Approbase

The process in eight steps

From choosing an authority to the formalities of your first month at work. Each step names the point where it most often gets stuck.

  1. 1. Decide on a federal state and authority

    Recognition is not handled federally. A state authority decides your case, so choosing a state also chooses the processing practice, the forms and the exam slots.

    • As a rule, the competent state is the one where you intend to practise.
    • All 16 authorities with address, phone and email are in the authority table on this site.
    • The ZSBA of the Federal Employment Agency advises free of charge and neutrally, including while you are still abroad.

    Marburger Bund – addresses of registration authorities (as of February 2026) · ZSBA – Central Service Point for Professional Recognition (free, neutral) · German Bundestag, printed paper 21/1831 – no nationwide Approbation figures

  2. 2. File the recognition application

    You apply for a decision on whether your training is equivalent to the German one. Most of the delay accumulates here, almost always over documents.

    • In 2025, 12,882 new physician recognition applications were filed nationwide; 13,900 physician recognitions were reported in the same year. These count different things and must not be added together.
    • The Federal Ministry of Health itself describes the document-based equivalence assessment as particularly burdensome. The reform therefore makes the direct Kenntnisprüfung the standard route, with document review still available on request.
    • Certifications, apostilles and sworn translations take lead time, and they are the most common cause of follow-up queries.

    Anerkennung in Deutschland – federal/state statistics · Federal Ministry of Health – FAQ on recognition of health professions

  3. 3. Medical language examination (FSP)

    The medical-language examination is taken at the chamber of physicians. Failure rates are high and repeats are common.

    • Nordrhein 2025: 3,352 sittings, 1,863 passes, 1,489 failures, so 44% of sittings were not passed.
    • Berlin 2025: 535 exam participations, 185 of them repeat examinations (34.85%).
    • There is no nationwide count of individuals examined: exam figures count sittings, not people.

    Ärztekammer Nordrhein – current annual report · Ärztekammer Berlin – 2025 activity report

  4. 4. Knowledge examination (KP)

    If you trained in a third country and equivalence is not certified, you prove your knowledge in an examination.

    • After the reform, the direct Kenntnisprüfung is the standard route; document review remains available on request.
    • No nationwide figure for pending knowledge examinations is published.
    • Exam dates and capacity differ by state, which is a real reason to choose your authority deliberately.

    Federal Ministry of Health – FAQ on recognition of health professions · Marburger Bund – addresses of registration authorities (as of February 2026)

  5. 5. Berufserlaubnis (temporary licence)

    The Berufserlaubnis is a time-limited permission to work as a doctor, often tied to one employer or region. It is the bridge to full Approbation.

    • The Berufserlaubnis usually marks the start of your first employment, and with it every formality under points 7 and 8.
    • For 2025, Baden-Württemberg reported about 3,900 ongoing recognition procedures and 704 Approbationen for third-country-trained doctors; Saxony reported 224 Approbationen for doctors trained outside Germany. No nationwide figures exist.
    • The Berlin chamber reported that in 2024 more than half of applicants, around 1,000 doctors, waited longer than a year.

    Regierungspräsidium Stuttgart – recognition of third-country physicians · Medienservice Sachsen – Approbationen 2025 · Ärztekammer Berlin – licensing of foreign physicians

  6. 6. Approbation (full licence)

    The Approbation is the unlimited, nationally valid licence to practise medicine.

    • No tie to an employer or state. From here you move freely on the German labour market.
    • In 2025, 5,448 physicians of foreign nationality were registered with a state chamber for the first time. Nationality is not the same as place of training, so treat this as a proxy for inflow.
    • 71% of working physicians without German nationality work in inpatient care, i.e. in hospitals.

    German Medical Association – physician statistics 2025 · KBV – physicians by activity and origin

  7. 7. Register with the chamber of physicians

    Anyone practising medicine in Germany registers with the chamber of the state where they work. The chamber is also the route into the professional pension scheme.

    • You register with the state or district chamber, not with the Approbation authority. These are two different bodies.
    • Deadlines, forms and fees are set by each chamber's own statutes; all chamber addresses are in the authority table.
    • Chamber membership is a precondition for the next step, exemption from statutory pension insurance.

    Marburger Bund – addresses of state chambers of physicians

  8. 8. Pension, Versorgungswerk, insurance cover

    The most expensive mistakes happen in the first three months of your first job, above all around the exemption from statutory pension insurance.

    • Pension exemption: the application is filed electronically through the competent Versorgungswerk, which forwards it to the pension insurer (Section 6(2) SGB VI).
    • The three-month rule: if you apply within three months, the exemption takes effect from the date the conditions were met. Otherwise it takes effect only from the date the application is received (Section 6(4) SGB VI).
    • The exemption covers only that particular employment (Section 6(5) SGB VI). Re-apply at every job change.
    • Health insurance: the 2026 income threshold is €77,400. Entry-level TV-Ärzte/VKA base pay is about €68,664.60 for a doctor in training and about €90,626.28 for a specialist. The first sits below the threshold, the second above it.
    • Professional liability: the professional code of the Nordrhein chamber requires adequate liability cover. Know what the hospital's policy covers, and whether personal recourse protection is missing, before your first shift.
    • Occupational disability: the Versorgungswerk includes disability cover, but its definition can be stricter. Nordrheinische Ärzteversorgung requires inability to practise medicine and cessation of medical activity.
    • Bank account: if you reside lawfully in Germany and have no other suitable payment account, you generally have a right to a basic account, which helps when normal onboarding fails.

    Section 6 SGB VI – exemption from compulsory insurance (statute) · Federal Ministry of Health – statutory health insurance (income threshold) · TV-Ärzte/VKA – current salary tables · Ärztekammer Nordrhein – professional code · Nordrheinische Ärzteversorgung – disability pension · Marburger Bund – recourse protection · BaFin – basic payment account under the ZKG