recognition of foreign qualifications (section 16d)

  For people whose recognition authority has said they need adaptation measures or exams such as the Kenntnisprüfung. Make it in Germany says you usually need German at about A2, proof that you can cover your living costs (for example a blocked account with at least €1,091 a month in 2026), and that the residence permit is granted for up to 24 months, extendable by 12 months to a maximum of three years. You may work up to 20 hours a week in any job, and without an hours limit in work related to your profession if the Federal Employment Agency approves.

• Recognition partnership (section 16d(3))

  Lets you enter with a job offer and start working while you complete recognition in Germany. You need a foreign qualification recognised by the state where you obtained it, a job offer, an agreement in which you commit to starting the recognition procedure and your employer commits to enabling the required qualification measures, at least A2 German, and approval from the Federal Employment Agency. The permit is granted for up to one year at first and can be extended up to three years.

• EU Blue Card (section 18g)

  For graduates with a job that matches their qualification and lasts at least six months. In regulated professions the licence to practise must be in place or in prospect when you apply for the visa. Make it in Germany gives the 2026 salary thresholds as €50,700 gross a year, or €45,934.20 in shortage occupations, which include medical doctors, dentists and pharmacists, with Federal Employment Agency approval.

• Skilled worker residence permit (sections 18a and 18b)

  Residence permits for skilled workers with vocational (18a) or academic (18b) training, for any qualified employment. For doctors, dentists and pharmacists the official guidance says a licence to practise (Berufsausübungserlaubnis), meaning the Approbation or a Berufserlaubnis, must be obtained before a residence permit for employment can be issued.

• Fast-track procedure for skilled workers (section 81a)

  Your employer can apply to the local foreigners authority on your behalf. The authority starts the recognition procedure, obtains the licence to practise in regulated professions, gets Federal Employment Agency approval and pre-approves the visa. Make it in Germany says the fee is €411, paid by the employer. The BÄO says the recognition decision should then be issued within two months.

• Visa fee, family and settlement

  The fee for a national (D) visa is €75 under the Residence Ordinance. Your spouse and children can join you, and Make it in Germany says spouses of skilled workers with a valid residence title do not need to prove German. Blue Card holders can apply for a settlement permit after 27 months with A1 German, or 21 months with B1; holders of skilled worker permits after three years with at least 36 months of pension contributions and sufficient German (B1).

Hospital doctors in municipal hospitals are paid under the collective agreement TV-Ärzte/VKA. The figures below are gross monthly basic pay from 1 June 2026 to 31 December 2026, as published by the Marburger Bund (one of the parties to the agreement) in its VKA pay tables. They exclude on-call (Bereitschaftsdienst) pay and allowances. University hospitals, church and private hospitals use other agreements or their own pay rules. There is no national pay scale for employed dentists or community pharmacists; pay is set by the employer or by collective agreements we could not confirm from an official table, so check the job offer.

Monthly amounts

• Doctor (Ärztin/Arzt), Ä1

  €5,722.05 to €7,355.29

  Year 1 to year 6 steps, TV-Ärzte/VKA from 1 June 2026.

• Specialist (Fachärztin/Facharzt), Ä2

  €7,552.19 to €9,698.91

  Rises at years 4, 7, 9, 11 and 13 as a specialist.

• Senior physician (Oberärztin/Oberarzt), Ä3

  €9,459.56 to €10,810.95

  Three steps, from year 1, year 4 and year 7.

• Deputy head physician, Ä4

  €11,127.50 to €11,922.95

  Two steps.

• Employed dentists: Set by employerNo national pay scale; most dentists work in private practice.
• Pharmacists: Set by employer or collective agreementCheck the agreement your pharmacy or hospital applies.

Pay for your profession: Doctors · Nurses · Midwives · Dentists · Pharmacists · Physiotherapists