How to Work as a Doctor in Germany: Approbation and Licensing

To work as a doctor in Germany, you need an Approbation, the full German medical license. If your degree comes from outside the EU, that means an equivalence check, a German language exam, and often a medical knowledge exam called the Kenntnisprüfung.

You would be in good company, working as a doctor in Germany. At the end of 2025, 71,480 doctors working in Germany did not hold German citizenship, which is 16% of all practicing doctors. That number grew by 5% in a single year.

This guide walks through the licensing process in order, the language exams, what the exams cost, and what doctors actually earn under the 2026 pay scale.

Advantages of Working as a Foreign Doctor in Germany

• Doctors in Germany get paid well, with additional benefits like Health Insurance, paid vacation, and a pension plan.
• The country offers excellent public services, clean environments, and a strong economy.
• You have access to modern equipment and facilities, which helps you give your patients the best care possible.
• There are many opportunities for ongoing education and training. You can join advanced training programs, attend workshops, and stay up to date with the latest medical advances.
• Working hours are regulated by law, which supports a reasonable balance between work and personal life. See our guide to working time rules in Germany.
• The German healthcare system is well-organized and supportive. You work in teams with other healthcare professionals.
• Doctors are on the shortage occupation list, so you qualify for an EU Blue Card at a lower salary threshold than most professions.

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Which Permit Do You Need to Come to Germany?

Two different permits allow foreign doctors to work in Germany, and choosing the wrong one can cost months. The question that decides it is simple. Do you already have a job offer?

Path 1: Coming With a Job Offer

This is the faster route, and it is the one most hospitals will steer you toward. Your employer offers you a post. You apply for a temporary license to practice, the Berufserlaubnis, which lets you work under supervision before your full recognition is finished.

You earn a salary from the start. That matters for more than your bank balance, because a contract with adequate pay satisfies the financial requirement on its own. No deposit, no Blocked Account, nothing to arrange in advance.

Once your Approbation is complete, you can move to an EU Blue Card. Doctors count as a shortage occupation in Germany, so you qualify at the lower salary threshold rather than the standard one. Given how short the country is of doctors, that is one of the few places where the shortage works in your favor on paper.

Path 2: Coming to Complete Your Recognition

If you have no job offer yet, section 16d of the Residence Act is your route. It was written for people in your exact position: qualified abroad, not yet licensed here, and needing to be in Germany to finish the process.

One thing has to happen before you can apply. The recognition office must assess your degree and issue a Defizitbescheid, the notice that names the specific gaps between your training and the German standard. It tells you what you still have to prove. Without it there is no permit, so your recognition application comes first and your visa application second.

Proving You Can Support Yourself

This is the requirement that catches people out, because it is easy to assume your future salary counts. It does not, unless you already have the job contract.

For a section 16d permit (path 2), you must show €1,091.20 per month for 2026, covering living costs, rent, and Health Insurance. There are three accepted ways to do it:

• A Blocked Account. You deposit the full period in advance and the bank releases it to you monthly once you arrive. This is the usual choice if you are applying from outside Germany.
• A formal undertaking. Someone already living in Germany signs a declaration at the immigration office accepting financial responsibility for you.
• Employment income. If your qualification measure is paid, or you hold a contract alongside it, the salary can cover the requirement instead.

If you are opening a Blocked Account, do it before you book your visa appointment. The confirmation is one of the documents the embassy will ask for, and arranging it late is one of the more avoidable reasons applications get delayed.

What You Need for Each Route

Side by side, so you can see which list is yours.

The order matters more than the paperwork. Recognition comes first on both routes, because the state authority has to look at your degree before anyone can issue you a permit. Doctors who file the visa application first usually end up waiting twice.

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Path to Becoming a Doctor in Germany: the Approbation Process

To work as a doctor in Germany you need a medical license known as an Approbation. It allows you to work as a fully licensed doctor anywhere in the country. You apply to the authority in the German state where you plan to work, so requirements and processing times differ from state to state.

Recognition of Foreign Medical Degrees

Where your degree comes from decides how much of the process applies to you.

If you got your medical degree outside the EU, the German authorities compare your qualification with the German standard to decide whether it is equivalent. Send your degree certificates, transcripts, and supporting documents to the recognition authority in your chosen state. All of them must be translated into German by a certified translator. The federal government's Recognition in Germany portal names the responsible office for each state, and our guide to the anabin database shows how to look up how your university is classified.

For the wider picture beyond medicine, see our guide to recognition of foreign qualifications in Germany.

Eligibility Criteria for a Medical License

Gather and prepare the documents for your approbation application. These usually include:

• Proof of identity (passport or ID card)
• A curriculum vitae in German, in the format German employers expect
• Medical degree and transcripts
• Proof of German language proficiency
• Certificates of good standing from medical boards or licensing authorities in your home country
• Health certificate proving you are fit to practice medicine
• Criminal record check

Language Tests for Physicians

German matters because you will talk to patients to diagnose and treat them. You also need German medical terms for accurate documentation and prescriptions. German hospitals and clinics run on German, so the language is what lets you work well inside a team.

