How long do I have to decide?

Until four weeks after you submit your application (§ 9d(2) BÄO). Once the four weeks pass, you stay on the standard route, the knowledge test.

How do I tell the authority my decision as a doctor?

The law prescribes no form. Ask the competent authority for a form. How to find the competent authority is explained on the page about jurisdiction and moving between states.

Do I need the document assessment as a specialist?

Several state medical chambers require the established equivalence of your degree before they recognise specialist training. The knowledge test does not give you that finding. We clarify this with your chamber.

What if I cannot obtain my documents?

Then you take the knowledge test. The law requires it where documents are missing for reasons beyond your control (§ 9d(3) BÄO).

As a doctor: patient exam or document assessment?

If you studied medicine outside the EU, the standard route is the medical knowledge test (Kenntnisprüfung). It is an oral and practical exam built around a patient you examine yourself. On your request the authority assesses your study documents instead (document assessment, Unterlagenbewertung). You choose exactly once, within a deadline set by law.

This choice exists only if your qualification comes from outside the EU, the EEA or Switzerland. With an EU qualification, see the overview for doctors.

Four weeks from your application

If you want your documents assessed instead of taking the knowledge test, you must declare this within four weeks of submitting your application (§ 9d(2) BÄO). The day you apply is what counts. After that, the knowledge test remains.

The choice binds you for the whole procedure, and the authority must inform you of the option and its consequences. Decide before you apply. Filing also starts the four weeks, so apply for the recognition grant before you file.

Standard route

The knowledge test for doctors

The medical knowledge test is an oral and practical exam with a patient presentation. It takes place on one day and lasts 60 to 90 minutes per person (§ 37 ÄApprO).

Before the date, the examination board assigns you one or more patients. You take the anamnesis, which is the conversation about the medical history, and examine the patients under supervision. You then write a report on the case with diagnosis, prognosis, treatment plan and epicrisis, the final summary of the case. The report counts towards your result.

The subjects are internal medicine and surgery. The board has three members, and the exam is held in German. Questions may also cover emergency medicine, pharmacology, imaging, radiation protection and legal issues of medical practice. If the authority found substantial differences in another subject, it can add that subject.

You may retake the test twice (§ 37(7) ÄApprO). Berlin, Brandenburg, Hesse and Mecklenburg-Western Pomerania state that they count failed attempts from other states, so moving to another state gives you no fresh attempt.

The test fee is between €400 (Schleswig-Holstein) and €1,350 (Hesse) in the eleven states that state a fixed fee. All 16 states are on the fees page. Waiting times for a date differ widely: North Rhine-Westphalia reports no waiting time at present, Rhineland-Palatinate names 16 months and Schleswig-Holstein about 12 months.

In its favour: You need no curriculum and no hour-by-hour transcripts, so no translations and certifications of that paperwork. Your clinical experience in internal medicine and surgery counts directly.
Against it: You must pass on the day, at the bedside, and pay the fee. You have three attempts in total.

On request

The document assessment for doctors

The authority compares your medical degree with the German one. If it is equivalent, you are licensed without the test. If substantial differences remain, you take the test anyway. Substantial differences are differences from German training, in content or in the way it was taught, that your professional experience does not make up for (§ 9c(5) and (6) BÄO).

For the comparison, most states obtain a report from the assessment body for health professions (Gutachtenstelle für Gesundheitsberufe, GfG). It sits at the Central Office for Foreign Education (Zentralstelle für ausländisches Bildungswesen) in Bonn. Nine states commission the GfG according to their own information. Bremen obtains a statement from the Central Office instead.

The equivalence report (Gleichwertigkeitsgutachten) costs €1,773 in six states, according to their information. Higher amounts are stated by Bavaria (up to €3,000), Baden-Württemberg (up to €2,500) and Saarland (up to €2,000). Lower is North Rhine-Westphalia at €1,150. For the comparison of training, Brandenburg states an additional authority fee of €130 to €895.

