Welcome to our latest Hippocratic Adventures chat! Today we are learning from Dr. Kathrina Alexander.

Dr. Alexander is an Anatomic & Clinical Pathologist with subspecialty training in Hematopathology. She was born in the US and did her Residency and Fellowship training at the University of Alabama in Birmingham. She has practiced in a variety of settings in the US and Germany, and is presently back in the US (albeit temporarily), working at a Contract Research Organization. She also holds a medical license in the UK with future plans to move to the UK.

Watch the full chat above. Below, we share the episode summary and show notes.

1. Tell us your story. How did you end up practicing in Germany?

This change was driven by a sense of adventure, a touch of a mid-life crisis, burnout, and the fact that medicine in the US is not having its finest hour. Dr. Alexander was working in community private practice when she joined an international pathology group. Through this group, she and a physician recruiter started a dialog spanning several months about a potential job opportunity in Germany. Around this time her daughter was graduating high school and her husband was ready to make a change, so they decided to explore the job opportunity in Germany.

She visited Germany for the first time for the job interview. She spent a week in Germany and by the end of the week, Dr. Alexander and her husband both left Germany with job offers in hand.

2. How was the process of obtaining a German medical license?

In working with a Contract Research Organization (CRO), Dr. Alexander was able to obtain a German medical license, through an “off-road” path.

Typically, medical licensure in Germany requires fluency in German. However, because she was working for a CRO where the communication and reports were in English, the German medical board made an exception. The CRO helped her submit her application to the Hessen state medical board, which then granted her a German medical license. Notably, the medical license was limited to her position within the CRO.

3. Did you need to take additional medical exams, repeat part of residency, or work under supervision?

For her role within a CRO, she did not need to complete additional training.

4. Do you need to be fluent in German?

If you are practicing within a traditional role as a pathologist or in a role with direct patient interactions, yes, you do need to be fluent in German. However, because Dr. Alexander worked for a CRO, where communication was in English, she did not encounter a language barrier.

That said, even with minimal knowledge of conversational German, she was able to read and decipher a German pathology report, since medical terminology rooted in Greek and Latin, are similar whether in German or in English.

At a point, she did consider working in community practice in Germany when her language skills improved. She currently has an A2 level proficiency in German. However, because pathology reports are standardized and medical jargon is similar in English and German, she feels that with a couple months of working with a translator and improving her German language skills, she would be able to communicate a pathology report in German! She emphasizes that the German language is a skill you can learn!

Dr. Alexander recommends that physicians develop some level of German language fluency prior to moving to Germany, because even if you find an English-speaking job, the rest of your life – the utilities, the groceries, social interactions, will be in German.

For those interested in developing your German language skills, sign up with this affiliate link for Babbel and benefit from an exclusive discount for Hippocratic Adventure members.

5. What are some differences you noticed as a pathologist in Germany compared to the US?

In working for a CRO, her hours were set, regimented, and she had time off on all the German holidays (and there are a lot of holidays!).

The work hours for private practice pathologists in Germany are long and the caseload is very similar to the caseload in the US. The practice of pathology is also is very similar- they still have frozen sections, tumor boards, etc. In the US, there is a much greater emphasis on subspecialty pathology, while Germany has more general pathology. That said, subspecialty training is becoming more attractive in the German job market.

The UK and the European market sector adopted digital pathology much quicker than the US. During her time in Germany, she bounced between the microscope and digital screens. She has brought her experience in digital pathology back to the US where she is now leading the digital pathology movement.

There was a more generous sick leave and an understanding and an expectation that you will use sick leave. There was a greater expectation that you will take time off for self-care and there is more of an emphasis on work-life balance.

6. What was your salary like in Germany compared to the US?

In moving to Germany, Dr. Alexander took a 60% pay-cut compared to her community private practice salary in the US. Importantly, her cost of living was much lower, and the tuition for her daughter who attended an EU university was much lower than what it would have been in the US.

7. You also hold a medical license in the UK. What was the process like of obtaining a medical license in the UK?

After returning to the US, Dr. Alexander initially worked at a VA in Arkansas. A health condition resulted in Dr. Alexander being disabled, and she sought out a position within a CRO.

It is through her current company that she is moving to the UK. The licensure process in the UK was a lot more arduous; no matter your specialty, they really want you to have a year where you do 6 months of surgery and 6 months of internal medicine as a practicing physician. The time you spent in medical school does not count. For the diagnostic specialties like pathology, this proves to be a challenge.

It took Dr. Alexander 359 days to work around this barrier. She worked very closely with her residency program for additional documentation that showed that her training was equivalent to the training in the UK. Her residency program submitted detailed descriptions of rotations such as flow cytometry and her medical school submitted evidence that she had put in central lines. Persistence paid off and the 3^rd time she submitted her time sensitive documents, the paperwork went through.

For more of the nitty-gritty on the UK licensure process, check out our fantastic guide to obtaining a UK medical license.  

8. Any lessons you would like to share about moving abroad?

Dr. Alexander reflects on three lessons she learned through the move to Germany that she will carry with her to the UK.

1. You have to stay patient.
2. Learn to reframe challenges into mini adventures
3. Moving abroad gave her an opportunity for adventure that she did not realize she was missing.

9. Tips and tricks for physicians thinking of moving abroad.

Dr. Alexander offers up some fantastic bits of advice throughout the chat. Here are a handful of highlights.

• Consider taking a job where you will be sponsored by a company or a hospital
• You will need a local bank and a global bank for currency exchange, consider using Wise (affiliate link for Hippocratic Adventures members).
• Consider a Global Mail forwarding service as you will likely need a US address to keep your US licenses and bank accounts
• Renew your US medical license board certifications, and continue with CMEs. It costs extra money but your US medical license is a valuable asset.
• Do not ship your American car abroad, buy a local car
• Don’t move all your stuff abroad – have a yard sale and move with as little as possible. International shipping is pricey and shipping containers get lost!
• Learn how to parallel park before moving to Europe
• Join some expat forums
• Try to find local equivalents of your favorite stuff or make it at home (like ranch dressing!)
• Get into the local culture and food

Bottom Line

Moving abroad could be the soul reboot you need to recharge your life and your career. Check out our Ultimate Guide Series for more information on moving to Germany and the UK.

If you’re feel overwhelmed with the licensure and relocation process and you’re ready for to make your dream of moving to Germany a reality, come work with our Guidance service. Sign up here!