• Introduction about where to apply for approbation
Step number six of the 10 steps for beginning a medical residency in Germany is to apply for a German permanent medical license (die Approbation).
In this article, we try to collect and summarize the advantages and disadvantages of applying for the German permanent medical license (Approbation) in each German state. You can find links to the websites of the 16 medical license authorities in each of the 16 German states here. In this article, we put direct links to the application forms for the Approbation and the required documents.
If you have the slightest doubt about a certain point or do not understand any information, ask at any time in the main group of our community “Facharzt JETZT” on Facebook and on Telegram (groups will appear as a folder). 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. 😊
Where should I apply for the Approbation? 😭😢
Hard question facing many foreign doctors wanting to come to Germany
The question: “Where should I apply for Approbation?” is a common question in all Facebook groups. We tried to make a summary of the differences between the German states. This is not an easy task because each state is different and writing about the topic depends only on what doctors post in the different groups on social networks about their experience.
Can you help us add information to the comparison tables in this article? Please write a short comment, JETZT (now) 😊
• General rules:
– Waiting times
States with long waiting times are suitable for those who have other things to do before beginning their medical residency (like wanting to travel, marry, or do a master’s degree).
• Long waiting times could be invested in:
– Learning for your future dream medical specialty (start learning for the German Board Exams!)
– Learning skills like (e. g. Blood withdrawal, inserting cannulas, ultrasound, etc.)
– Enjoying yourself before starting working, traveling,
– Making connections through Facharzt JETZT (article)
– Doing a master’s or PhD degree (like in business health administration; if you want to have a future career in German hospitals) (article)
– Should I rather study for the medical knowledge exam rather than to work?
• Finding a job with Berufserlaubnis is not easy. So you might opt out to choose a state where you can quickly do the medical knowledge exam (like Baden-Wurttemberg). In this case, invest your time in intensive learning and maybe visiting preparatory courses (more details about the exam here).
– Racism
• Racism is strongly prohibited in Germany and the police and hospitals take immediate procedures against that. So, this should be one of your very least concerns. That being said, in East German states, the Germans are not used to many foreigners. So, the possibility of having a racist experience is there higher.
💡 East German states: Brandenburg, Mecklenburg-Vorpommern, Saxony, Saxony-Anhalt, Thuringia.
– Easiness or hardness of the exams
Some states or exam locations are known to be hard (e. g. Münster or in the LMU in München). Nonetheless, there are sometimes exam committees that give easy questions in these locations. In some exam centers, known to have easy exams, sometimes, you will find hard committees.
• Abbreviations used in the table “Where to apply for Approbation”
| Abbreviation | Meaning |
|---|---|
| State | Name of the German state in English (🇩🇪 name in German) |
| General evaluation | 0: Very bad –> 10: Perfect. So, the higher the score, the better is it to apply for the Approbation there. |
| Proof | Is a proof of intention needed to apply for approbation? (In Bavaria, e. g. this is not needed) |
| B2 | Is a B2 certificate needed to apply? (In some states, like NRW, you can send your documents after the internship year without a language certificate and still can know that you will get Gleichwertigkeit or not) |
| BE | Berufserlaubnis (Temporary medical license) |
| FSP | Fachsprachenprüfung (The Medical Language Exam) |
| KP | Kenntnisprüfung (The Medical Knowledge Exam) |
| How hard is the exam or to get job with BE | 😍: easy 😊: normal 😢: hard 😭: very hard |
| Time to Eingangsbestätigung (months) | Time to getting a confirmation that your documents were received = Eingangsbestätigung |
| Time to get Defizitbescheid (months) | How many months they need before they reply and send you the 🇩🇪 Defizitbescheid |
• Where to apply for approbation: Comparison tables
We need your help. Can you help us add more information to the table? Be careful. The information change with time. You should always ask what the current requirements and times are.
N.B. Because this table is large, you can see it best on a PC. But if you use a mobile phone, turn on the horizontal mode.
