There is a shortage of doctors in many communities and clinics. It’s a good thing that there are applicants from abroad. But there are enormous hurdles for them to overcome in Germany.
The applicants come from Turkey, Syria, Ukraine and many other countries. They all want to work as a doctor in Germany. Many municipalities and hospitals are happy about this. A regional shortage of doctors has long been creating gaps in care.
But before foreign doctors can be deployed in German practices, care centers or clinics, there are lengthy procedures. There are currently many applications backing up in the authorities responsible for recognition and work permits – to the annoyance of those affected. Will patients ultimately receive worse care as a result? What could help?
Problems on site – current cases
Whether in the southern Black Forest or on the Mecklenburg Lake District, in the Taunus or in Thuringia: Foreign doctors are sought after in many German cities. In Bad Säckingen, Baden, for example, the search for a successor to the gynecological practice in the local medical care center (MVZ) already seemed unsuccessful.
An employment contract had already been concluded with a Turkish applicant – but approval was a long time coming. Medical assistants have already been terminated. After anxious weeks, the MVZ finally found a gynecologist from the region, according to the “Badischer Zeitung”. Meanwhile, in Aalen on the Ostalb, a doctor from Venezuela has been fighting for months for recognition to work as a family doctor.
In Eisenach, Thuringia, a Ukrainian woman who has worked as a pediatrician in her home country for 27 years is waiting for her degree to be recognized. “It’s a shame that it’s taking a very, very long time,” she told MDR. At first, all she could do was work as an intern in the children’s ward.
Meanwhile, in Bad Schwalbach, Hesse, a Colombian doctor’s anger was growing: he already had an employment contract at a clinic – only the license he applied for was a long time coming, and he didn’t even reach the responsible state authority to ask questions, as he told Hessischer Rundfunk.
More and more foreign doctors – and the trend is rising
The number of foreign doctors rose to a new high last year – to almost 64,000. After a slowdown in immigration during the corona pandemic, immigration is increasing again, as the Vice President of the German Medical Association, Ellen Lundershausen, says. “The immigration of foreign doctors is expected to continue in the coming years.”
Syria led the way in terms of countries of origin in 2023 (6,120 doctors), followed by Romania (4,668), Austria (2,993), Greece (2,943), Russia (2,941) and Turkey (2,628). “We have been experiencing a major increase from Turkey for around a year and a half,” reports the head of the expert assessment center for health professions, Carola Dörfler. The reason could be widespread dissatisfaction with the political and economic situation in the country. The number of applicants from Ukrainian war refugees has also been increasing for around a year.
In Dörfler’s facility, doctors and therapists as well as documentarians, among others, check the submitted degrees and documents on behalf of the federal states to determine their equivalence in Germany. In many regions, a lot is being done to attract foreign doctors.
The clinic in Neubrandenburg recruited eleven young doctors from Mexico for further qualification through a program run by the employment agency. Baden-Württemberg wants to facilitate the procedures through a bundled contact point for authorities, Bavaria also wants to use artificial intelligence.
The hurdles for applicants – often a vicious circle
But instead of joy, there is frustration in many places. “The increase in the number of applicants from Turkey and Ukraine has led to a traffic jam,” admits head of the assessment center Dörfler. “The staffing levels of the authorities are lagging behind developments.”
The duration of the equivalence test in your company: six months, eight months or in some cases up to a year. Medical Association Vice President Lundershausen says: “There is undoubtedly a risk of long waiting times or hanging situations due to the complex recognition process.” The processes of the various authorities often appeared contradictory.
Elitsa Seidel can tell you a thing or two about the practical problems. With her agency “inmed personal” in Mainz, she helps applicants get recognition. Seidel complains about the different requirements in the federal states – from the form in which documents are certified to the waiting time for the specialist language test, which is also necessary. “It takes two months to six months.”
Some applicants found themselves in a vicious circle. “The clinics need planning security and therefore only accept fully recognized applicants,” says Seidel. However, many licensing authorities require proof of employment before they even process the application – especially if the doctors do not yet have a German residence.
The foreign documents – often a drama
“Everything often seems very simple: a clinic or an MVZ wants to hire a doctor, the doctor wants to be hired,” says agency boss Seidel. For the applicants, obtaining all the documents and comparing them with the German requirements often turns into a drama.
Seidel explains that it could easily take two or three months longer if the recognition authority lacks a certificate. “The recognition process takes a long time if the documents are not complete or the human resources in the authorities do not allow a quick check,” says Lundershausen.
“It’s often not the fault of the authorities, for example when documents are subsequently submitted,” says Dörfler. She thinks: Everything could be simpler. Today, applicants must first have their documents checked for equivalence in Germany. But for around three out of four applicants, the certificates are not sufficient. You have to take a personal doctor’s exam, the knowledge test.
Dörfler suggests that those affected should be able to choose in advance whether they want to have their documents checked. If there is no chance of success, you should be able to concentrate on the knowledge test straight away. Dörfler promotes the idea: “It would save a lot of administrative work.”
Demands and criticism – an outlook
The experts agree: the cooperation between the authorities can be expanded, says Medical Association Vice President Lundershausen. Seidel: “It would be important to reduce bureaucratic hurdles – in contrast to the linguistic and technical requirements that simply have to be met.” But are the professional qualifications for use on patients always given?
“We are dealing with a very heterogeneous field of applicants,” warns the head of the Institute for Training and Student Affairs at the Medical Faculty in Münster, Bernhard Marschall. “It’s very rare for someone to have very experienced experience.” Thorough recognition procedures are essential to protect patients.
Federal Health Minister Karl Lauterbach (SPD) admitted at the Doctors’ Day in May that not enough doctors had been trained in this country for years, partly for reasons of savings. Instead, Germany is bringing more and more foreign doctors into the country. “This is not ethical and cannot continue.”
Marschall also points out another imbalance: Due to the uneven distribution of the 428,000 doctors in Germany, foreign doctors often end up in structurally weak regions. Where work and life seem less attractive to the doctors trained here – and patients may already feel left behind.