Working as a Doctor in Germany: Approbation, Salaries, and Career Paths

Working as a doctor in Germany is attractive due to stable demand, collectively bargained salaries, and a clear career path from Assistenzarzt to Facharzt, Oberarzt, and Chefarzt. For a doctor with a foreign degree, the main hurdle is not finding a job, but obtaining the right to treat patients: you need an Approbation or a temporary Berufserlaubnis, recognition of your education, German language proficiency, and, in some cases, a Kenntnisprüfung.

Below is a practical overview for doctors, medical students, and healthcare professionals who are considering a career in the German healthcare system.

Where Do Doctors Work in Germany

Doctors in Germany can pursue their careers in several different ways:

Krankenhaus — a hospital or clinic; employment is most often salaried and governed by a collective bargaining agreement.
Universitätsklinikum — a university hospital where patient care is often combined with research and teaching.
Arztpraxis — a medical practice that is either owned or leased.
Berufsausübungsgemeinschaft, formerly known as Gemeinschaftspraxis, is a joint practice involving several doctors.
MVZ, Medizinisches Versorgungszentrum — a medical center with multiple specialists, often employing doctors on a contract basis.
Gesundheitsamt and other public health authorities—monitoring, prevention, hygiene, epidemiology, and expert assessments.
Pharmaceutical companies, medical technology firms, and insurance providers — consulting, research, clinical projects, and medical expertise.

For foreign doctors, the most common first step is to join a hospital: there, it is easier to find a position as an Assistenzarzt, adapt to German medical documentation, and gain experience for further specialization.

How the Career Path Works: Assistenzarzt, Facharzt, Oberarzt

A medical career in Germany typically follows these steps:

Approbation or Berufserlaubnis — authorization to practice medicine.
Assistenzarzt — a doctor in Weiterbildung, that is, in the period of training leading to specialization.
Facharzt — a medical specialist after completing Weiterbildung and passing the exam administered by the Ärztekammer.
Oberarzt — a senior physician with managerial and clinical responsibilities.
Chefarzt or leitender Oberarzt — a leadership position, often with customized compensation terms.

Approbation does not automatically make a doctor a Facharzt. If a specialization was obtained outside of Germany, it is usually recognized separately through the Landesärztekammer. To be recognized as a Facharzt, Approbation as an Ärztin/Arzt is almost always required first.

Working Conditions in Hospitals

In hospitals, the workload depends on the department, the federal state, on-call shifts, and staffing levels. A doctor’s work includes not only seeing and treating patients, but also documentation, rounds, conferences, night and weekend shifts, and communication with insurance companies and other institutions.

Common aspects of clinical work:

Shifts and on-call duties can significantly increase actual working hours;
Compensation consists of a base rate plus additional pay for on-call shifts, night shifts, weekends, and holidays;
Research and teaching responsibilities are possible at university hospitals;
Moving between hospitals does not typically reset a doctor’s experience for pay grade purposes, but the details depend on the contract.

The German healthcare system is based on the GKV and PKV, so doctors constantly deal with reimbursement rules, referrals, service coding, and documentation. Health insurance funds play a key role in billing, authorizations, and the organization of outpatient care. For patients, this involves mandatory state health insurance, while for doctors, it involves the administrative side of the profession.

Doctors’ Salaries in Germany in 2026

A doctor’s salary in Germany depends most heavily on the type of employer, the collective bargaining agreement, the position, years of experience, on-call duties, and specialization. For patients from abroad, receiving medical care in Germany also involves a medical visa (), but this is a separate issue from a doctor’s employment. Clinics most commonly use the TV-Ärzte pay scales: separate scales apply to university hospitals, public hospitals, and private hospital networks.

The guidelines for 2026, based on the published pay scales, are as follows:

Level	Typical Gross Monthly Salary	Comments
Resident Physician, 1st year	approximately 5,500–5,800 €	base salary excluding on-call shifts and individual bonuses
Resident Physician, later years	approx. 6,000–7,300 €	increases in stages based on years of experience
Specialist Physician	approximately 7,400–9,700 €	depends on the fee schedule and years of experience
Oberarzt	approximately 8,800–10,800 € and up	more responsibility and on-call shifts
Chief Physician / Senior Attending Physician	often outside the pay scale or in the highest pay scale groups	conditions are individual

These amounts are gross, not net. A doctor’s take-home pay is lower due to factors such as tax bracket, state, church tax, insurance, family status, and pension contributions. On-call shifts can significantly increase income but also increase the workload.

Why Old Salary Tables Become Outdated Quickly

Medical pay scales change following negotiations between the Marburger Bund, VKA, TdL, and private employers. Therefore, figures from materials covering the years 2018–2024 cannot be applied to 2026 without verification. When deciding whether to relocate, it is best to consult the employer’s specific collective bargaining agreement and the clinic’s written offer.

Private Practice and MVZ

Running your own Arztpraxis can be highly lucrative, but it’s no longer just about medicine—it’s about entrepreneurship. A doctor with their own practice often operates under the “” model of a liberal profession, but with medical licensure and in accordance with the rules of the Kassenärztliche Vereinigung. Income depends on specialization, region, patient demographics, equipment, contracts with GKV/PKV, staff, and rent expenses.

Private or group practices are particularly common among experienced Fachärzte. A young doctor with a foreign degree does not usually start with an independent practice: first, they must obtain an Approbation, complete a German clinical internship, confirm their specialization, or finish their Weiterbildung.

The market is seeing a noticeable shift from solo practices to group practices, medical care centers (MVZ), and salaried positions in the outpatient sector. This reduces the entrepreneurial risk for doctors but changes the way they work: less autonomy and more organizational rules set by the employer.

