Germany is the Land of Bureaucracy and details are important. Here we provide a detailed guide to medical registration to help you practice medicine in Germany. If the registration paperwork isn’t exactly how they want it, it will be rejected. Trust me – I learned the hard way causing MONTHS of delay. So yes, I will provide a lot of details. Importantly, I am a DO, not an MD. In the EU, American DOs are equivalent to MDs. And yes, to practice medicine in Germany, you have to be fluent in German.
For a general overview of practicing medicine in Germany, see Everything You Need to Know About Practicing Medicine in Germany.
The German Medical Association, Bundesärztekamme, is the governing body for the medical profession and sets standards for medical licensure. In order to practice medicine in Germany, the state health authority is responsible for issuing a full or temporary medical license.
Full Medical License: Approbation
A full medical license, Approbation, is valid for life and enables you to practice medicine anywhere in Germany, or even in the EU (more on this later)!
Step 1: Decide on a Bundesland: Decide which German State, Bundesland, you would like to practice in. Each Bundesland has slightly different regulations. Some are stricter than others, but the basic process and paperwork is the same.
Step 2: Bundesland Specific Licensing Requirements: Go to the Bundesland or district-specific, Bezirksregierung, licensing website, and review the instructions and requirements brochure, the Merkblatt, for a non-EU citizen obtaining an Approbation in Germany. The Merkblatt is in German and is not translated into English. TheBezirksregiurung constantly changes the Merkblatt without notice or announcement; so, check at least once per month if the requirements have changed. When you submit your paperwork, you will be held to the standards of the most current Merkblatt.
Step 3: Learn German: This takes time and can be done in parallel as you complete and submit your paperwork. All states, Bundesländer, require at least a B2 level of German. Some states require a C1 level. You will need to pass a language proficiency exam from TELC or Goethe Institute to prove B2/C1 language proficiency. No other language testing companies are valid.
Step 4: The Paperwork: Gather the paperwork indicated on the Merkblatt. This typically involves documents verifying credentials, a doctor’s note verifying health status, verification of immigration status, and a few other items. I elaborate below on key steps in the process.
Translation: All documents (including your US Passport) must be translated into German by an official and registered German translator. The translator must provide their certification number, stamp, and signature on the document. This can be quite expensive since most officially registered, certified translators charge about 75 euros per page before taxes. If you find someone less expensive, they most likely are not certified. VERIFY THE TRANSLATION IS ACCURATE by running it by a native German speaker or German teacher.
Haager Apostille: Your US state medical license, medical diploma, medical school and undergraduate transcripts, and board specialty diploma will require a Haager apostille which confirms the authenticity of a public document. The apostille is obtained in the US state in which the certificate was issued. For example, if you graduated medical school in Arizona, the apostille for your medical school diploma can only be obtained from the Arizona Secretary of State Office. However, in some US states, if the document is notarized in a particular US state, you can obtain the Haager Apostille in that state regardless of where the certificate was issued. For example, if you notarize all of your certificates in Colorado, regardless of which state issued the certificate, you can obtain the apostille at the Colorado Secretary of State office.
For the documents requiring the Haager Apostille, I recommend obtaining the Apostille first, then obtaining a certified copy in Germany of these Apostilled documents.
Beware: there are companies online that will obtain apostilles for you. They charge hundreds of dollars. The secretary of state office only charges $15.00/document.
Certified Copy: All documents must be provided in a, “certified copy” format. This can only be done in Germany at either a, Notar (Lawyer) office or your German city’s Bürgeramt, thegovernment office branch that handles citizen affairs. In Germany, a certified copy is called a “notarized copy”. Notarizing in Germany, unlike in the USA, can only be done by a lawyer or at the Bürgeramt. Do not be fooled by the vocabulary.
The Bürgeramt will only make certified copies of German documents. This means you need to get the translation FIRST then then take the certified translation to the Bürgeramt. Some Notars will make certified copies of English documents, but not all of them.
Lebenslauf (CV/Resume): You will need a Lebenslauf in German according to German standards. This is slightly different from your American CV. It has a specific format and you need to provide a photo of yourself on the CV. Consider asking a German teacher to review your CV.
Führungszeugnis (background check): You need to complete a background check and possibly obtain fingerprints. The Führungszeugnis needs to be in German, must be certified, and should not be more than 3 months old when you submit the paperwork to the Bezirksregierung.
If you have lived in Germany for 3 or more years, you can obtain the Führungszeugnis at the Bürgeramt. This does not require fingerprints.
If you have not lived in Germany for three years or more, you are required to obtain an American FBI background check requiring fingerprints. You can obtain your fingerprints at any police station, and then mail the fingerprints to the FBI. Once again, the Führungszeugnis needs to be translated to German, must be certified, and should not be more than 3 months old when you submit the paperwork to the Bezirksregierung.
Obtaining fingerprints in Germany is challenging. It has to be done at a detective’s office and can cost up to 300 euros, 150 euros per hand.
Alternatively, you can go to the US Consulate General Frankfurt to complete a form detailing the reason for fingerprints and then walk to the Frankfurt police station just across the street to have your fingerprints taken for free. The police station across from the US Consulate General Frankfurt is the only police station in Germany that will do this.
