Germany’s rapidly growing physician shortage is making doctors from abroad an indispensable part of the healthcare system. According to 2024 statistics from the Bundesärztekammer, the number of foreign-born physicians in the country has been increasing for years; 5,383 physicians registered for the first time in 2024 alone, and the proportion of younger generations in the total number of physicians is directly linked to emigration. The agency emphasizes that without this immigration, the number of physicians would decrease by approximately 2,000 people annually (https://www.bundesaerztekammer.de/baek/ueber-uns/aerztestatistik/2024). Furthermore, detailed 2024 physician statistics show that the share of foreign physicians in the total has reached approximately 15% (https://www.coliquio.de/content/aerztliches-leben/zahlen-fakten-zu-deutschlands-aerztinnen-und-aerzten-51692). However, obtaining equivalence (Approbation) and actually starting to practice has become a bureaucratic ordeal for many international physicians, spanning years. Fragmented application processes across states, limited quotas for the Fachsprachprüfung (C1 medical language exam) and Kenntnisprüfung (competence/adaptation exam), and waiting times for appointments and evaluations are lengthy. In recent years, waiting times of up to 15 months to three years, particularly for physicians from Ukraine, have been the subject of harsh public criticism (https://www.welt.de/politik/deutschland/article252822286/Bilanz-verheerend-Deutsche-Buerokratie-bremst-gefluechtete-ukrainische-Aerzte-aus.html).
A recent report by DER SPIEGEL provides detailed examples of how physicians from Turkey are being “disprofessionally disqualified” in Germany due to long waiting times, repeated exams, difficulties with document verification, and differing practices across states. The report emphasizes that, despite the physician shortage, bureaucratic bottlenecks are costing both immigrant physicians and patient care (https://www.spiegel.de/panorama/tuerkische-aerzte-in-deutschland-warum-sie-hier-keine-zulassung-erhalten-a-0719e52d-2a9a-4604-a568-451a393abca4?sara_ref=re-xx-cp-sh). These findings align with the healthcare system’s experience in the field: While small towns and provincial hospitals struggle to fill positions, physicians awaiting equivalency are losing time in temporary jobs or non-clinical positions. The German Medical Association and physician recruitment platforms also confirm that foreign physicians keep the healthcare system afloat, but that paperwork and examination processes are a “bottleneck” (https://aerztestellen.aerzteblatt.de/de/redaktion/deutschland-arbeiten-woher-kommen-auslaendische-aerzte).
A 2024 study by Zekeriya Aktürk and colleagues from the University of Augsburg compares the pre- and post-migration professional/economic situations of healthcare professionals who left Turkey. The findings indicate that push factors (professional uncertainty, security, and merit concerns) and pull factors (stable employment, advancement, and training opportunities) are both influential. The same article and related datasets also report a significant increase in the number of Turkish immigrant physicians in Germany after 2012 (https://ijmshr.com/uploads/pdf/archivepdf/2024/IJMSHR_398.pdf).
Two facts are clear: Germany struggles to maintain the level of service in the field without foreign physicians; dependence on external resources is particularly strong in rural areas and small hospitals. Equivalence and language exam processes are unpredictable, inconsistent, and slow across states, leading to long waits for qualified physicians to be excluded from the system.
The data is clear: International doctors are filling Germany’s physician shortage; however, the fragmented and slow equivalence mechanism is harming both physicians’ careers and the system’s capacity. Spiegel’s fieldwork and the academic literature converge: a fast, standardized, and fair recognition process for doctors in Germany must be established as soon as possible.
In this regard, we believe the following recommendations would be beneficial:
- A standardized and transparent “national core procedure”: Aligning application, document verification, and exam schedules with minimum standards at the federal level; transparently announcing state differences.
- Increasing capacity and accelerating it: Regular and frequent slot scheduling for Fachsprachprüfung and Kenntnisprüfung; migrating the digital application and appointment infrastructure to a single portal. 3. Bridging programs: Making the waiting period clinically valuable for physicians awaiting equivalence through supervised clinical rotations and modular training packages.
- Safeguarding against abuse and illegal registration: Minimum wage/mentoring standards and corporate responsibility principles for physicians during the waiting period.
- Purpose-oriented language skills: Practice-oriented exam content and targeted language courses that measure clinical communication proficiency while maintaining the C1 medical language standard.
