Doctor in Germany as a foreigner: Approbation steps (2026)

• A completed medical degree that entitles you to practise as a doctor in the country where you trained.
• For training outside the EU, EEA and Switzerland: equivalence with German training (at least six years and 5,500 hours, including eight to twelve months of practical training), or a pass in the Kenntnisprüfung.
• General German at B2 (CEFR) from a recognised provider, unless an exemption applies, and a pass in the Fachsprachprüfung run by the medical chamber.
• A certificate of good standing or equivalent from your home authorities, and a medical certificate of fitness, each no more than three months old when you submit them.
• Proof that you are entitled to practise in the country of training, and documents showing that you intend to practise in Germany.
• A link to the federal state where you apply, such as a job offer, a placement or residence there, or a location note from the ZSBA at the Federal Employment Agency.
• No definitive failure of the German medical state exam, unless you hold a qualification recognised under the EU directive.
• For a visa: the right residence permit, usually section 16d for completing recognition, or the EU Blue Card or a skilled worker permit once you hold a licence to practise.

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• ApprobationState licensing authorities (Approbation)

  Doctors, dentists and pharmacists; nurses through professional recognition

  Read the registration guide

1. 1

   1. Start German early

   Begin German as soon as you decide on Germany, aiming for a B2 certificate from a recognised provider and then medical German for the Fachsprachprüfung. Exams, forms and patient care are all in German. Doctors often underestimate how long it takes to move from B2 to the professional level the language test expects.
2. 2

   2. Choose a federal state and authority

   Decide where you want to work and find the authority with the Recognition Finder at anerkennung-in-deutschland.de. That authority must remain responsible throughout, so you need a job offer, placement, address or ZSBA location note for the state. In North Rhine-Westphalia, all foreign-trained doctors apply to the Zentrale Anerkennungsstelle für Gesundheitsberufe at the Bezirksregierung Münster.
3. 3

   3. Collect, certify and translate your documents

   You need proof of identity, a tabular CV, an officially certified copy of your medical diploma and transcripts, proof of your internship and work experience, proof of your licence to practise, a certificate of good standing and a medical certificate. The Bezirksregierung Münster requires qualified translations of all foreign-language documents, including English, and may ask for an apostille or legalisation. Good standing and health documents expire three months after issue, so time them carefully.
4. 4

   4. Apply for the Approbation (and a Berufserlaubnis)

   Submit your application to the state authority, online where available. The authority must confirm receipt within one month and tell you which documents are missing. You can usually apply for a Berufserlaubnis at the same time, so you can work while you prepare for the Kenntnisprüfung.
5. 5

   5. Pass the Fachsprachprüfung

   The authority registers you with the medical chamber, which contacts you, collects its fee (for example €400 at the Ärztekammer Westfalen-Lippe) and your B2 certificate, and gives you a date. The exam has three 20-minute parts: a history-taking conversation with a simulated patient, a written report and a presentation of the case to a doctor. It tests language only, not your medical knowledge.
6. 6

   6. Receive the equivalence decision

   The authority, or the medical chamber or an expert on its behalf, compares your training with German training. If it finds substantial differences that your experience does not make up for, it issues a formal decision naming the subjects. The BÄO requires this within four months of complete documents, or two months under the fast-track procedure.
7. 7

   7. Work on a Berufserlaubnis if granted

   With a Berufserlaubnis you can work as a doctor under its restrictions, often as an assistant doctor in a hospital. The law limits it to two years in total, and in North Rhine-Westphalia it is limited to that state. Use this time to prepare for the Kenntnisprüfung, because extensions are only possible in special cases.
8. 8

   8. Pass the Kenntnisprüfung

   The exam is oral-practical, in German, in internal medicine and surgery, with questions on emergency medicine, clinical pharmacology, imaging, radiation protection and medical law. You examine a patient, write a report and then sit an examination of 60 to 90 minutes. You can repeat it twice, and the state must offer a date within six months of its decision.
9. 9

   9. Receive the Approbation and register with the chamber

   Once you pass, the authority issues the Approbation, valid throughout Germany, and charges its fee (€150 to €700 in North Rhine-Westphalia). You then register with the medical chamber of the state where you work and, if you hold a residence permit linked to your Berufserlaubnis, update the foreigners authority.
10. 10

    10. Plan specialist training or recognition

    Specialist training and specialist titles are regulated by the state medical chambers. You can enter specialist training in Germany or apply to the chamber to have training completed abroad recognised. Rules and documents differ by chamber, so contact the chamber in your state early.

