Approbation in Germany: Requirements, Exams and Process

• Doctors (Ärztinnen und Ärzte): Approbation under the BÄO, or a temporary Berufserlaubnis under section 10 BÄO.
• Dentists (Zahnärztinnen und Zahnärzte): Approbation under the ZHG, or a temporary Berufserlaubnis under section 13 ZHG.
• Pharmacists (Apothekerinnen und Apotheker): Approbation under the BApO, or a temporary Berufserlaubnis under section 11 BApO, which in North Rhine-Westphalia lets you work as a pharmacist under supervision (Apotheker unter Aufsicht).
• Psychotherapists are also licensed by Approbation; nurses and other health professions go through a separate professional recognition procedure (in North Rhine-Westphalia, the ZAG-PuG at the same Bezirksregierung).
• There is no single public national register of licensed doctors like the UK's. After licensing you register as a member with the chamber in the state where you work.

• A completed medical, dental or pharmacy qualification. German training is at least six years and 5,500 hours for medicine, five years and 5,000 hours for dentistry, and five years including 12 months' practical training for pharmacy; foreign training is compared against this.
• No conduct that shows you are unworthy or unreliable to practise, evidenced by a certificate of good standing or equivalent from your home country, no more than three months old when submitted.
• Health fitness to practise, shown by a medical certificate, also no more than three months old.
• The German language skills needed for the profession: usually a B2 general German certificate plus a passed Fachsprachprüfung.
• Equivalence of your training with German training, shown by a document-based assessment, the Kenntnisprüfung (third countries) or the Eignungsprüfung (EU, EEA or Switzerland with substantial differences).
• For third-country applicants, proof that you are entitled to practise in the country of training and documents showing that you intend to practise in Germany.
• Proof that the authority is responsible for your case, such as a job offer in that state or, in North Rhine-Westphalia, a location note from the ZSBA. The Bezirksregierung Münster says its responsibility must exist throughout the procedure.
• You cannot get an Approbation if you have definitively failed the German state exam in your profession, unless you hold a qualification recognised under the EU directive.

Check your route with the route finder

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   1. Find the competent authority

   Use the Recognition Finder at anerkennung-in-deutschland.de to identify the authority for your profession in the state where you intend to work. If you are abroad and have no link to a state yet, contact the ZSBA at the Federal Employment Agency, which advises on choosing a location. Applying to the wrong state, or losing your link to it during the procedure, causes delays or closure of the case.
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   2. Gather and certify your documents

   Section 3(6) BÄO lists the core documents: proof of identity, a tabular CV of training and work, an officially certified copy of your diploma, proof of professional experience where relevant, proof of your right to practise in the country of training, a certificate of good standing and a medical certificate. The Bezirksregierung Münster requires qualified translations of all foreign-language documents, including English ones, by a translator publicly appointed in Germany or confirmed by the German mission, and may require an apostille or legalisation. Documents submitted become part of the file and are not returned.
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   3. Submit the application and receive confirmation

   Many authorities accept online applications, often with paper originals later. By law the authority must confirm receipt within one month and tell you which documents are missing. In North Rhine-Westphalia you can apply for the Approbation and a Berufserlaubnis together on one form.
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   4. Register for the Fachsprachprüfung

   Once your file is in order, the authority registers you with the chamber for the professional language test; you cannot book directly. The chamber then contacts you, asks you to pay its fee and send your B2 certificate, and gives you a date. Retakes are usually booked directly with the chamber.
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   5. Equivalence decision

   For third-country training, the authority, or the chamber or an expert on its behalf, compares your curriculum with German training. If it finds substantial differences that your professional experience or certified lifelong learning do not make up for, it issues a formal decision (Bescheid) naming the subjects concerned. The law requires this decision within four months of receiving complete documents, or two months under the fast-track procedure for skilled workers. You can request a separate decision on equivalence alone.
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   6. Kenntnisprüfung or Eignungsprüfung

   Third-country applicants with substantial differences sit the Kenntnisprüfung, based on the content of the German final state exam; EU applicants sit the Eignungsprüfung on the differences found. You also prove your knowledge through the Kenntnisprüfung if the documents needed for a document-based check cannot be produced for reasons outside your control. States must offer you a date within six months of the decision.
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   7. Berufserlaubnis while you prepare