The standard requirement across Germany is general German at B2 level plus medical German at C1 level. The C1 part is tested by the Fachsprachprüfung, the medical language exam set by your state medical association. It has three parts:

• Doctor and patient: you take a medical history in German and explain the next steps.
• Documentation: you write up the case in a patient file.
• Doctor and doctor: you present the case to a colleague and answer questions.

For the B2 part, exams such as telc Deutsch B2-C1 Medizin or the Goethe-Zertifikat C1 are widely accepted. Some states set their own list, so check with your state medical board before you book a course. If you are still building up your German, start with our guide to learning German.

Medical Knowledge Assessment (Kenntnisprüfung)

If your medical degree is not judged fully equivalent, you take an additional exam called the Kenntnisprüfung. It tests whether your medical knowledge meets the German standard. It covers several disciplines, including internal medicine, surgery, emergency medicine, pharmacology, and radiology. Most doctors take it after receiving a temporary license and working under supervision for a while.

1. Oral and practical exam

• Patient examination: you examine a patient, take their medical history, and do a physical exam.
• Case presentation: you discuss your findings with a panel of doctors, suggest possible diagnoses, and recommend treatment.
• Questioning: the panel asks you about the case and about other medical topics.

2. Written exam (in some states)

Some states add a written test with multiple-choice or short-answer questions across a range of medical subjects.

You can take the Kenntnisprüfung before or after the Fachsprachprüfung, but we recommend the language exam first. It gives you more confidence and makes sure you can present medical facts clearly in German. Apply at least six months ahead so you have enough time to prepare. Exam fees vary by state and are typically between €400 and €1,100. Budget for translations, certifications, and a preparation course on top.

Once you pass, you receive a certificate of equivalence (Gleichwertigkeitsbescheinigung). That lets you apply for the Approbation. After roughly four to five years of working as a doctor, you sit the Facharztprüfung to complete your postgraduate training and become a specialist.

Temporary License (Berufserlaubnis)

While you wait for your approbation, you can apply for a temporary license called a Berufserlaubnis. It allows you to work under supervision in a hospital or clinic and gain practical experience in the German healthcare system. It is valid for a limited period and can usually be extended until you receive your approbation. For most international doctors this is the step that turns the process into a paid job rather than a waiting game.

Anerkennungspartnerschaft and Anerkennungsverfahren

The Anerkennungsverfahren is the formal recognition procedure itself. The Anerkennungspartnerschaft is a newer option: you and a German employer agree to complete the recognition process together after you arrive, so you can enter the country before your qualification is fully recognized. Both routes exist to get you into work sooner, and both are worth asking your employer about early.

Careers in Medicine in Germany: Salary for Doctors

One of the most appealing parts of working as a doctor or a nurse in Germany is the pay. Most hospital doctors are paid on a collective agreement, so the figures are public rather than a matter of negotiation. The table below shows monthly gross pay under the TV-Ärzte/VKA agreement for municipal hospitals, valid from June 2026.

Source: the TV-Ärzte/VKA pay tables published by the Marburger Bund, valid from June 1, 2026. On-call and night duty are paid on top.

What Factors Affect Your Salary as a Doctor in Germany?

• Experience and qualifications: the pay steps rise with years of service, and specialist certificates move you into a higher group.
• Location: doctors in Berlin, Munich, and Frankfurt often earn more than in smaller towns, because of higher living costs and demand. Rural hospitals sometimes pay a recruitment premium instead.
• Type of employer: university hospitals, municipal hospitals, and private groups each use a different agreement. On-call duty can add a large share to your monthly total.

What the Approbation Costs, by State

The fee for the same license is not the same everywhere. Saxony charges €490. Bavaria charges €400. North Rhine-Westphalia decides case by case, anywhere between €150 and €700.

That gap is worth knowing before you apply, because you apply in the state where you intend to work. Most guides give one national range and leave it there. These are the figures the state authorities publish themselves.

Hamburg is not unusual. Several states publish no figure at all, which is the main reason a straight cost comparison for the Approbation is so hard to find anywhere. If your state is not listed above, write to the licensing authority and ask for the fee in writing before you start. They will tell you.

How Long Does the Process Take?

There is no single national answer, because each state runs its own procedure. Plan in stages instead of waiting for one decision.

• Documents and translations: start collecting them months before you apply. Certificates of good standing often expire, so check their validity period.
• Language: reaching B2 from scratch takes most learners well over a year. The Fachsprachprüfung then needs a few months of focused preparation.
• Equivalence check: the authority reviews your file and tells you whether a Kenntnisprüfung is required.
• Berufserlaubnis: apply for it as soon as you can, so you are earning and gaining German clinical experience during the wait.

The doctors who get through fastest usually do two things: they pick their state early and they start working on a Berufserlaubnis instead of waiting at home for the full approbation.

Who to Contact for Each Step

No single office handles all of this. Recognition, licensing, visas, and exams sit with different bodies, and the licensing office changes depending on the state you apply in. Here is who does what.

For language preparation, start with our guide to learning German for course types and levels, then add a medical German course before you sit the Fachsprachprüfung.

The Words You Will Keep Running Into

German medical licensing comes with its own vocabulary, and most of it has no clean English equivalent. Here is what each term means in plain language. Come back to this table whenever a word stops making sense.