Career·Europe· 9 min read

Approbation in Germany: Getting a Foreign Medical Degree Licensed to Practise

How foreign doctors obtain the Approbation to practise medicine in Germany: the state authority, equivalence check, Kenntnisprüfung, Fachsprachprüfung and the temporary Berufserlaubnis.

Last updated 3 July 2026

Key facts

What it is: Approbation — the state-issued, unrestricted licence to practise medicine in Germany
Who issues it: The competent state authority (Approbationsbehörde/Landesprüfungsamt) of your target federal state
Core assessment: Equivalence check; EU/EEA/Swiss vs third-country routes differ
Knowledge test: Kenntnisprüfung — oral-practical, benchmarked to the German state exam (when equivalence isn't established)
Language: Specialist medical-language exam (Fachsprachprüfung), professional level C1 — run by state physicians' chambers
Temporary route: Berufserlaubnis — time-limited, restricted permission; conditions vary by state

Licensing to work — not studying

This guide is about the reverse direction of a study guide: how a doctor who already holds a medical qualification gets licensed to work as a physician in Germany. That licence is called the Approbation — an official, state-issued, unrestricted authorisation to practise medicine, and it is mandatory to work in a German hospital or to open a private practice.

Getting the Approbation is a professional-recognition process, separate from studying medicine and separate from practising in any other country. It is handled by German state authorities, not by a university, and the exact steps depend on where your qualification is from. This page explains the pieces; it is general information, not professional-recognition advice, so verify the current procedure with the responsible authority.

The Approbation is the state-issued, unrestricted licence to practise medicine in Germany.
It is mandatory to work in a hospital or open a private practice.
This is a recognition-to-work process — distinct from studying medicine — verify with the official authority.

The state authority decides

Germany is federal, so the licence to practise medicine is issued by the competent state health authority (the Approbationsbehörde / Landesprüfungsamt) of the federal state where you intend to work — not by a single national office. This means the fine detail of the process, and which documents and tests are required, can differ from one state to another.

Because of that, the first practical step is to identify the responsible authority in your target state and follow its instructions. The federal recognition portal (anerkennung-in-deutschland.de) can point you to the right authority. Treat any generic checklist with caution: only the responsible state authority's current requirements are authoritative for your case.

The Approbation is issued by the competent state authority (Approbationsbehörde/Landesprüfungsamt).
Requirements and documents can differ between federal states.
Identify your target state's authority first and follow its current instructions.

The equivalence check

At the core of the process is an equivalence assessment: the authority compares your medical training with the German standard. For qualifications from within the EU/EEA/Switzerland, recognition is generally more straightforward under EU rules. For qualifications from a third country (outside the EU/EEA/Switzerland), the authority examines whether your training is equivalent and whether any substantial differences exist.

If your training is found equivalent (and you meet the other conditions), you can be granted the Approbation. If substantial differences are found and cannot be offset by documented experience, you are generally directed to demonstrate your knowledge through an examination. The assessment is evidence-based and document-heavy, so accurate, legalised paperwork about your degree and training is essential.

The authority compares your training against the German standard (equivalence check).
EU/EEA/Swiss qualifications generally follow a more straightforward route than third-country ones.
Substantial differences that can't be offset by experience typically lead to a knowledge test.

The Kenntnisprüfung (knowledge test)

Where equivalence is not established, third-country doctors typically demonstrate their competence through the Kenntnisprüfung — a knowledge test benchmarked to the German medical state examination. It is an oral-practical, case-based examination; official sources describe it as covering core areas such as internal medicine and surgery, with supplementary aspects like emergency medicine.

The exact content, format and scheduling are set by the responsible authority and can vary by state, and there is no guaranteed pass — it tests clinical competence. Do not treat any coaching provider's summary as the rule. Confirm the current scope and arrangements for the Kenntnisprüfung with your state authority before you prepare.

The Kenntnisprüfung is the knowledge test used when equivalence isn't established.
It is oral-practical and case-based, benchmarked to the German state examination.
Exact content and scheduling vary by state — verify with the responsible authority; no pass is guaranteed.

