The 10 steps to start a medical residency in Germany (2024)

Medical residency in Germany and getting a German Approbation

• Introduction

Welcome to the most detailed article on the internet on how to start a medical residency in Germany and get a German permanent medical license. In German, the word for the permanent medical license is called 🇩🇪 Approbation. A temporary medical license is called in German 🇩🇪 Berufserlaubnis (BE). To be able to start working as a medical doctor and start a medical residency in Germany, you need to have one of these licenses (Article: Differences between the two in detail).

If you have the slightest doubt about a certain point or do not understand any information, ask at any time in the main Facharzt JETZT group on Facebook and on Telegram. We remind you that this article is a guidance article to help you understand things and you should not rely solely on it. You should always return to the official websites. 😊

• General notes

▪ The exams required from International Medical Graduates (IMG) do not depend on their nationality (e.g., if EU or not EU), but depend on in which country they studied medicine (more explained in step number 9).

▪ The steps should not always be followed in the same chronological order to start a medical residency in Germany.


▪ This article was written with a help from Mr. Teddy Kabel, admin of the largest English group for foreign doctors in Germany. Vielen Dank 🙂

• The ten steps to start a medical residency in Germany:

The ten steps to start a medical residency in Germany and getting a German Approbation

1. Finish medical school

Logically, to start medical residency in Germany, you need to have received your medical degree. In most countries of the world, medical school lasts six years. In a few countries, like Germany itself or China, medical school lasts five years. The duration of medical school does not play a role in Germany.

For those who failed a year or more in medical school…

– Are your university and faculty recognized in Germany?

Use “Anabin” website to see if your university and your medical degree are recognized in Germany. If your university and faculty have the status “H+/+”, then they are recognized in Germany. 🥳😊 This YouTube video shows you how to find this out using Anabin.

– Stop & think: Is a medical residency in Germany the best option in “your” case?

Before deciding to come to Germany and start medical residency, please read a lot about the advantages and disadvantages of medical specialization in Germany and other countries. If you want to start on a specific pathway, then you should only concentrate on it. Therefore, we wrote many articles to help you with your decision: “Thinking about coming to Germany?”

An important point in helping you in your decision is knowing if your bachelor’s degree will be considered equivalent to a German one (🇩🇪 gleich/Gleichwertigkeit). This is critical because it will save you from doing the medical knowledge exam (step 9). We explained this in the following article:

🇩🇪 Avoiding a medical knowledge exam (🇩🇪 die Kenntnisprüfung) for doctors who studied in non-EU/EEA countries 🇪🇺

By the way, if you find the above route complicated and particularly if you do not like to work with patients, there is an academic route:

🇩🇪 For physicians: Doing a Master’s or PhD degree in Germany

If you still cannot decide. Read as much as possible about this route of specialization. Look in our main Facebook group and main Telegram group, and see what doctors are discussing and what problems they are facing. You are welcome to post as many questions as you like.

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2. Learn the German language & improve your CV to start medical residency in Germany

– Learning German

During your internship year, or already before that, start learning the German language until at least the B2 level. We recommend learning at least until the C1 level. The language is essential later on during interviews, working with patients, and even for the board exams. Besides having German Approbation, language proficiency is the most critical criterion for the selection process.

Should the language certificate be from a particular testing authority/institute? Yes…

Should I get an official certificate for each language level I finish, from A1 to B2?

Should I get the C2 level certificate? No…

The following are articles related to doctors learning German:

– Improving CV

Even before you arrive in Germany, enhance your chances of securing your dream medical specialty in a renowned German hospital by not only focusing on learning German but also engaging in activities that bolster your CV. Discover valuable insights and guidance in another article on our website:

🇩🇪 Improve CV as a foreign doctor: Before and after coming to Germany

To quickly start a medical residency in Germany, do not forget to build connections. This is important because connections will save you a lot of time, money, and stress. With Facharzt JETZT it is now possible and for free to make connections with doctors working in Germany:

🇩🇪 Doctors wanting to work in Germany: How to make connections? Why? 🕵️

🇩🇪 How to make connections through our community “Facharzt JETZT”? Get a training or even a job! 🥳🥳😊💓

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3. Finish the internship year to start a medical residency in Germany (das Praktische Jahr)

You MUST finish an internship year to start a medical residency in Germany; either in the country where you studied medicine or in your home country.

The internship year should contain certain rotations and should have certain characteristics. We explained all of that in the following article:

🇩🇪 For medical doctors: The internship year (🇩🇪 das Praktische Jahr – PJ) is a must to be able to work in Germany. 100% sure! No exceptions!

Did you finish your internship year, or can you finish it in the future?

