How long does it take to get the Approbation in Germany as a non-EU doctor?

Processing times vary by federal state and individual case complexity. On average, expect 6–12 months from the time you submit a complete application. States like Bavaria tend to be faster (3–6 months), while Berlin or NRW can take up to 12–18 months during peak periods. Having all documents correctly certified and translated from the start is the single biggest factor in avoiding delays.

Can I work as a doctor in Germany without the Approbation?

Yes, but only with a Berufserlaubnis — a temporary, limited work permit issued by the same State Examination Office (Landesprüfungsamt). It is tied to a specific employer and state, lasts up to 2 years, and requires supervision. Many hospitals actively help foreign doctors obtain it so they can work while their full Approbation is being processed.

What happens if my medical degree is not recognised as equivalent to a German degree?

The LPA will issue a formal Deficiency Notice listing the gaps. You then choose between completing an Anpassungslehrgang (supervised adaptation period at a German hospital) or sitting the Kenntnisprüfung (oral medical knowledge exam). Most foreign doctors choose the Kenntnisprüfung. If you pass, the Approbation is granted without needing further study.

Which German language certificate do I need for the Approbation?

You need two things: a general German proficiency certificate at C1 level (e.g., Goethe-Institut C1, TestDaF TDN 4, or telc C1 Hochschule) AND a Fachsprachprüfung (FSP) — a medical language exam conducted by your regional Ärztekammer. The FSP tests your ability to take patient histories, document findings, and communicate with colleagues in German. Both are mandatory in most federal states.

Do I need a job offer before applying for the Approbation?

Technically no — you can apply without a job offer. However, having a German hospital employer speeds the process significantly. Employers experienced with foreign doctors know local LPA requirements, can provide support letters, and can apply for your Berufserlaubnis on your behalf so you can start earning while your Approbation is processed. Most foreign doctors secure at least a conditional job offer before or during their application.

How long does it take to get the Approbation in Germany as a non-EU doctor?

Processing times vary by federal state and individual case complexity. On average, expect 6–12 months from the time you submit a complete application. States like Bavaria tend to be faster (3–6 months), while Berlin or NRW can take up to 12–18 months during peak periods. Having all documents correctly certified and translated from the start is the single biggest factor in avoiding delays.

Can I work as a doctor in Germany without the Approbation?

Yes, but only with a Berufserlaubnis — a temporary, limited work permit issued by the same State Examination Office (Landesprüfungsamt). It is tied to a specific employer and state, lasts up to 2 years, and requires supervision. Many hospitals actively help foreign doctors obtain it so they can work while their full Approbation is being processed.

What happens if my medical degree is not recognised as equivalent to a German degree?

The LPA will issue a formal Deficiency Notice listing the gaps. You then choose between completing an Anpassungslehrgang (supervised adaptation period at a German hospital) or sitting the Kenntnisprüfung (oral medical knowledge exam). Most foreign doctors choose the Kenntnisprüfung. If you pass, the Approbation is granted without needing further study.

Which German language certificate do I need for the Approbation?

You need two things: a general German proficiency certificate at C1 level (e.g., Goethe-Institut C1, TestDaF TDN 4, or telc C1 Hochschule) AND a Fachsprachprüfung (FSP) — a medical language exam conducted by your regional Ärztekammer. The FSP tests your ability to take patient histories, document findings, and communicate with colleagues in German. Both are mandatory in most federal states.

Do I need a job offer before applying for the Approbation?

Technically no — you can apply without a job offer. However, having a German hospital employer speeds the process significantly. Employers experienced with foreign doctors know local LPA requirements, can provide support letters, and can apply for your Berufserlaubnis on your behalf so you can start earning while your Approbation is processed. Most foreign doctors secure at least a conditional job offer before or during their application.

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Approbation Germany: How Foreign Doctors Get Their Licence — GoGermany

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Approbation Germany: How Foreign Doctors Get Their Licence

· 2026-07-03

Learn how foreign doctors get their Approbation in Germany — from required documents and language certificates to the Kenntnisprüfung exam and key authorities.

What the Approbation Means for Your Medical Career in Germany

Moving to Germany as a doctor is one of the most rewarding career decisions you can make — the country has a well-documented shortage of physicians, with over 5,000 unfilled hospital positions at any given time. But before you can treat a single patient, you must hold the Approbation, Germany's state-issued medical licence that grants you the unlimited, permanent right to practise medicine. Understanding the Approbation Germany doctors need — and the exact steps to get it — can save you months of frustration, costly mistakes, and unnecessary delays.