The Fachsprachprüfung (medical German)

Language is a separate, non-negotiable requirement. Alongside general German ability, foreign doctors must pass the Fachsprachprüfung — a specialist medical-language examination that tests your ability to communicate with patients and colleagues and to handle clinical documentation. Official sources place the professional medical-language requirement at the C1 level, and the exam is run by the state chambers of physicians in most federal states.

General German at a lower level may be enough to begin the process, but the professional-language standard for the licence is higher. Because the exact level, format and provider can vary by state, confirm the current language requirement and the Fachsprachprüfung arrangements with your state's medical chamber and authority.

A specialist medical-language exam (Fachsprachprüfung) is required in addition to general German.
Official sources set the professional medical-language requirement at C1 level.
It is run by the state chambers of physicians in most states — verify the current arrangements.

The Berufserlaubnis (temporary permission)

While working toward the Approbation, some doctors can practise under a Berufserlaubnis — a temporary, restricted permission to practise. Official definitions describe it as a state authorisation that is time-limited and generally carries further restrictions, unlike the unrestricted Approbation. In practice it lets a doctor work under conditions while completing the remaining steps.

Eligibility, duration and conditions for the Berufserlaubnis are decided by the responsible state authority and vary, and it is not a permanent substitute for the Approbation. If a temporary permission is part of your plan, confirm with your target state's authority whether it applies to you and on what terms — do not assume it is automatic.

The Berufserlaubnis is a temporary, restricted permission to practise — not the full Approbation.
It is time-limited and generally carries further restrictions.
Eligibility, duration and conditions are set by the state authority and vary — verify before relying on it.

Frequently asked questions

What is the Approbation and why do I need it?

The Approbation is the official, state-issued, unrestricted licence to practise medicine in Germany. It is mandatory to work as a doctor in a German hospital or to open a private practice. Obtaining it is a professional-recognition process handled by state authorities — separate from studying medicine — and its exact steps depend on where your qualification is from.

Which authority handles my Approbation?

The competent state health authority (Approbationsbehörde / Landesprüfungsamt) of the federal state where you intend to work issues the licence — Germany has no single national office for this. Requirements can differ between states, so identify your target state's authority (the anerkennung-in-deutschland.de portal can help) and follow its current instructions.

When do I have to take the Kenntnisprüfung?

Typically when the equivalence check does not establish that your training matches the German standard and the differences cannot be offset by documented experience. The Kenntnisprüfung is an oral-practical, case-based knowledge test benchmarked to the German medical state examination. Its exact content and scheduling vary by state, and there is no guaranteed pass — verify with your state authority.

How much German do I need, and what is the Fachsprachprüfung?

In addition to general German, foreign doctors must pass the Fachsprachprüfung, a specialist medical-language exam covering patient communication and clinical documentation. Official sources set the professional medical-language requirement at C1 level, and the exam is run by the state chambers of physicians in most federal states. Confirm the current level and arrangements with your state's authority and chamber.

What is the Berufserlaubnis and is it the same as the Approbation?

No. The Berufserlaubnis is a temporary, restricted permission to practise — time-limited and generally with further conditions — whereas the Approbation is the full, unrestricted licence. Some doctors work under a Berufserlaubnis while completing the remaining steps, but its eligibility and terms are set by the state authority and vary. It is not a permanent substitute for the Approbation.

Is this guide professional-recognition advice?

No. This is general information explaining how the Approbation process works, not personalised professional-recognition or legal advice. The rules, tests and documents are set by the responsible state authority and can change and vary by state, so verify your specific requirements with that authority and the official anerkennung-in-deutschland.de portal before acting.

Official sources

This guide explains the process and is for guidance only. Eligibility, dates, fees and rules change every year — always confirm the current details on the official site before you act.

Verified against: Recognition in Germany (BIBB) — Doctor of medicine; Recognition in Germany (BIBB) — Recognition procedure; German Medical Association (Bundesärztekammer) — Recognition of qualifications from outside the EU/EEA/Switzerland; Recognition in Germany (BIBB) — Glossary (Approbation, Berufserlaubnis, Kenntnisprüfung).

Last verified: 3 July 2026.