| State | Evaluation | Proof | B2 | Time to Eingangs -bestätigung (months) | Time to Defizit- bescheid (months) | FSP | KP | Job with BE | |
|---|---|---|---|---|---|---|---|---|---|
| 1 | Baden-Württemberg (BW) (🇩🇪 same) | 1 | ✅ | 10-12 | 😍 | 😍 | 😢, somehow, half salary often | ||
| 2 | Bavaria (🇩🇪 Bayern) | 9 | ❌ | ✅ | 1-3 | 6-8 | 😊 | 😊 | 😊 |
| 3 | Berlin (🇩🇪 same) | 2 | 😊 | 😊 | 😭 | ||||
| 4 | Brandenburg (🇩🇪 same) | 3 | 😊 | 😊 | 😊 | ||||
| 5 | Bremen (🇩🇪 same) | 1 | 😊 | 😊 | 😢 | ||||
| 6 | Hamburg (🇩🇪 same) | 1 | 😊 | 😍 | 😭 | ||||
| 7 | Hesse (🇩🇪 Hessen) | 1 | 😊 | 😊 | 😊 | ||||
| 8 | Mecklenburg-Vorpommern (🇩🇪 same) | 3 | 😊 | 😊 | 😊 | ||||
| 9 | Lower Saxony (🇩🇪 Niedersachsen) | 9 | 4-6 | 😊 | 😊 | 😊 | |||
| 10 | North Rhine-Westphalia (NRW) (🇩🇪 Nordrhein-Westfalen) | 7 | ✅ | ❌ | 1-3 | 1-5 | Düsseldorf: 😊 Münster: 😭 | 😭 | 😊 |
| 11 | Rhineland-Palatinate (🇩🇪 Rheinland-Pfalz) | 5 | ✅ | 8-11 | Some say: 😭 | 😊 | 😭 | ||
| 12 | Saarland (🇩🇪 same) | 3 | 😊 | 😊 | 😭 | ||||
| 13 | Saxony (🇩🇪 Sachsen) | 3 | 4-6 | 😊 | 😊 | 😊 | |||
| 14 | Saxony-Anhalt (🇩🇪 Sachsen-Anhalt) | 3 | 😊 | 😊 | 😊 | ||||
| 15 | Schleswig-Holstein (🇩🇪 same) | 5 | 😊 | 😊 | 😊 | ||||
| 16 | Thuringia (🇩🇪 Thüringen) | 5 | 😊 | 😊 | 😊 |
• Proof of intention to apply for Approbation
To apply for the Approbation, one needs a proof of intention:
We list here which proof of intention accepts each state.
| State | Nothing needed | Hospitation | Anmeldung | Standortvermerk | Zusage | Others | |
|---|---|---|---|---|---|---|---|
| 1 | Baden-Württemberg (BW) (🇩🇪 same) | ✅ | “Strong” family connection | ||||
| 2 | Bavaria (🇩🇪 Bayern) | ✅💞 | no need | no need | no need | no need | |
| 3 | Berlin (🇩🇪 same) | ✅ (or 5 refusals) | ✅ | ✅ | ✅ | ||
| 4 | Brandenburg (🇩🇪 same) | ✅ | |||||
| 5 | Bremen (🇩🇪 same) | ✅ | |||||
| 6 | Hamburg (🇩🇪 same) | ✅ | |||||
| 7 | Hesse (🇩🇪 Hessen) | ✅ | |||||
| 8 | Mecklenburg-Vorpommern (🇩🇪 same) | ❌ | ❌ | ✅ | ❌ | ✅ | |
| 9 | Lower Saxony (🇩🇪 Niedersachsen) | ✅ | |||||
| 10 | North Rhine-Westphalia (NRW) (🇩🇪 Nordrhein-Westfalen) | ❌ | ✅ | ✅ | ✅ | ||
| 11 | Rhineland-Palatinate (🇩🇪 Rheinland-Pfalz) | ✅ | ✅ | ||||
| 12 | Saarland (🇩🇪 same) | ✅ | |||||
| 13 | Saxony (🇩🇪 Sachsen) | ✅ | |||||
| 14 | Saxony-Anhalt (🇩🇪 Sachsen-Anhalt) | ✅ | |||||
| 15 | Schleswig-Holstein (🇩🇪 same) | ✅ | |||||
| 16 | Thuringia (🇩🇪 Thüringen) | ✅💞 | no need | no need | no need | no need |
• Where to apply for Approbation: Advantages & disadvantages of each state
| State | Advantages 😊 | Disadvantages 😢 | |
|---|---|---|---|
| 1 | Baden-Württemberg (BW) (🇩🇪 same) | • Relatively easy exams • Beautiful nature, warm weather • 3rd populated state (>11 million) | • Long waiting timesز • Some say, a salary with BE lower than a normal salary • Living costs are relatively high |
| 2 | Bavaria (🇩🇪 Bayern) | • Good weather, nature wonderful, hiking paradise • 2nd populated state (>13 million). Hence large number of hospitals. | • High living costs • Hard to find accommodation in large cities |
| 3 | Berlin (🇩🇪 same) | • International • Events, night-life | • Very hard to get accommodation and job |
| 4 | Brandenburg (🇩🇪 same) | • Good alternative for those who want to live in or near Berlin | |
| 5 | Bremen (🇩🇪 same) | • Small state (around 0.5 million) | |
| 6 | Hamburg (🇩🇪 same) | • Hard to get accommodation and job | |
| 7 | Hesse (🇩🇪 Hessen) | • Center of Germany | |
| 8 | Mecklenburg-Vorpommern (🇩🇪 same) | • Some coastal cities • Weather not hot like in the south | |
| 9 | Lower Saxony (🇩🇪 Niedersachsen) | • Large state & many hospitals | • Fourth populated state (>8 million) > Many hospitals, normal |
| 10 | North Rhine-Westphalia (NRW) (🇩🇪 Nordrhein-Westfalen) | • Most populated state (>18 million) > largest number of hospitals • Waiting times are short | • Some wrote, if the doctor did “very bad” in the KP, then he will no longer be allowed to work with BE, but may re-take the KP • The KP & FSP in Münster are the hardest in Germany. In Düsseldorf there is a second test centrum for the FSP only & the exam there is normal. |
| 11 | Rhineland-Palatinate (🇩🇪 Rheinland-Pfalz) | • Many say it is hard to get a job there with BE | |
| 12 | Saarland (🇩🇪 same) | • Small state (1 million) and few hospitals | |
| 13 | Saxony (🇩🇪 Sachsen) | • Some areas are isolated in the most northern parts of Germany, but this could be an advantage if you want to live near Scandinavian countries | |
| 14 | Saxony-Anhalt (🇩🇪 Sachsen-Anhalt) | • Small state and few hospitals | |
| 15 | Schleswig-Holstein (🇩🇪 same) | • Some areas are isolated in the most northern parts of Germany, but this could be an advantage if you want to live near Scandinavian countries | |
| 16 | Thuringia (🇩🇪 Thüringen) |
• The best two states to apply for Approbation
When taking all factors together, the best states for non-EU/EFTA graduates are Bavaria (Bayern) and Lower Saxony (Niedersachsen).
