The most heavily regulated sector in this repo. Almost every profession here needs a state licence before you may work at all — recognition is not optional, and the pattern is near-identical across them, so it is collected once here.
The two exceptions are worth knowing first. The assistant occupations — MFA, and the dental, veterinary and pharmacy equivalents — are not regulated; they are ordinary dual Ausbildungen, examined by the chamber of the profession they assist. And Pflegefachassistenz is regulated by the Bundesländer rather than federally, in sixteen different versions.
The recognition path, in general
- Apply to the competent authority of the Bundesland where you intend to work — Landesprüfungsamt, Bezirksregierung, or Landesamt für Gesundheit, depending on the state. There is no national office. Start at anerkennung-in-deutschland.de.
- EU/EEA/Switzerland: doctors, dentists, nurses, midwives, vets and pharmacists have automatic recognition under Directive 2005/36/EC. This is much the shorter path. It does not extend to the rest of this folder — physiotherapy, psychotherapy, the therapy professions, PTA, MT/MTA and ATA/OTA are all assessed individually even from inside the EU. See Architekt for the full list of seven and why it is closed.
- Third countries: a Gleichwertigkeitsprüfung compares your training to the German curriculum. Gaps close through either an Anpassungslehrgang (supervised practice, typically 6–12 months) or a Kenntnisprüfung (examination). The course is safer, the exam faster.
- Language: B2 is the common statutory minimum. Doctors, dentists and pharmacists additionally sit a Fachsprachprüfung at their Kammer — a profession-specific oral exam that is the usual failure point, not clinical knowledge. What that exam actually consists of, and which certificate each authority accepts, is in language certificates.
- Visa: §16d AufenthG to enter while recognition runs, then the skilled-worker permit. Nursing additionally has the Anerkennungspartnerschaft (§16d(3)), which allows entry at A2 German.
Working in the interim
Most of these professions have a lower tier you can legally work in while recognition runs — Pflegehelfer/in for nursing, Rettungssanitäter for paramedics, Berufserlaubnis for doctors and pharmacists. Agree in writing what the contract converts to on licence, and at what pay grade. Drifting in the interim role is the single most common bad outcome, and the nursing-assistant file sets out in detail how to stop it happening to you.
Pay
Public-sector healthcare pay is tariff-verified throughout this repo — TVöD-K, TVöD-P, TVöD SuE, TV-Ärzte/VKA and TVöD EG N all have published scales. See reference/pay.md for the tables and their expiry dates. Church providers (Caritas, Diakonie) use comparable AVR agreements; private operators often pay less.
Profiles
- Arzt / Ärztin
- Apotheker/in
- Pflegefachfrau / Pflegefachmann
- Notfallsanitäter/in
- Medizinische/r Technologe/Technologin (MT / MTA)
- Physiotherapeut/in
- Zahnarzt / Zahnärztin
- Psychotherapeut/in
- Hebamme
- ATA / OTA
- Logopädie und Ergotherapie
- PTA — Pharmazeutisch-technische/r Assistent/in
- MFA — Medizinische/r Fachangestellte/r
- Pflegefachassistenz / Pflegehelfer/in
Professions in this category
- Apotheker/in (Pharmacist) Dispenses and advises on medicines.
- Arzt / Ärztin (Physician) Diagnoses and treats patients.
- ATA / OTA — Anästhesie- und Operationstechnische Assistenz (Anaesthesia and Surgical Assistants) Federally regulated since 2022, and before that not regulated at all.
- Hebamme / Entbindungspfleger (Midwife) The cleanest example in this repo of a profession changing its entry route wholesale: in 2020 the Ausbildung was abolished outright and replaced by a dual Bachelor, under EU pressure.
- Medizinische/r Fachangestellte/r (MFA) (Medical Assistant) One of the largest occupations in German healthcare and one of the worst paid relative to what it carries.
- Medizinische/r Technologe/Technologin (MT) — formerly MTA Runs the diagnostic technology behind medical decisions: lab analyses, imaging, and functional testing.
- Notfallsanitäter/in (Paramedic) The highest non-physician qualification in German emergency medicine.
- Pflegefachassistenz / Pflegehelfer/in (Nursing Assistant) The tier directly below nursing: one to two years, and — uniquely among the healthcare qualifications here — regulated by the sixteen Bundesländer rather than by federal law. It matters disproportionately, because it is what internationally recruited nurses are actually employed as while their recognition runs, and the nursing file warns about getting stuck there without documenting what “there” is.
- Pflegefachfrau / Pflegefachmann (Registered Nurse) Generalist nursing: assessment, treatment, medication, documentation and patient care across hospital, elderly care and home care settings.
- Pharmazeutisch-technische/r Assistent/in (PTA) (Pharmaceutical Technical Assistant) Dispenses, advises and compounds in a pharmacy, under a pharmacist’s supervision — reformed in 2023 to loosen that supervision for experienced staff.
- Physiotherapeut/in (Physiotherapist) Treats movement and musculoskeletal disorders through manual therapy and exercise.
- Psychotherapeut/in (Psychotherapist) Reformed in 2020 into a direct-study route ending in Approbation at the end of a Master’s, replacing a post-graduate training that was among the worst-paid in German professional life.
- Logopäde/in und Ergotherapeut/in (Speech and Occupational Therapy) Two regulated professions written as one file, because their structural story is identical and it is the same one Physiotherapie tells: a state licence, a school-based training that used to charge you for it, pay that does not match the responsibility, and an academisation that has been announced for years and not delivered.
- Zahnarzt / Zahnärztin (Dentist) Approbation, like a doctor — but with two things medicine does not have: no specialist training is required to practise generally, and a large private economy sitting on top of a deliberately basic statutory entitlement. The second is what makes dentistry financially unlike the rest of healthcare in this repo.