An American Doctor Moves to Germany

In the middle of my intern year, March 2013, I fell in love with a tall, dark, and handsome German man at an osteopathic course in Oregon.  We had a long-distance relationship for 3.5 years spanning my residency and a year as an attending. In July 2016, I took the big leap and moved to Germany to be with my now husband and stepdaughter.

I spent my first year in Germany enrolled in an intensive German language school with a language school visa . This visa is valid for one year and you are not allowed to work in Germany with this visa. I earned an income by teaching online for a US medical school. German is the first foreign language I speak fluently, and it took me a long time to learn it – about two years to achieve a B2 level.  I suppose learning German would have been faster if my husband and I had spoken in German together, but honestly, after blasting through medical school and residency in the US, I am happy that I took my time learning German.  I also get plenty of practice with my stepdaughter who only speaks German; kids can be the best teachers. They don’t care if you have an accent or make mistakes!

On Approbation: The Full German Medical License

Approbation is a prolonged process. It took me about a year to gather all of my paperwork, including all of my syllabi/evaluations. In January 2019, I submitted my paperwork to the Bezirksregion Dusseldorf, and due to requirement changes, I had to re-do a few things. Once the Bezirksregierung approved my paperwork, I was eligible for, took, and passed the Fachsprachprüfung (FSP) – the medical language exam – in September 2019. The Gutachter, an appraiser who upon reviewing medical training documentation could exempt you from taking the Kentnissprüfung (KP) – the German medical knowledge exam – notified me in November 2019 that all 500 pages of medical education documentation had been rejected and that I would need to take the KP exam. In 2020, I spent 6 months in the US working due to COVID-19, and it is only now that I will be taking the KP – sometime in the winter of 2020/2021.

The Approbation application period is too long a period of time to not work as a physician and to not have an income. During my approbation process, I have been blessed to have a part-time teaching job at a US medical school online and a position at a practice in Virginia that gives me a lot of flexibility with my schedule.

So far, I am 3.5 years into this process, and I am now on the last step prior to getting my Approbation. See Eight Steps to a German Medical license for more information on the approbation process.

I am not 100% sure yet what my career will look like. My specialty is Osteopathic Neuromusculoskeletal Medicine, which does not exist in Germany.  Osteopathy isn’t a recognized profession in Germany. In order to practice osteopathy, I need to open a private practice and accept private insurance or self-paying patients. I am happy to open a private practice since I have no desire to repeat residency, which would be required if I were to accept public insurance. My specialty is unique so I don’t think I will have a problem building a practice. My American optimism, grit, discipline, and perseverance have pulled me through the process so far, and I am sure it will continue to be a great asset to my success as a private physician.

On a German Physician’s Salary

American doctors literally earn 3x more than German doctors for the same amount of work.  If you have a private office where you don’t take state insurance, you can see fewer patients and earn more money. That said, there are a many perks about being employed in Germany: paid sick days, 6 weeks of paid vacation, a YEAR worth of paid maternity/paternity leave (one parent can take the whole year, or it can be divided between the two parents), and health insurance.  If you are self-employed, you are responsible for giving yourself sick/vacation days and paying for your health insurance.  Maternity/paternity leave is paid for by the government and is based on your tax returns- so this might be a benefit to both employed and self-employed individuals.

On Medical School Debt

I am still in major medical school debt. This is something I have not figured out how to pay off while living and working in Germany.  So far, between traveling back and forth to the USA and my online job, I work 32hrs/week and I am able to make qualifying Public Service Loan Forgiveness payments.  I don’t know how long this will last after I have kids…this is still a journey!  I pray that other solutions present themselves in the future. Fingers crossed.

On Settling Into German Society

Do I feel settled?  Not really.  I don’t live in an international part of Germany like Munich, Frankfurt, or Berlin; this is helpful for learning German but bad for making friends. It is REALLY hard to make friends with Germans – to an open-hearted American like myself, the German culture feels very closed off. Knowing German is helpful, but the USA still feels like home to me.

Honestly, I feel jaded these days. I don’t recommend coming to Germany unless you really have to or REALLY want to.  I love my husband and stepdaughter and that is the only reason I have done all this.  It has been a very degrading experience dealing with the German government – basically flying blind the entire time, no one being straight forward with you, struggling to understand, and grasping at straws for someone to help you.  Even my poor husband had no idea getting my Approbation was going to be this horrific.

This last week I was able to hold my own, in German, during a gaslighting conversation with a, Arbeitsagentur (job Center) employee after she accused me of, “waiting until the last minute” when in fact the job center had misplaced my paperwork.  It was the first time I navigated a German government agency without the help of my husband. It took 3.5 years and it felt good!  After hours of phone calls, lost paperwork, and weeks of waiting, the Arbeitsagentur reimbursed me for the 3,500 euro KP prep course! #AmericanGrit

The cost of living is an advantage of living in Germany. I comfortably live on $2,500/month.  I don’t need a car and I only spend 155 euros/month on healthcare.  Germany takes climate change and caring for the environment seriously, Germany is politically stable, and is relatively safe.

On Personal Growth

Moving to Germany has been a great experience for personal development.  I’ve learned about cultural differences, how cultural trauma affects society, and how cultural agreements affect how we live our lives and how we build our governments. It is humbling to be an educated adult physician who speaks like an 8-year-old. I’ve learned to surrender control to the unknown. I have WAY more compassion for immigrants (we get the job done!). I can see, own, and appreciate the things about myself that are uniquely American in a way I never would have been able to before moving to Germany.  It’s been a character-building and character affirming experience.  Once I get my Approbation, I can use this experience as proof that you really can do and succeed in anything you put your mind to.

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



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