Congrats 🙂 You are finished with step number 3. Please go to the next step (number 4)To do it in a third country or in Germany is a complicated thing and should be avoided, not to mention that doing it in a third country would be most probably not recognized. The full details are in the following article:
For medical doctors: Is the internship year (🇩🇪 das Praktische Jahr – PJ) a must to be able to work in Germany? 100% yes! No exceptions!

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4. Get your permanent medical license

You can get it after finishing the internship year, either in your home country or in the country where you studied medicine. This is a very important document. Without it, you cannot start a medical residency in Germany.

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5. Prepare your documents for applying for the German permanent medical license (die Approbation)

To ensure getting a medical residency in Germany, you can start during the internship year to slowly collect all the needed documents for applying for the German permanent medical license (🇩🇪 die Approbation). Be careful, do not prepare your documents too early because some documents are allowed to be maximally one to six months old at the time of application for the Approbation (For example, the police clearance certificate – 🇩🇪 die Straffreiheitsbescheinigung). A complete list of the needed documents is in the following link:

🇩🇪 Required documents to apply for Approbation in Germany

– Find which documents you need exactly

The documents differ slightly between the 16 medical license authorities in the 16 German states. You can find the exact needed documents on the websites of the 16 medical license authorities. On the website of each medical license authority, the required documents and application files are listed depending on where you studied medicine; either in the European Union/European Economic Area (EU/EEA) or outside of it. Here we collected the links for you: Direct links.

The authorities do not give a lot of explanations about the documents and there are many pitfalls. Therefore, please read first exactly our article about the required documents.

– The translation of the documents

Wrongly translated documents could destroy your chances of working in Germany, or make it a nightmare. Therefore, we wrote a whole article to explain the translation of documents for you:

🇩🇪 Translation of documents: Where and what to pay attention to

– The authentication

We recommend the legalization of your documents in the countries where you got them from (country of origin or the country where you studied medicine). However, in a few countries of the world, the German embassies do not legalize documents. We explained all of this here:

🇩🇪 What is authentication (die Beglaubigung) & where to do it

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6. Send via mail your application for the German permanent medical license (die Approbation)

After you finish the internship year, you can send your application by mail to one of Germany’s 16 medical license authorities. Unlike the USA, Canada, or England, there is no centralized authority for that.

– To start medical residency in Germany: Proof of intention

To be able to apply for a German Approbation, you need in 14 out of 16 medical license authorities a “proof of intention”. We explained this and how to get it in the following article:

🇩🇪  Applying for the Approbation: The proof of intention

The two German states which do not require proof of intention are Bavaria (🇩🇪 Bayern) and Thuringia (🇩🇪 Thüringen). In Berlin, it is enough to provide email copies of answers from hospitals that refused your application for a Hospitation (medical training) (Articles: What is a Hospitation & How to apply).

– For non-EU/EEA doctors: Decide whether you want to apply for the Gleichwertigkeit

All foreign doctors need to do the Fachsprachenprüfung (FSP) (medical language exam) (step 8).

The Kenntnisprüfung (medical knowledge exam) (step 9), is NOT required from graduates of universities in the European Union (EU)/European Economic Area (EEA). Graduates from universities in the rest of the world should decide at the time of the approbation application if they want to register for the Kenntnisprüfung exam or if they want to undergo the process of the Gleichwertigkeit. We explained this in step number 8.

More questions and answers about step six of the 10 steps to start a medical residency in Germany:

The ECFMG: Applying for a medical license in the USA

What are the 16 German medical license authorities (🇩🇪 die Approbationsbehörden)?

In which one of the 16 medical license authorities should you apply for the Approbation?

Can the application be online?

Can I apply simultaneously to many authorities?

Can I apply for Approbation in one German state and work in another?

Can you change your mind and move your application for the Approbation from one German state to another?

Do the months/years of residency I spend working with Berufserlaubnis (temporary medical license) count for the residency period?

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7. Apply for a visa (if you need one) & travel to start medical residency in Germany

Medical residency in Germany - Step 7

To travel to Germany, citizens of many countries in the world need to apply for a German visa. You should give the German embassy a reason for coming to Germany. We explained the reasons and other issues related to this topic in separate articles:

🇩🇪 Applying for a German visa: How? Reasons for coming to Germany?

• There are in 2024 new changes coming to the visa laws, making it easier to come & work in Germany and get the German nationality. This is thoroughly explained in the following article:
🇩🇪 The Skilled Immigration Law (Das Fachkräfteeinwanderungsgesetz)

To get a German visa, one of the things you need is “proof of financial resources”. We explained the two methods for that in this article:

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8. Do the medical language exam (die Fachsprachenprüfung – FSP)

This exam is required from all doctors who did not finish high school in Germany; even if they have a German passport. You can do it ONLY after you send your application to apply for the German permanent medical license (🇩🇪 die Approbation) (step number 6) and get a reply that you can do this exam. Again, as explained in step number 5, applying for a permanent medical license is only possible after finishing medical school.