Unbedenklichkeitsbescheinigung (Certification of no pending US medical lawsuits): This can be obtained from the National Practitioners Databank. Keep in mind that one of the steps required by the National Practitioners Databank is having a notary notarize your identity. This is easily done for free in the USA at a bank. If you are in Germany, you need to go to the US Consulate General Frankfurt in order to get documents notarized by USA standards (as explained above, notarizing in Germany has a different meaning). Getting a document notarized at the US Consulate costs $50.00.
Step 5: Mail Paperwork & Wait: Mail the documents to your Bezirksregierung and wait. It can take up to 3 months to be notified that the officials have received your paperwork. Do not get discouraged.
There is a 3 month turn-around with any Bezirksregierung communication. For example, if there are any mistakes in your paperwork, they will notify you within 3 months. Then, once you correct the mistake and send it to them, it will take another 3 months for them to tell you they received your updated information. Depending on how many mistakes you make in your paperwork, this process can take up to a year.
Step 6: Medical Language Exam: Once the Bezirksregierung approves your paperwork, you are eligible to take the Fachsprachprüfung (FSP), medical language examat the B2/C1 level. This is required in all Bundesländer.
This exam assesses German medical communication skills. It involves taking a history of a standardized patient, writing a SOAP note, presenting the note to an attending, and being questioned by the attendings. The exam is slightly different in every Bundesland and more challenging in some Bundesländer compared to others. There is a linguist present to ensure the evaluation of communication skills only and not of medical knowledge.
I recommend a preparation course such as Fia Academy or using a board-preparation website like Amboss. Courses cost 3000-4000 euros. You might be able to get a course paid for by the German government through your local Arbeitsagentur, job center. If you want to apply for government financial aid, be sure to start the application process at least 6 weeks before the course begins. This is also a long and grueling process- one must be persistent, or paperwork may get, “lost”.
Step 7: Medical Knowledge Exam: Once you pass the FSP, you are eligible to take the Kentnissprüfung (KP), the medical knowledge exam. This is required in all Bundesländer if you studied medicine in a non-EU country. The KP is not required if you studied medicine in an EU country. You sign up through your Bezirksregierung.
The KP is the same as the German medical school’s step 3 board exam. The exam involves obtaining, writing, and presenting a complete H&P on a standardized patient and an oral exam where you are questioned by 3 attendings about internal medicine, surgery, emergency medicine, pathology, medical law, psychiatry, and radiology. The exam is in German. The pass/fail rate depends on your Bundesland. Some Bundesländer are more forgiving than others. For example, in Nordrhein Westfalen (NRW), the pass rate is 50%, whereas in Hessen, the pass rate is 90%.
Again, I highly recommend a preparation course such as that offered by Fia Academy and/or using a board preparation website like Amboss. You might be able to get a course paid for by the German government through your local Arbeitsagentur (remember-persistence is key when working with any German government agency).
Germany focuses on testing different aspects of medicine than the USA, so taking some kind of course is helpful not only to get experience with the language but to also understand what German attendings see as important. The study approach is a little different than that for the USMLE/COMLEX.
The Merkblatt advertises that there might be a way for physicians of non-EU countries to get out of taking the KP. This is a scam. DO NOT DO IT. I share my experience in “Beware the Gutachter, an expert opinion scam“.
Step 8: Apply for Approbation!!!! Once you pass the KP, you are eligible for your Approbation. This is handled first by the Bezirksregierung then by your state’s Ärztekammer (medical board).
Temporary Medical License: Berufserlaubnis
A temporary medical license, Berufserlaubnis, is valid for up to two years in the state in which it was issued. In some cases, the temporary license is limited to you working in a specific position. The application requirements are found on the Bundesland website, the criteria vary from state to state, and you typically need a B2 German language certificate. You may work under a temporary license while studying for the KP, but keep in mind, the pay will be minimal if at all. For example, you may work as a Gastarzt (visiting physician) though some hospitals provide only a small allowance and a dorm room, while other hospitals pay minimally, or not at all.
Practicing medicine in Germany requires an individual who trained outside the US to apply for German medical registration – an involved, intense, and frustrating process. Gathering and submitting the approbation paperwork, correctly, even for a native German speaker, can take well over a year – mostly because the Merkblatt changes its requirements frequently without notice and there is generally no one at the Bezirksregierung available to talk to and ask questions. For those who are not fluent in German, be prepared for a prolonged process. Regardless, it is a character-building and character-affirming experience. Where there’s a will, there’s a way – and you will be rewarded with castles, beer, and Goethe! Want to learn more, check out Everything You Need to Know About Practicing Medicine in Germany.
Dr. Shana Alexandra Greven (Shosky) is an Osteopathic Neuromusculoskeletal Medicine specialist, an American doctor living in Germany who recently received Approbation (a German Medical License). She works part-time as an Assistant Professor at ATSU Kirksville College of Osteopathic Medicine in Kirksville, MO as well as at Liberty Mountain Medical Group in Lynchburg, VA. Dr. Greven enjoys spiritual and contemplative studies, meditation, yoga, running, fitness, nutrition, nature, equality, and believes in supporting the physical, spiritual, and mental Health of her patients. She is also an Adventure Guide, providing a personlized approach to help others move to Germany through our Guidance Service.