• Fachsprachprüfung (medical language test)

  Run by the state medical chamber after the authority registers you. At the Ärztekammer Westfalen-Lippe it is an individual exam before three examiners, at least two of them doctors, oriented to C1, with three 20-minute parts: doctor-patient conversation, written report and doctor-doctor conversation. The Ärztekammer Nordrhein scores each part out of 20, with 36 of 60 points needed to pass, and allows repeated attempts.

  Read the guide

• Kenntnisprüfung (knowledge test)

  A state exam under section 37 ÄApprO for third-country doctors with substantial differences. It is held on one day, in German, before a commission of three. You take a history from and examine a patient (at the Ärztekammer Westfalen-Lippe, a trained simulated patient), write a report with history, diagnosis, prognosis, treatment plan and epicrisis (30 minutes each for the examination and the report), then sit an examination of 60 to 90 minutes. Subjects are internal medicine and surgery, plus any subject named in your decision. It can be repeated twice.

  Read the guide

• Eignungsprüfung (aptitude test)

  For doctors trained in the EU, EEA or Switzerland whose training is not automatically recognised and shows substantial differences. Under section 36 ÄApprO it is an oral-practical exam with a patient presentation, of 30 to 90 minutes, limited to the subjects where differences were found.

• General German certificate

  Not a medical exam, but required before the Fachsprachprüfung: a B2 certificate from a recognised language provider. The Bezirksregierung Münster publishes a list of recognised providers and exemptions.

• Germany does not accept IELTS or OET for doctors. The requirement is German.
• General German: a B2 (CEFR) certificate from a recognised provider, according to the Bezirksregierung Münster; the Ärztekammer Westfalen-Lippe asks for it when you register for the Fachsprachprüfung.
• Professional German: the Fachsprachprüfung, which the Ärztekammer Westfalen-Lippe says is oriented to C1 in a professional context.
• Exemptions from the B2 certificate include a final medical exam taken in German, a passed Kenntnisprüfung or specialist exam, German as your mother tongue, school leaving qualifications from a German-language school or at least ten years of schooling in German.
• For the section 16d recognition visa, Make it in Germany says German is usually required at about A2, but you will need far more to pass the Fachsprachprüfung.

Estimate your total cost

• German: reaching B2 and then the professional level for the Fachsprachprüfung often takes longer than any administrative step; plan for it first.
• Receipt of your application: confirmed within one month, with a list of missing documents, under section 39 ÄApprO.
• Equivalence decision: within four months of complete documents under the BÄO, or two months under the fast-track procedure. The Bezirksregierung Münster warns of longer processing times because of high demand.
• Fachsprachprüfung: at the Ärztekammer Westfalen-Lippe exams usually run four times a month after your documents are in.
• Kenntnisprüfung: the state must offer a date within six months of the decision; the Ärztekammer Westfalen-Lippe usually sends the invitation five to six weeks before.
• Berufserlaubnis: up to two years in total, so aim to pass the Kenntnisprüfung within that time.

Gross monthly basic pay for doctors in municipal hospitals under the TV-Ärzte/VKA, valid from 1 June 2026 to 31 December 2026, as published by the Marburger Bund (a party to the agreement). On-call pay (Bereitschaftsdienst), shift allowances and overtime are paid on top. University hospitals, church hospitals and private groups apply their own agreements or rules, so the figures there can differ.

Monthly amounts

• Ä1 doctor, year 1

  €5,722.05

• Ä1 doctor, year 2

  €6,046.42

• Ä1 doctor, year 3

  €6,278.07

• Ä1 doctor, year 4

  €6,679.58

• Ä1 doctor, year 5

  €7,158.37

• Ä1 doctor, year 6

  €7,355.29

• Ä2 specialist (Facharzt)

  €7,552.19 to €9,698.91

  Steps at years 1, 4, 7, 9, 11 and 13 as a specialist.

• Ä3 senior physician (Oberarzt)

  €9,459.56 to €10,810.95

  Steps at years 1, 4 and 7.