These states are good because:
- High population… this means more hospitals
- Lower racism in comparison with eastern German states
- Reasonable exams
- Moderate waiting times
- The ability to work with Berufserlaubnis is relatively good.
- They have many small and isolated cities. These cities are cheap to live in and need often many doctors and you have good chances of getting popular specialties like neurosurgery.
- In our FSP (Fachsprachenprüfung) group on Telegram, there is a lot of free learning material for the FSP exam in Bayern (link).
• Further readings about where to apply for approbation
• A beautiful table from Wikipedia containing a comparison between all 16 German states: Link.
• Contributing author: Fortune Okafor
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)
Respected sir/ma’am,
I am MBBS doctor from India. I am currently doing B2 and I wanted to know about C1 FSP and KP courses and learning institutes in Hamburg, Germany. If you could suggest some , then would be a great help .
Thank you
Hi Akash, welcome to Facharzt JETZT 🙂 Unfortunately, I have never lived in Hamburg, but in our main groups with more than 62 thousand members, probably, you can find an answer:
• Facebook: https://www.facebook.com/groups/arabische
• Telegram: https://t.me/addlist/EDf_7TH3qlE0MmNi
Which state would be the best for me? I have my MBBS degree from Kyrgyzstan but permanent license and residency from home country Pakistan.
Bayern is good. But please read a lot. Ask so maany people as you can. You can ask in our main groups:
🇩🇪 Ärzte in Deutschland – الأطباء العرب في ألمانيا – Doctors in Germany
• Facebook: http://www.facebook.com/groups/arabische
• Telegram:
– https://t.me/facharztJETZT
– Join all all of our Telegram groups (they appear as single folder): https://t.me/addlist/EDf_7TH3qlE0MmNi
🇩🇪 Foreign Doctors in Germany (Posts auf Deutsch/Englisch, nicht nur Arabisch bitte im Text): http://www.facebook.com/groups/auslaendische
🇩🇪 Medical PG in Germany – Doctors wokring in Germany: http://www.facebook.com/groups/1436238759972943
🇺🇦 Ukrainische Ärzte in Deutschland (Posts auf Deutsch/Englisch, nicht nur Arabisch bitte im Text):
– Facebook: http://www.facebook.com/groups/41589709991320
– Telegram: https://t.me/+-Yc7VzITWbMzMWNi
🇩🇪 الأطباء السوريون في ألمانيا Syrische Ärzte in Deutschland – فاخ آرتست يتست
https://www.facebook.com/groups/1532223027581074
Hello, I have done my MBBS and MD ( anaesthesia) in India with 1+ year work experience after PG. I am considering between Lower Saxony and NRW states. Which would you suggest? also is it possible to register my post graduation after KP rather than joining for a residency course all over again?
Hi, work certificate is helpful: https://facharztJETZT.de/importance-of-work-certificates/
“also is it possible to register my post graduation after KP rather than joining for a residency course all over again?” I did not understand.
hi, i already have my MD from India, so after approbation how to register my speciality rather than entering a residency program?
Very good question. We have an article about that: https://facharztjetzt.de/importance-of-work-certificates/
May I ask how you reached our website? 🙂
Hi there,
Nicely written article. I liked the comparison tables.
I am MBBS and MD General Medicine from India. I want to pursue Cardiology Training in Germany (likely Bavaria), could you tell me about the duration of cardiology training and if my internal medicine residency would be accepted as such without needing to repeat some or whole of it . Thank you very much.
Hallo Sir,
1. Durations of all medical specialties in Germany: https://facharztJETZT.de/durations/
2. Did not understand the second question.
I wouldn’t need kenntnisprüfung since I studied in EU.
When considering the FSP prüfung. Which state would be the easiest? I am between NRW, Lower Saxony and Bavaria.
I don’t have a b2 certificate, I am still trying to get it. I would like to move to the state where I will apply for approbation to learn the language with a language school and perhaps arrange a hospitation.
As for zusage, Don’t we need to get approbation first to look for jobs? Do we need the zusage first and then apply for approbation?
I would really appreciate any help and recommendations.