Doctors from third countries: from 1 November a knowledge test will normally be the route to a German licence

For doctors, dentists and pharmacists with a qualification from a third country, the route to a licence to practise (Approbation) is changing. On 1 November 2026, the law to speed up the recognition of foreign professional qualifications in the health professions takes effect; it is dated 22 July and was approved by the Bundesrat. The Federal Ministry of Health's ordinance setting out the procedures and examinations in detail was published in the Federal Law Gazette on 30 October and also applies from 1 November. The rules concern qualifications from countries outside the EU and the European Economic Area; for countries that EU law treats as equal for recognition purposes, the rules for EU qualifications apply.

The test becomes the rule

Until now, for qualifications from third countries the authorities first assessed from the documents whether the training was equivalent to German training. A knowledge test was needed only if they found substantial differences, or if the documents could not be produced for reasons beyond the applicant's control. From now on it is the other way round: the required knowledge and skills are as a rule proven in a knowledge test based on the content of the state final examination. The same applies to doctors, dentists and pharmacists.

Applicants who still want their documents assessed for equivalence must opt for this within four weeks of applying. The choice is binding for the whole procedure, and the authority must explain the option and its consequences. If it then finds substantial differences, a knowledge test must be taken as well. Midwives with a qualification from a third country will be able to waive the assessment of their training irrevocably and go straight to a compensation measure instead.

Deadlines for authorities and states

The ordinance sets out how the test works. For doctors, the knowledge test is an oral and practical examination in German before a state examination board, preceded on the same day by a patient-based preparation. The subjects are internal medicine and surgery, plus further content. At most four candidates are examined at a time, each for at least 60 and at most 90 minutes. The test is to be offered at least twice a year and can be retaken twice. The states must ensure that applicants can sit it within six months of applying or, after an equivalence assessment, within six months of the decision on the differences found.

Applications can be made in writing or electronically. The authority must confirm receipt within one month and say which documents are missing. It must decide on an application for a licence to practise no later than three months after the documents have been submitted, or one month later where the documents are assessed for equivalence. Documents in German or English generally need no translation. For other languages, translations into German or English are sufficient, but as a rule they must be made by a publicly appointed or sworn translator. The authority may also accept other translators or translate documents itself using translation software. Applications made by 31 October 2026 remain subject to the previous rules.

Why the rules are changing

The federal government justifies the reform with the shortage of skilled workers. Medical professionals with foreign qualifications are to be able to work in their profession sooner; according to the government, there will be no compromise on patient safety and quality of care, and professional requirements will not be lowered. According to the Federal Employment Agency's latest bottleneck analysis of May 2026, which the agency referred to in October, shortages show up above all in nursing and care occupations, medical occupations, and construction and craft trades.

Many immigrant doctors already work in Germany. According to the German Medical Association's physician statistics for 2025, their number rose by 5% on the previous year to 71,480, so that 16% of all practising doctors in Germany did not hold German citizenship. The increase came mainly from doctors from countries outside the EU, whose number rose by 7.6%, while the number of doctors with EU citizenship was almost unchanged.