• Ä4 deputy head physician

  €11,127.50 to €11,922.95

• Hospitals are the main employers of international doctors: municipal hospitals, university hospitals, church-affiliated non-profit hospitals and private hospital groups. Most international doctors start as assistant doctors and train towards a specialist title.
• Pay and conditions depend on the employer's collective agreement: TV-Ärzte/VKA in municipal hospitals, separate agreements in university hospitals and private groups, and church rules in many church hospitals.
• A job offer helps in two ways: it proves the state authority is responsible for your case, and it lets you apply for a Berufserlaubnis and a visa. Some employers support recognition through a recognition partnership under section 16d(3) of the Residence Act.
• Outpatient care is mostly delivered by doctors in their own practices; working in or opening a practice that treats statutory insurance patients needs further approvals from the regional association of statutory health insurance physicians, after the Approbation and specialist title.
• Employers may use the fast-track procedure for skilled workers, in which the foreigners authority starts the recognition procedure and obtains the licence to practise for you, for a €411 fee paid by the employer.
• Expect employers to check your Approbation or Berufserlaubnis, your residence permit and your German, and for many posts your specialist status. Practice varies by employer.

• If you still have to pass the Fachsprachprüfung or Kenntnisprüfung, the visa for the recognition of foreign qualifications (section 16d) lets you come to Germany for qualification measures and exams. Make it in Germany says it is granted for up to 24 months, extendable by 12 months to a maximum of three years, usually needs German at about A2 and proof of funds (for example €1,091 a month in a blocked account in 2026).
• On a section 16d permit 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.
• With a job offer and a licence to practise in place or in prospect, the EU Blue Card is often the best route. Make it in Germany lists medical doctors as a shortage occupation, with a 2026 threshold of €45,934.20 gross a year with Federal Employment Agency approval (€50,700 otherwise). Doctors' collective pay is above these thresholds.
• A skilled worker residence permit under section 18b is the alternative. For regulated professions, the official guidance says the licence to practise must be obtained before a residence permit for employment can be issued.
• The national visa fee is €75. Apply through the German mission responsible for your place of residence, increasingly via the Federal Foreign Office's Consular Services Portal.
• EU Blue Card holders can apply for a settlement permit after 27 months with A1 German, or 21 months with B1. Your spouse and children can usually join you, and spouses of skilled workers do not need to prove German.

1. 1

   Your Gulf medical degree counts as third-country training unless it was awarded in the EU, EEA or Switzerland. Expect a full equivalence assessment and, in many cases, the Kenntnisprüfung. A Gulf licence (DHA, DOH Abu Dhabi, MOHAP, SCFHS, QCHP, OMSB, KIMS or NHRA) does not replace the Approbation.

2. 2

   Good standing: the German authority needs proof that you are fit and proper to practise from the authorities of your home country, no more than three months old when submitted. If you have practised in the Gulf, obtain a certificate of good standing from each Gulf regulator you are or were licensed with and ask your state authority whether it wants it sent directly. Time requests so that they do not expire while you wait for other documents.

3. 3

   Experience counts: under section 3 BÄO, substantial differences can be made up for by knowledge gained in professional practice, regardless of the country in which you gained it. Ask your Gulf employers for detailed work certificates with dates, departments and duties, as these support the equivalence assessment.

4. 4

   Translations: Gulf documents in Arabic or English need qualified translations into German for authorities such as the Bezirksregierung Münster, and may need an apostille or legalisation. Budget for this early, as it applies to every page, including stamps.

5. 5

   Specialist titles: Saudi Board, Arab Board or other Gulf specialist certificates are assessed by the state medical chamber after you have the Approbation, not by the licensing authority. Keep your training logbooks and programme descriptions.

6. 6

   Language: Gulf practice in English or Arabic does not count towards the German requirement. Plan on a B2 certificate and the Fachsprachprüfung before you leave your Gulf post.

• Application plan with every step, fee and deadline

• Document checklist tailored to you, and a review of each document before upload

• Timeline built around the regulator's closure windows and document validity periods

• Help completing the application forms accurately and consistently

• Support with profession-specific evidence, such as the HCPC standards of proficiency mapping

• Guidance on certificates of good standing, references and certified translations

• Preparation for identity checks and declarations on health and character

• Tracking your application and help responding to regulator requests

• Next steps after the decision: exams, adaptation, PIN or licence and your first job

Regulators make all registration decisions and set all fees. Our fee is separate from the regulator's fees, exam fees and translation costs.

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