Ultimate Guide to Practicing Medicine in Germany

Castles, beer, and Goethe are only some of the enticing reasons for an American physician to practice medicine in Germany. The process of transitioning to Germany is involved. It is suited for those who have committed to the move and it requires fluency in German. Here is a guide to make the transition to practicing medicine in Germany as smooth as possible.

The German Health Care System

Health insurance is mandatory in Germany. Germany has public and private health insurance, with 86% of Germans enrolled in the public statutory health insurance. Statutory health insurance covers inpatient, outpatient, mental health treatment, and prescription medications. Germans with yearly earnings of more than 62,000€ can opt out of public health insurance and obtain private health insurance. Private health insurance covers 11% of the population and reimburses physicians a lot more than public insurance. Patients with private insurance may be treated separate hospital floors and often receive more specialized care compared to patients with public insurance.

German Medical Education & Post Graduate Training

After graduating high school, Germans directly attend medical school for six years. In the classic curriculum the first two years are pre-clinical, the next two years are more clinically oriented, and the last year is a sub-internship in the specialty of choice. In contrast, Americans attend 4 years of undergraduate college, then 4 years of medical school including 2 completely clinical years. In light of this discrepancy, German residency, Assistenzarzt Ausbildung, is longer – the shortest program spans 5 years, and most residencies in Germany are 2 years longer than their American counterparts. For example, Internal medicine training is 3 years in the US and 5 years in Germany. Ultimately, the total amount of training is typically the same between the US and Germany.

Once you have a medical license, Approbation, getting a resident position, Assistenzarzt, is easy in many specialties.  Ortho? Anesthesia? PM&R? They all have openings and it isn’t that competitive. You can apply directly for an Assistenzarzt position at a hospital. Residency in Germany is less structured than in the US and you do not need to apply for a residency program. You do need to complete a specific amount of time in specific specialties, though you are not tied to one hospital. You can work at many different hospitals, and as long as you complete your rotation requirements, you can finish residency and sit for your specialty boards to become a Facharzt, a specialist. All first-year residents are paid a base salary of 4,500 – 5000 euros/month by the hospital. This does not include compensation for working overtime, nights, or weekends/holidays. The salary increases each year.

Medical Licensure/Registration

Practicing medicine in Germany requires medical licensure. Obtaining a full medical license, approbation, can take well over a year for a fluent German speaker to receive, and much longer for someone who is learning German. See Eight Steps to a German Medical License for details.

After you get approbation, you can apply for specialty certification through your local State Chamber of Physicians. They will evaluate your specialty and sub-specialty training and advise you if you need additional training, procedures, or exams. For more information on this see Practice Medicine as a Specialist in Germany.

Finding a Job

Hospitation, an unpaid rotation at a teaching hospital is an opportunity for foreign physicians to be immersed in the German medical system and improve their medical German. This can be done in parallel with the approbation process. Outside of this experience, you cannot see patients or apply for a job prior to having approbation. If you see patients before getting Approbation, you are practicing without a license, which is verboten, and will prevent approbation.

Physicians are in demand in Germany. Hospitals are constantly advertising vacancies on Facebook groups like “ Approbation in ___ Bundesland”. You can look for positions on Jobborse, Arztestellen, or Monster. Alternatively, you can email hospitals directly for open positions in your field.

Salary & Work Culture

Doctors practicing medicine in Germany make significantly less than doctors in the USA. The salary is dependent on the length of training – the more years of training, the higher the salary. A junior attending, Facharzt, earns about €60,000-80,000 per year and then after several years of experience will become an Oberarzt, an attending. An Oberarzt can expect a yearly salary around €90,000-130,000 if taking a union position and greater than €130,000 if taking a non- union position. A Chefarzt, the department head, can expect a salary greater than €200,000. Specialists in private practice can earn more than €180,000. Only physicians in leadership positions are able to negotiate salary. Notably, medical schools are FREE and German physicians are not burdened with school debt!

You will need to complete German Residency if you want to accept public health insurance. If you prefer not to go through German residency, you can start your own private practice and choose to accept private insurance which can include TriCare (US military insurance). For those practicing medicine in Germany in private practice, you are required to share night call once or twice a month with the other private practices in your region. In order to share call, you need to be eligible to accept public health insurance which requires completion of German residency. The good news is you can sell your call shifts to other doctors, for 100-300 euros/shift so you don’t have to take your own call. Some doctors in Germany make their entire living taking other doctor’s call shifts!

If you accept government insurance you will have to see A LOT of patients to earn money. Some general practice doctors see about 50-80 patients a day, to earn about 150,000 euros a year. Here is a calculator to help you determine your expected salary. If you accept private insurance, you can see fewer patients and make more money. However, only 11% of the population has private insurance, which accounts for only 8% of health care expenditure. It might be harder to find the clientele for a private practice.

Immigration

You will need a visa to work and live in Germany. The Blue Card EU Visa is applicable to those with a recognized university degrees, inclusive of a medical degree, with a job-offer in hand and a minimum annual salary of 43,056 euros. The Job Seeker (academic) visa enables a physician to stay in Germany for up to 6 months while finding a job. Once you find a job you can obtain a residence permit. For those with familial connections to Germany there are several visa options for joining a parent, a partner, or a child. There are also some German citizenship options for those of German Ancestry. 

Practicing Medicine in Other EU Countries

Once you have a medical license in one EU country, it is easier to practice in other EU countries.  All credentials are interchangeable though you might be required to take a language exam.

US Taxes

All US citizens are required to submit a tax return every year regardless of where you live and work. The German-US Tax treaty prevents double taxation, so you will not be taxed by both Germany and the US. For more information see the 5 Tips to Filing Expat Taxes.

Bottom Line

Moving and practicing medicine in Germany is a commitment – a commitment to learning German.

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.