• Detailed articles:

🇩🇪 What is the medical language exam (FSP)?

🇩🇪 Ultimate Fachsprachenprüfung (FSP) preparation tips

After passing the medical language exam, the steps required from you depend on the country in which you studied medicine. We explain this in the following algorithm and table:

Medical residency in Germany: Required exams

Did you study medicine in a country of the European Union (EU) or of the European Economic Area (EEA)?

🇪🇺 🇮🇸 🇱🇮 🇳🇴 🇨🇭
(Rest of the world)
Congratulations 🥳🥳💐💐
After passing the medical language exam, you are going to get the approbation. 🥳🥳
You do not need to read further in steps 8 or 9. Go straight to the last step (number 10).
Most graduates from outside the EU/EEA need to take the medical knowledge exam (🇩🇪 die Kenntnisprüfung). Who should now take it is explained in the next questions in yellow.

– All about the Gleichwertigkeit/gleich & should you apply for it

What is the 🇩🇪 Gleichwertigkeit/gleich?

How do I know if the graduates of my “batch” from our university get the Gleichweritgikeit?

Should I apply for the Gleichwertigkeit?

If I applied for the Gleichwertigkeit, can I work until I receive an answer?

Can you apply for the Approbation in one German state, do the Fachsprachenprüfung (FSP) there, and then do the medical knowledge exam (Kenntnisprüfung) (KP) in another German state?

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9. When requested from you, do the medical knowledge exam (die Kenntnisprüfung – KP)

As we explained in detail in step number 8, not all foreign doctors are required to do this exam. This is an oral medical exam. There is not a single MCQ question in it. 🥳 This means that the exam is a friendly discussion and the doctors need at least a general outline of diseases, medications, and therapies. We wrote a detailed article about it here: “What is the medical knowledge exam (die Kenntnisprüfung – KP)?

Doctors who need to do a medical knowledge exam are allowed by many medical license authorities to work for 6 to 24 months with a temporary medical license ( eine Berufserlaubnis). We explained the differences between a permanent and a temporary medical license in this article:

🇩🇪 Approbation vs Berufserlaubnis: Can I work as a doctor with Berufserlaubnis? Yes, but…

We hope that you could avoid doing a medical knowledge exam (🇩🇪 die Kenntnisprüfung) and that you now have a permanent German medical license (🇩🇪 die Approbation).

When requested from you, do the medical knowledge exam (die Kenntnisprüfung - die KP)
Approbation day
German Board in Neurology day

Do not forget to post your photo with the Approbation document in the main group of Facharzt JETZT on Facebook and Telegram.😊🥳 This will motivate others, especially if you write small tips from your experience. That would be very nice of you. 😊💐

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10. Apply for a job (die Bewerbung um eine Stelle)

Medical residency in Germany: Step 10 - Apply for a job

To save time, already after passing the required exams from you, and while waiting for the Approbation/Berufserlaubnis document, start applying for a job. Simply write in your job application that you passed the exam(s) and include a copy of the confirmation of that (you get this on the day of the exam). You can begin working immediately after getting the approbation certificate by mail.

• We explained in the following articles how you can apply for a job (including free samples for your application email and your motivational letter):

• In the following articles, we explained the job interviews and how you can fully succeed in them:

After being accepted in the job, there are small few easy steps to take. Some of them are voluntary and some are mandatory. Please do not forget them because they could cause you to earn more or less money.

🇩🇪 Steps to do after being accepted in a job

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• YouTube video: Same steps summarized

At the end of this article, we want to assure you that if you followed carefully these 10 steps to start medical residency in Germany, we will guarantee you that you will get your German Approbation. 🥳

Herzlichen Glückwusnch (Congratulations) 😊
You will get the job! 🥳💐😊

Want to learn more? Questions?
Join JETZT (🇺🇸 now) all of our groups & ask what you like
(On mobile phone: The links are at the end of this page/ On PC: On the right side)

Further readings:
• “Approbation in Germany”, Helena Mamić – Soprano website (Foreign doctor in Germany from Croatia), link.
• “Getting Started with Medical Residency in Germany”, German medical residency website, link.
• “Application Process for Medical Residency in Germany”, German medical residency website, link.
• “Preparation of documents for Berufserlaubnis / Approbation”, your second heart blog, link.


  1. I’m a medical student in Africa level 4 general medecin , wheeling to specialise in Germany. Just want to know the differents steps involved.

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