What Is the Approbation and Who Issues It?

The Approbation is not a registration or a temporary permit; it is a lifelong licence granted under the Bundesärzteordnung (BÄO), Germany's Federal Medical Licensing Act. Once issued, it is valid across all 16 German federal states and cannot expire unless you lose it through professional misconduct.

Crucially, the Approbation is issued by the Landesprüfungsamt (LPA) — the State Examination Office — of the federal state where you intend to work. Each state has its own office:

Bavaria: Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit (LGL), Erlangen
North Rhine-Westphalia: Landesprüfungsamt für Medizin, Psychotherapie und Pharmazie, Düsseldorf
Berlin: Landesamt für Gesundheit und Soziales (LaGeSo), Berlin
Hamburg: Behörde für Gesundheit und Verbraucherschutz, Hamburg
Baden-Württemberg: Regierungspräsidium Stuttgart

You apply to the LPA in the state where your employer is located, or where you plan to first reside. Processing times vary significantly — Bavaria is known for relatively faster turnaround (~3–6 months), while some states take 9–12 months.

Who Qualifies for the Approbation Germany Doctors Pathway?

Your eligibility depends heavily on where your medical degree was earned.

EU/EEA and Swiss Graduates

If your degree is from an EU/EEA country or Switzerland, Germany must recognise it under EU Directive 2005/36/EC on the mutual recognition of professional qualifications. The process is faster and rarely requires an additional exam — you mainly need to prove your qualification, good standing, and language skills.

Non-EU (Third-Country) Graduates

If you trained outside the EU — for example in Egypt, India, Syria, Iran, Nigeria, or Pakistan — your path is more demanding. The LPA assesses whether your medical degree is substantially equivalent to a German medical degree (Approbationsordnung für Ärzte standard). This comparison looks at:

Total duration of your medical studies (Germany requires at least 6 years / 5,500 hours)
Clinical practical year (Praktisches Jahr)
Subject areas covered in your curriculum
The university's standing in the anabin database (maintained by the KMK)

If your degree is from a university listed as H+ or H++ in anabin, equivalence is easier to argue. For unknown or lower-rated institutions, equivalence is rarely granted automatically. You can check your institution's standing as described in our guide Anabin Check: Is Your Pakistani Degree Recognised in Germany?.

Documents Required for the Approbation Application

Gathering documents is the single most time-consuming step. Start at least 6 months before your planned application date. The standard document list includes:

Completed application form (available from the relevant LPA website)
Passport copy (valid)
Medical degree certificate — original + certified German translation
Academic transcript — listing all subjects, hours, and grades, with certified German translation
Proof of clinical training (internship/residency certificates)
Good standing certificate from your home country's medical council (must be recent — usually not older than 3 months)
Certificate of no criminal record (Führungszeugnis equivalent from your home country + German Führungszeugnis if you've lived in Germany)
Health certificate confirming you are physically and mentally fit to practise (from a German physician)
Proof of German language proficiency (see next section)
Curriculum vitae in German (tabular format — see our guide on How to Write a German-Style CV (Lebenslauf) That Gets You Hired in Germany)
Biometric passport photos

All foreign documents must be officially translated by a sworn translator (beeidigter Übersetzer) into German, and in many cases apostilled or legalised depending on your country of origin.

Application fees typically range from €100 to €300, varying by state.

German Language Requirements: What Level Do You Really Need?

This is where many foreign doctors underestimate the bar. Germany requires not just conversational German but medical-level language proficiency.

General Language Certificate: C1 Level

The baseline requirement is C1 of the Common European Framework of Reference (CEFR), demonstrated through:

Goethe-Institut C1 certificate
TestDaF (score of TDN 4 in all four skills)
telc Deutsch C1 Hochschule
DSH (Deutsche Sprachprüfung für den Hochschulzugang)

Fachsprachprüfung: The Medical Language Exam

A general C1 certificate is necessary but not sufficient in most states. You must also pass the Fachsprachprüfung (FSP) — a medical language examination conducted by the relevant Ärztekammer (State Medical Association). This oral/written exam assesses your ability to:

Take a patient history (Anamnese)
Document findings in written German
Discuss diagnoses and treatment plans with colleagues
Write discharge summaries (Entlassbriefe)

The FSP is offered by all 17 regional Ärztekammern. For example:

Ärztekammer Berlin holds FSP sessions every 4–6 weeks
Bayerische Landesärztekammer in Munich requires prior registration and charges approximately €300–€450 per attempt
Ärztekammer Nordrhein in Düsseldorf is one of the busiest, with waiting times of 2–4 months

Prepare specifically for the FSP — general language courses are not enough. Look for FSP preparation courses offered by Goethe-Institut, Berlitz, or specialised providers such as doctors-in-germany.de.

