Arzt / Ärztin (Physician)

Diagnoses and treats patients. The most heavily regulated profession in this repo, and the one where the gap between “qualified abroad” and “allowed to work” is widest.
Official title Arzt / Ärztin
Protected title Yes — Bundesärzteordnung (BÄO)
Category healthcare
Typical qualification Medical degree (~6 years) + Approbation
Regulated Yes — Approbation (full licence) or Berufserlaubnis (temporary)
Last reviewed 2026-09

Two different licences

This distinction decides your whole first year in Germany:

  • Approbation — the full, permanent, nationwide licence. Unrestricted practice.
  • Berufserlaubnis (§10 BÄO) — a temporary, restricted permission, usually limited to two years, one Bundesland, and one named employer, granted while you work toward Approbation. Many international doctors start here.

Qualification route (in Germany)

  • Medical school: ~6 years and 3 months, ending in the Dritter Abschnitt der Ärztlichen Prüfung. Admission is brutally competitive and largely NC-driven.
  • Approbation is granted on passing.
  • Facharztweiterbildung (specialist training): a further 5–6 years depending on specialty, supervised, regulated by the Landesärztekammer, ending in the Facharztprüfung. You are employed and paid as an Assistenzarzt throughout.

A long-running reform of the Approbationsordnung für Ärzte (ÄApprO) has been in preparation for years and keeps slipping. Check its current status rather than trusting any written summary, including this one.

Pay

Hospital doctors are covered by dedicated collective agreements — TV-Ärzte/VKA (municipal hospitals) or TV-Ärzte/TdL (university hospitals). Figures below are TV-Ärzte/VKA, from the table valid 01.06.2026 – 31.12.2026, verified 2026-09, excluding on-call. The agreement grades by Stufe, not by calendar year, and TdL differs:

Stage Gross/month
Assistenzarzt (Stufe I, 1→6) €5,722 – €7,355
Facharzt (Stufe II) €7,552 – €9,699
Oberarzt (Stufe III) €9,460 – €10,811
Leitender Oberarzt (Stufe IV) €11,128 – €11,923
Chefarzt Individually negotiated, outside the agreement

Bereitschaftsdienst and Rufbereitschaft (on-call) add substantially — for many Assistenzärzte this is 20–30% on top. Note that on-call pay is a perennial source of disputes; read the Dienstplan terms before signing.

Established practice owners (niedergelassene Ärzte) earn on a completely different model via the Kassenärztliche Vereinigung, and require a Kassensitz — a limited, tradeable licence to treat statutory-insurance patients.

Foreign-trained candidates

  1. EU/EEA/Switzerland: medical degrees are automatically recognised under Directive 2005/36/EC. You apply for Approbation and, subject to language, get it.
  2. Third countries: the Landesprüfungsamt runs a Gleichwertigkeitsprüfung. If your training is found not equivalent, you sit a Kenntnisprüfung — an oral-practical exam at the level of the German final medical exam, covering internal medicine and surgery plus a third area. It is demanding; failure rates are high, and you generally get three attempts.
  3. Fachsprachprüfung (FSP): a medical-German exam at the Landesärztekammer — patient interview, documentation, doctor-to-doctor handover. Required in essentially every state. The formal entry level is B2 general + C1 medical; in practice, plan for C1.
  4. Visa: §16d AufenthG while pursuing recognition, or the skilled-worker/EU Blue Card route once licensed. Doctors qualify for the Blue Card comfortably on salary.

Pitfalls

  • The FSP is the real bottleneck, not clinical knowledge. Doctors with excellent everyday German routinely fail it on documentation and register-switching.
  • State shopping is common and imperfectly legal-grey — processing times and Kenntnisprüfung waiting lists differ hugely by Bundesland. Changing state mid-process can restart it.
  • Berufserlaubnis is a trap if you get comfortable. It is time-limited; some doctors drift for years in restricted roles without converting to Approbation.
  • Your specialty may not map. Facharzt recognition is a separate procedure from Approbation, decided by the Landesärztekammer, and years of foreign specialist training are often only partly credited.

Sources

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