Doctor Shortage and Opportunities for Foreigners

Germany has been discussing a shortage of doctors for many years, but the problem is unevenly distributed. This affects wait times for doctor’s appointments, especially outside major cities. Competition is higher in large cities and at popular clinics. In rural areas, in the eastern part of the country, and in certain medical specialties, it’s easier to find a position, but workloads there may be heavier, infrastructure may be more limited, and it may be more difficult for families to adjust.

Official data shows that foreign doctors have become an important part of German medicine: in 2025, tens of thousands of doctors without German citizenship were working in Germany. However, the mere fact of a shortage does not waive the requirements for an Approbation, language proficiency, documentation, and professional competence.

The following factors increase a foreign doctor’s chances of success:

German language skills are essential not only for the exam but also for clinical communication;
willingness to start as an Assistenzarzt or with a temporary Berufserlaubnis;
flexibility in terms of region and specialty;
a complete set of documents with translations and certifications;
Understanding that the recognition process can take months and varies by federal state.

Recognition of Foreign Medical Degrees

Medical practice in Germany is regulated. Without authorization, you cannot work independently as a doctor with patients. The main document is the Approbation, a state-issued, unlimited license to practice medicine. In certain cases, a temporary Berufserlaubnis may be granted pending full Approbation, but it is limited in duration, by state, and subject to specific conditions.

The procedure for the “” (recognition of a foreign medical degree in Germany) typically includes:

Choosing a federal state and the zuständige Approbationsbehörde.
Submission of your diploma, supporting documents, curriculum, proof of clinical training, passport, resume, and translations.
A Gleichwertigkeit assessment—verification that one’s education is comparable to German medical education.
Proof of good character: Führungszeugnis, Certificate of Good Standing, or similar documents.
Proof of gesundheitliche Eignung—medical fitness.
Proof of German language proficiency: typically a minimum of B2 in General German and a Fachsprachprüfung Medizin at a level equivalent to C1.
If significant differences in education are identified—training and passing the Kenntnisprüfung.

Formally, the equivalency review often takes several months, but in practice, the timeframe depends on the state, the completeness of the documents, translations, and wait times for the Fachsprachprüfung and Kenntnisprüfung.

German Language Skills for Doctors

Practicing medicine requires more than just a certificate. A doctor must understand a patient’s symptoms, explain risks, write medical reports, call colleagues, maintain records, and navigate regional dialects.

A basic guide:

B2 German — the general language proficiency level typically required by all federal states;
Fachsprachprüfung Medizin — medical German, typically based on the C1-Kommunikation model;
To actually work in a clinic, a level higher than the formal minimum is often required.

If your German is weak, , finding a job in Germany becomes a secondary concern: first, you should focus on mastering the language and preparing for medical communication.

Medical Training in Germany

The traditional path through a German university lasts at least six years and three months and culminates in the Staatsexamen. The final stage includes the Praktisches Jahr. After successfully completing their studies, graduates are eligible to apply for an Approbation.

It is important for international applicants to check the following in advance:

Is a high school diploma recognized for direct admission?
Is a Studienkolleg () required? and M-Kurs;
What level of German is required for university admission;
whether the application is submitted through Hochschulstart, directly to the university, or via uni-assist;
What are the application deadlines for a specific university?

Medicine remains one of the most competitive fields of study. A high GPA, German language proficiency, and a properly submitted application are critical. Requirements vary by university and federal state, so there is no one-size-fits-all formula for admission.

What Doctors Should Check Before Moving

Before starting the process, it’s important to gather not only your motivation but also the necessary documents:

diploma and transcript listing course hours/subjects;
documents regarding internship, residency, clinical practice, or specialization;
a certificate of professional fitness and the absence of disciplinary violations;
proof of work experience;
German language certificates;
translations by a certified translator, if required by the state;
Information on visas if you are not a citizen of the EU, the EEA, or Switzerland.

If your degree, internship, or specialty does not meet German requirements, it is best to consult in advance with official recognition advisory services (Anerkennungsberatung), the Central Office for the Recognition of Foreign Medical Qualifications (ZSBA), or the relevant Medical Association (Ärztekammer), rather than relying on the promises of intermediaries.

Common Mistakes

Relying on old salary figures and failing to check the current collective bargaining agreement.
Consider the Approbation and recognition of Facharzt status as a single procedure.
Moving to Germany without a realistic plan for the Fachsprachprüfung and Kenntnisprüfung.
Focusing only on Berlin, Munich, or Hamburg while ignoring regions with high demand.
Don’t underestimate the importance of documentation, medical correspondence, and the administrative aspects of the job.
Consider the Berufserlaubnis as a full substitute for the Approbation.

FAQ

Is it possible to work as a doctor in Germany without an Approbation?

It is not possible to practice medicine independently with patients without authorization. A temporary Berufserlaubnis is possible, but it is limited and depends on the decision of the specific state.

Is a C1 level of German required?

Generally, a minimum B2 level in general German and a medical Fachsprachprüfung (specialized language test) aimed at the C1 level are required. The exact rules are set by the federal state.

How much does an Assistenzarzt earn?

In 2026, the starting base salary at a hospital is typically in the range of 5,500–5,800 € gross per month. On-call shifts and bonuses are calculated separately.

Is it possible to open a private practice right away?

In practice, this is rarely the first step. You need an Approbation, often a Facharzt certification, authorization to treat GKV patients through the Kassenärztliche Vereinigung, and business training.

Does the shortage of doctors help with the recognition of a degree?

The shortage of doctors increases the demand for specialists, but it does not eliminate the need for an Approbation, language requirements, or an equivalency assessment.