Baden-Württemberg currently names about 15 months for the report. Rhineland-Palatinate, Saxony and Schleswig-Holstein give four months after complete documents, longer if an external expert is involved.

In its favour: With a fully documented degree and a curriculum close to the German one, you may avoid the patient exam altogether.
Against it: You obtain, translate and certify the full set of evidence and pay for the report. If the authority finds substantial differences, you have paid for the report and still take the test.

If you are already a specialist

Several state medical chambers require, before they recognise specialist training, that the equivalence of your degree has been established. The knowledge test does not give you that finding. We clarify this with your chamber before you decide.

Specialist recognition in all chambers (in German)

Which starting point fits which route

These five situations are the most common among doctors:

1. You have worked for years in a narrow specialty.
The test requires internal medicine and surgery at the bedside. If you worked only in a field such as radiology or pathology, you need time to refresh. The document assessment can save that time if your degree is found equivalent.
2. You can reach your university and get the curriculum.
Ask your university whether it issues the curriculum with hours, how quickly and at what cost. If the answers are clear and your degree is close to the German one, the assessment is worth considering. We check with you before you apply whether your documents can be obtained.
3. Your university cannot issue documents.
Then the knowledge test applies regardless of your choice. The law requires it where documents are missing for reasons beyond your control and the authority could examine the application only with disproportionate effort (§ 9d(3) BÄO). Examples are destroyed university archives or a home country without a functioning administration. Choose the test straight away.
4. You want to work as a doctor again soon.
Until you are licensed, you can apply for a temporary permit (Berufserlaubnis, § 10 BÄO) of two years in total, across all states. Several states grant it only for a specific post under supervision. A waiting time of 16 months, as Rhineland-Palatinate states, equals two thirds of that period. Requirements and limits are explained on the temporary permit page (in German).
5. Your professional German is still unsure.
The test is held in German, and a specialist language test is needed on both routes (details in German). Plan time to prepare before the test route. Structure, subjects and retakes are on the knowledge test page.

Worked example from the states of the doctors

A doctor applies in Saxony. The knowledge test costs €850 there. The document assessment runs through a report that costs €1,773. If your degree is found equivalent, you therefore pay €923 more than on the test route. If the authority finds substantial differences, the €850 for the test are added, €2,623 in total.

In North Rhine-Westphalia the two routes are closer: the report costs €1,150 and the test €1,050, a difference of €100. Translations, certifications and the specialist language test are not included in any of these figures.

The cost calculator adds up both routes for your state: the option "My training is assessed on the basis of documents" adds the equivalence report.

The knowledge test Fees in all states

Frequently asked questions

What does the knowledge test for doctors cover?: Internal medicine and surgery, in an oral and practical exam with a patient presentation. It lasts 60 to 90 minutes per person (§ 37 ÄApprO). The knowledge test in detail
How long do I have to decide?: Until four weeks after you submit your application (§ 9d(2) BÄO). Once the four weeks pass, you stay on the standard route, the knowledge test.
How do I tell the authority my decision as a doctor?: The law prescribes no form. Ask the competent authority for a form. How to find the competent authority is explained on the page about jurisdiction and moving between states. Jurisdiction and moving states (in German)
What does the equivalence report cost for doctors?: The report costs €1,773 in six states. Higher amounts are stated by Bavaria (up to €3,000), Baden-Württemberg (up to €2,500) and Saarland (up to €2,000). Lower is North Rhine-Westphalia at €1,150. What both routes cost
How often can I retake the medical knowledge test?: Twice (§ 37(7) ÄApprO), so you have three attempts in total. Berlin, Brandenburg, Hesse and Mecklenburg-Western Pomerania state that they count failed attempts from other states, so moving to another state gives you no fresh attempt.
Do I need the document assessment as a specialist?: Several state medical chambers require the established equivalence of your degree before they recognise specialist training. The knowledge test does not give you that finding. We clarify this with your chamber. Specialist recognition in all chambers (in German)
What if I cannot obtain my documents?: Then you take the knowledge test. The law requires it where documents are missing for reasons beyond your control (§ 9d(3) BÄO).