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Library Resources for COM Clerkships and Clinical Electives: Medical Residency in Germany

Library materials, subject guides, and useful resources compiled by Alfaisal University librarians

Medical Residency in Germany

Medical Specialist Training in Germany

Basic Medical Education in Germany leads to graduation (M.D. - Diplom in Medizin) with an Approbation (Licence to practice medicine) after six years of studies at medical universities in Germany including 48 weeks of continuous practical training. It is important to note that it is not difficult to obtain Specialist Medical Training positions for those candidates who have completed their basic medical education or M.D. in Germany as they already hold Approbation.

For doctors from outside Germany, they have to meet all the requirements leading to the Approbation first, before they can start their Specialist Medical Training in Germany. Specializations in a certain area of medicine is an important part of Specialist Medical Training in Germany and elsewhere. There are 30 different areas of Medicine to choose from for your Medical Specialist Training. Specialist Medical Training in Germany takes around 5-6 years and is conducted at universities clinics and medical facilities such as hospitals which are authorised for it. Regulations regarding Specialist Medical Training are different in each state in Germany. However, with excellent German language skills up to B2/C1 followed by a medical license, the “Approbation” is the starting point towards your Specialist Medical Training in Germany.

Medical Specialist Training in Germany is a non-university degree and is not offered by universities. The degree “Facharzt” (Medical Specialist) is awarded by the authorized centers where the doctors are trained. Usually during Medical Specialist training doctors work full-time at a doctor's practice, a university clinic or medical center, or other “institution authorized to provide medical treatment and at the same time are trained under more senior physicians and surgeons in their field of specialties. During the training as a Medical Specialist, one is normally paid the salary of an assistant physician.

An important aspect of the Medical Residency or Medical Specialist Training for doctors who have completed their medical education outside of the EU or Norway or Switzerland is the recognition of your medical education. The equivalency of the academic qualification is assessed by an examination called Kenntnisspruefung. If the medical board decides that your education is not equivalent to that of Germany, you will receive a temporary medical license valid for a maximum of 2 years during which you are required to take the equivalency assessment examination. One normally receives “Approbation” or a German medical license after passing the exam.

Foreign Doctors in Germany

Germany today needs approximately 4000-5000 medical doctors each year and there are already a huge number of doctors working in Germany.  



The starting point of Medical Specialist training is that you should have a good medical education and a license to practice medicine in your home country followed by German language courses upto B2 level and either the TELC Medizin test or Patientkommunikationtest 1 or PatientKommunikationTest 2. For successful integration and stress-free work in a German hospital, you need a C1 level of German language.



If you are interested in doing Medical Specialist training in Germany or Facharztausbildung in Germany, you have several pathways to support your medical residency in Germany. However, most of these pathways start after passing Goethe Zertifikat B1. It is important to note that a very good German language skill at least up to B1 is required in order to start the process. A simple pass may not be enough and we advise you to learn a German language course at Edupark so that we can create a tailored learning plan depending upon your needs.


Important things to know !

Duration of residency:

The length of residency varies from five to six years depending on the residency area. Dentistry residencies are between 1 and 3 years long.

Minimum wage:

 The medical residency position in Germany has a salary in the range of 3000 -4500 Euros depending upon the area of your medical residency. 


Application date:

You can embark on residency anytime. The main requirement is the knowledge of the German language at the necessary level.

Language competency:

Usually, at least language level B2 is required for admission into residency. It is impossible to get admission without knowledge of the language. Those who do not command German can avail themselves of our language course services.


To specialize in Germany, doctors who have completed their education in any EU/EEA member state must exhibit their knowledge of the German language at a satisfactory level. With the automatic recognition of professional qualification, doctors are not obliged to perform additional internships, as is the case in some countries, but can begin with the residency as soon as they agree with a hospital. Of course, you have to focus on taking the oral test of medical German. Fachsprachenprüfung (FSP) requires an extremely high level of comprehension of the German language which is almost at the C1 level, so this oral exam should not be taken for granted. Once you have passed the FSP and collected all the necessary documentation, you apply to the competent authority of the region in which you want to find a specialization. It is worth noting that Bavaria does not require a certificate of language proficiency, which is mandatory for other regions, but the candidate must know the language at a satisfactory level and have passed the FSP. You can read a more detailed list of documentation required to obtain a medical license “Approbation” here.


To obtain a work license you need:

  • knowledge of German at B2 level at the minimum
  • necessary documentation
  • successfully passed Fachsprachenprüfung

Register with the German Medical Association

If you want to work as a medic in Germany, it is necessary to register with GMA (The German Medical Association), which is a competent authority for all doctors in Austria. The entire process requires a certain amount of time.


To work as a doctor in Germany, you need a work permit called Approbation.

Based on your resume you will be invited to an interview.
List of Documents, which need to be submitted with the forms:
1. An updated CV
2. Photocopy of ID or passport
3. Photocopy of Certificate of birth
4. Photocopy of Certificate of Marriage, if names in ID and Certificate of Birth are different
5. Extract from Police Records, not older than 3 months (Original)
6. Medical Certificate, not older than 1 month; (existing form [in German] can be used, also must be original)
7. Language Certificate, at least B2
8. Diploma
9. Certificate of Conformity, if the study started before the country entered the EU
10. Certificate of Good Standing, from all countries where employed. Cannot be older than 3 months. If asked for purpose: Approbation in Germany


Check the link above, where you have the application form and the address where you can submit them.


Knowledge of German is a prerequisite for Approbation.
Physicians, dentists, and pharmacists must have language skills at the C1 level.
Professionals like Psychological psychotherapists and child / adolescent psychotherapists must have language skills at the C2 level.

Furthermore, the competent authority will determine the fee. Therefore, inquire about the probable cost of the procedure before submitting the application. If you are registered as a job seeker in Germany or seeking social assistance, costs may be lower but must meet certain conditions of the government, such as the Federal Employment Service or the Employment Center. Please note that you must always request financial assistance in advance.

All copies submitted must be translated into German by an authorized court interpreter and certified by a notary public.


You will need a visa to work and live in Germany. The Blue Card EU Visa is applicable to those with a recognized university degree, 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.

Eight Steps to German Medical Licensure

Medical Registration/Licensure

The German Medical Association, Bundesärztekammeis 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 1Decide 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 are 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 3Learn 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 4The Paperwork: Gather the paperwork indicated on the Merkblatt. This typically involvedocuments verifying credentials, a doctor’s note verifying health status, verification of immigration status, and a few other items. I elaborate below on the 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 from 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, the government 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 in 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 5Mail Paperwork & Wait: Mail the documents to your Bezirksregierung and waitIt 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 turnaround 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 6Medical Language Exam: Once the Bezirksregierung approves your paperwork, you are eligible to take the Fachsprachprüfung (FSP), medical language exam at 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 attending. 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 7Medical 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 8Apply for Approbation!!!! Once you pass the KP, you are eligible for your Approbation.  This is handled first by the Bezirksregierung and 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.

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