The Kenntnisprüfung: Germany's Medical Knowledge Exam for Non-EU Doctors

If your medical degree is assessed as not substantially equivalent to a German degree, the LPA will issue a Deficiency Notice (Bescheid über wesentliche Unterschiede). At this point, you have two options:

Anpassungslehrgang: A supervised adaptation period (typically 3–6 months) at a German hospital to fill the gaps
Kenntnisprüfung: A comprehensive knowledge examination

Most foreign doctors opt for the Kenntnisprüfung because the Anpassungslehrgang requires a hospital to formally accept you, which can be difficult without the licence you're trying to obtain.

What the Kenntnisprüfung Covers

The exam is an oral examination (sometimes with written components) conducted by a panel of examiners appointed by the LPA, typically including:

A representative of the Approbationsbehörde
A professor or senior physician from a local medical school
A representative of the Ärztekammer

Topics span the entire spectrum of medicine as taught in Germany:

Internal medicine (Innere Medizin)
Surgery (Chirurgie)
Gynaecology and obstetrics
Paediatrics
Neurology
Psychiatry
Clinical pharmacology
Emergency medicine

The exam lasts approximately 60–90 minutes and is conducted entirely in German. Passing requires demonstrating knowledge equivalent to a German medical graduate — the bar is high.

Preparation resources:

AMBOSS (amboss.com) — the gold standard for German medical exam prep
Hammerexamen question banks
Preparation courses offered by universities in Frankfurt, Munich, and Hamburg specifically for foreign doctors

If you fail the Kenntnisprüfung, you may typically re-sit it — but rules on the number of allowed attempts vary by state (usually 2–3 attempts maximum before further restrictions apply).

The Berufserlaubnis: Working While You Wait

The Approbation process can take 6–18 months. During this time, you are not idle — you can apply for a Berufserlaubnis, a temporary, limited work permit for physicians. It allows you to work as a doctor under supervision, typically:

For a maximum of 2 years (renewable in some states)
Only at a specific named employer/hospital
Only in the state that issued it

The Berufserlaubnis is issued by the same LPA and requires most of the same documents as the Approbation. Many hospitals actively help candidates obtain it so they can start working immediately while the full Approbation is pending. This is a practical bridge that lets you earn a salary (German hospital doctors start at €4,500–€6,000/month gross at TV-Ärzte/VKA tariff rates) while completing the recognition process.

Common Mistakes Foreign Doctors Make When Applying

Avoid these pitfalls that routinely delay or derail Approbation applications:

Using non-sworn translators: Only translations by officially certified (beeidigt/öffentlich bestellt) translators are accepted. Using cheaper online services will get your application rejected.
Submitting outdated good standing certificates: Most LPAs require these to be dated within 3 months of submission. If your process drags on, you may need to renew them.
Underestimating the FSP: Doctors who pass C1 general exams often fail the Fachsprachprüfung. Allocate 2–3 months of dedicated medical German preparation.
Applying to the wrong state LPA: You must apply to the state where you will work. Switching states mid-process means starting over.
Ignoring the anabin database: Assuming your university is well-regarded internationally does not mean it is rated positively in anabin. Always verify before applying.
Missing legalisation requirements: Countries not party to the Hague Apostille Convention (e.g., some Middle Eastern and African nations) require full legalisation through the embassy chain, which can take months.
Not securing a job offer first: Having a hospital employer on your side dramatically speeds up the process — they know local LPA requirements and often have HR staff experienced in foreign doctor applications.

Conclusion: Your Path to Practising Medicine in Germany Starts Now

The Approbation Germany doctors need is demanding to obtain, but the effort is absolutely worth it. Germany offers some of Europe's best medical salaries, excellent professional development, and a healthcare system that genuinely values its physicians. The key is to approach the process systematically: verify your university in anabin early, begin German language training at C1/FSP level immediately, gather and legalise your documents in parallel, and target a federal state with reasonable LPA processing times.

If you are navigating Germany's job landscape more broadly — or if you have questions about employment contracts once you do receive your Approbation — our guide on Arbeitsvertrag: What to Check Before Signing a German Job Contract is an essential next read.

GoGermany is here to help you every step of the way. If you would like personalised guidance on your Approbation application — from document checklists to state selection — reach out to our team today.