   If you need to work before the Approbation, you can apply for a Berufserlaubnis. The law allows it for a total of up to two years, revocable, and it can be limited to certain activities and workplaces. The Bezirksregierung Münster grants it normally for two years after the Fachsprachprüfung, limited to North Rhine-Westphalia, and says there is no legal right to it or to an extension.
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   8. Grant of the Approbation

   When equivalence, language, good standing and health are all confirmed, the authority issues the Approbation certificate (Approbationsurkunde) and charges its fee. You then register with the chamber in the state where you work. Keep certified copies, because employers, chambers and the foreigners authority will ask for them.

• Fachsprachprüfung (professional language test)

  Run by the state chambers for doctors, dentists and pharmacists. For doctors at the Ärztekammer Westfalen-Lippe it is an individual exam before three examiners, oriented to C1, in three 20-minute parts: a history-taking conversation with a simulated patient, a written report, and a doctor-to-doctor case presentation. The Ärztekammer Nordrhein marks each part out of 20 and requires 36 of 60 points to pass. The pharmacists' version at the Apothekerkammer Nordrhein also lasts 60 minutes, with a patient consultation, documentation, and a pharmacist-to-pharmacist discussion with a vocabulary test.

  Read the guide

• Kenntnisprüfung for doctors

  Under section 37 ÄApprO, an oral-practical state exam with a patient presentation, held in German on one day, covering internal medicine and surgery, with questions on emergency medicine, clinical pharmacology, imaging, radiation protection and law. It lasts 60 to 90 minutes per candidate, with up to four candidates. You must examine a patient and write a report with history, diagnosis, prognosis, treatment plan and epicrisis. It is offered at least twice a year and can be repeated twice.

  Read the guide

• Kenntnisprüfung for dentists

  Under sections 104 to 118 ZApprO, three parts taken in order: a written treatment plan (45 minutes), an oral exam (60 to 90 minutes) and a practical exam on simulated cases in prosthetics (about two hours), conservative dentistry (about two hours) and oral and maxillofacial surgery (about one hour). Each failed part can be repeated twice.

  Read the guide

• Kenntnisprüfung for pharmacists

  Under section 22d AAppO, an oral exam on one day covering pharmaceutical practice and special areas of law for pharmacists, plus one subject chosen by the authority where it found differences. It lasts 30 to 60 minutes per candidate and can be repeated twice.

  Read the guide

• Eignungsprüfung (aptitude test)

  For applicants trained in the EU, EEA or Switzerland whose training shows substantial differences. It covers only the subjects where differences were found. For doctors, section 36 ÄApprO describes an oral-practical exam with a patient presentation of 30 to 90 minutes.

• The state authorities do not accept English tests such as IELTS or OET. The requirement is German.
• General German: the Bezirksregierung Münster says you should normally show a B2 certificate (CEFR) from a recognised provider. The Ärztekammer Westfalen-Lippe asks for a B2 certificate when you register for the Fachsprachprüfung.
• Professional German: shown by the Fachsprachprüfung, which the Ärztekammer Westfalen-Lippe says is oriented to C1 and the Apothekerkammer Nordrhein describes as based on C1.
• The B2 certificate is not needed, according to the Bezirksregierung Münster, if you took your final exam in German, passed a Kenntnisprüfung or specialist exam, are a native speaker, gained your university entrance qualification at a German-language school, had at least ten years of schooling in German, or completed at least three years of vocational training in German.
• The Kenntnisprüfung and Eignungsprüfung are held in German, so your clinical German needs to be strong well before the exam date.

Estimate your total cost

• Receipt: the authority must confirm receipt and list missing documents within one month of your application.
• Equivalence decision: within four months of complete documents under the BÄO, ZHG and BApO, or two months under the fast-track procedure for skilled workers.
• Kenntnisprüfung: the state must let you sit it within six months of the decision on substantial differences, and it is offered at least twice a year.
• Fachsprachprüfung: at the Ärztekammer Westfalen-Lippe, exams usually run four times a month once your documents are in.
• In practice: the Bezirksregierung Münster warns that the volume of applications means longer processing times, and German language learning often takes the most time.