If you are an international doctor planning to work in Germany, two terms will appear again and again: Approbation and Berufserlaubnis. They are both medical licences, but they are not interchangeable.
The short version is simple: Approbation is the full, unrestricted medical licence. A Berufserlaubnis is a temporary and restricted permission to practise medicine. Which one you can obtain first depends on your training, your recognition process and the rules of the federal state where you apply.
I went through this process in Germany myself, and one of the most confusing parts at the beginning was understanding what each licence actually allows you to do. This guide explains the difference in practical terms and points you toward the official German authorities you should always verify before applying.
Berufserlaubnis vs Approbation: the quick comparison
| Feature | Berufserlaubnis | Approbation |
|---|---|---|
| Type of licence | Temporary and restricted | Full and unrestricted |
| Validity | Time-limited | Unlimited in duration |
| Where it applies | Usually limited to one federal state and sometimes a specific workplace | Valid throughout Germany |
| Purpose | Allows temporary medical work while full recognition is still being completed | Final licence to practise medicine in Germany |
| Issued by | Competent state licensing authority | Competent state licensing authority |
The BundesÀrztekammer states that medical practice in Germany requires either a valid Approbation or Berufserlaubnis. Approbation is unlimited and valid throughout Germany, while Berufserlaubnis is time-limited and restricted to a federal state and, in some cases, a specific workplace.
What is Approbation?
Approbation is the full state licence to practise medicine in Germany. It is the licence most international doctors ultimately need if they want to build a long-term medical career in the country.
Once you have Approbation, the licence itself is not tied to a particular employer or one federal state. According to the official German recognition portal, Approbation is the unrestricted authorisation to practise medicine and is required for full professional recognition as a physician.
You can read the official overview on the German government’s Recognition in Germany portal.
Typical requirements for Approbation
The exact document list and process depend on where you trained and which federal state is responsible for your application, but the authorities generally assess:
- your medical qualification and whether it is equivalent to German medical training;
- your German language skills;
- your personal reliability;
- your medical fitness;
- and, where applicable, whether you need an additional knowledge examination.
For many applicants, German language requirements include general German at approximately B2 level plus proof of medical-language competence. The exact proof accepted and the sequence of examinations can vary by state, so always check the responsible authority directly.
What is a Berufserlaubnis?
A Berufserlaubnis is a temporary authorisation to practise medicine. It is not simply a âsmaller Approbationâ; it is a different legal instrument designed for limited medical practice under specific conditions.
The BundesÀrztekammer explains that a Berufserlaubnis can be limited in time, to a particular federal state and sometimes to certain activities or workplaces. Older federal guidance also notes that it may be granted for a maximum period of up to two years under the relevant legal framework, although the practical details should always be confirmed with the competent authority.
For many non-EU doctors, the Berufserlaubnis can be useful because it may allow clinical work while the path toward full Approbation is still being completed. But whether it is available to you, and under which conditions, is a state-specific question.
EU/EEA/Swiss qualification vs non-EU qualification
If you trained in the EU, EEA or Switzerland
For many medical qualifications from the EU, EEA or Switzerland, recognition can be more straightforward because European rules may allow automatic recognition when the qualification meets the relevant requirements. You still need to satisfy the German licensing authority’s requirements, including language and personal/health suitability requirements.
Many EU-trained doctors therefore move directly toward Approbation rather than relying on a temporary Berufserlaubnis.
If you trained outside the EU, EEA or Switzerland
If you obtained your medical degree in a third country, the competent authority examines whether your education is equivalent to German medical training. Professional experience and additional qualifications may be considered during this assessment.
If substantial differences remain and cannot be compensated for, you may need to pass the KenntnisprĂŒfung before Approbation is granted. The exact path depends on the assessment made by the state authority.
The BundesĂ€rztekammer’s recognition guidance for non-EU qualifications is a useful official starting point.
Where do you apply?
Germany does not have one single national Approbation office. Applications are handled by the competent authority in the federal state where you intend to work.
This matters more than many international doctors realise. Processing times, document requirements, language procedures and the practical availability of a Berufserlaubnis can differ from one state to another.
Before sending documents, identify the responsible authority for your intended federal state and use that authority’s current checklist. The BundesĂ€rztekammer maintains a list of the relevant licensing authorities.
Can you apply from outside Germany?
In many cases, yes. You do not necessarily need to be physically living in Germany before starting the recognition procedure. However, the authority may ask you to show a credible intention to work in its area of responsibility.
That is one reason it can help to have a clear target state, applications to hospitals, interview invitations or another concrete connection to the region where you are applying.
Do you need the FachsprachprĂŒfung before a Berufserlaubnis?
This is one of the questions where you should be especially careful with general internet advice. The answer can depend on the federal state and the current local procedure.
Some authorities require proof of medical-language competence before they will issue a temporary licence. Others structure the sequence differently. Because these procedures change, check the official state authority rather than relying only on old forum posts or blog articles.
If you are preparing for medical German, see my guide on preparing for the FachsprachprĂŒfung without expensive courses.
Can time worked with a Berufserlaubnis count toward specialist training?
Potentially, but do not assume that every month automatically counts toward your Facharztausbildung.
Specialist training is governed by the responsible LandesÀrztekammer, and the rules can differ between chambers. Before accepting a position, ask the relevant medical chamber whether your work under a Berufserlaubnis will be recognised toward specialist training and under what conditions.
This point is important because a job can be legally possible without every period necessarily being credited toward your final specialist qualification.
How long does the process take?
There is no single realistic timeline for all of Germany. Your waiting time depends on the federal state, the completeness of your documents, the need for an equivalence assessment, language examinations and whether a KenntnisprĂŒfung is required.
In practice, international doctors should plan for delays. Use the waiting period strategically: improve your medical German, prepare applications, organise documents and, where possible, consider a Hospitation in Germany to understand the hospital system and build contacts.
What I would do if I were starting again
If I were starting the process today, I would not begin by collecting random documents from internet checklists. I would first choose the federal state where I genuinely want to work and download the current checklist from the responsible authority.
Then I would build the process around that exact checklist: translations, certifications, language documents, proof of professional standing and any state-specific requirements.
I would also start medical German much earlier than I thought necessary. The bureaucracy is frustrating, but language is usually the part that has the biggest effect on how confident you feel once you enter a German hospital.
If you are still deciding whether Germany is right for you, read Things Every Doctor Should Know Before Coming to Germany.
Frequently asked questions
Is Berufserlaubnis the same as Approbation?
No. Approbation is the full, unrestricted medical licence. Berufserlaubnis is temporary and can be restricted by time, federal state, workplace or permitted activity.
Is Approbation valid throughout Germany?
Yes. The BundesÀrztekammer states that Approbation is valid throughout Germany and has unlimited duration.
Can I work as a doctor in Germany with a Berufserlaubnis?
Yes, if the Berufserlaubnis issued to you permits the specific medical activity and you stay within its restrictions. The exact conditions are written in the licence and depend on the authority that issued it.
Do all foreign doctors need the KenntnisprĂŒfung?
No. Whether you need a KenntnisprĂŒfung depends on how the competent authority evaluates your medical qualification and whether substantial differences remain.
Can I apply for Approbation regardless of nationality?
Yes. The BundesÀrztekammer notes that Approbation can be applied for regardless of nationality. What matters is whether you meet the professional and legal requirements.
Bottom line
Think of Approbation as the destination and Berufserlaubnis as a possible temporary step on the way there. The temporary licence can be extremely useful, but it comes with restrictions and its value depends heavily on the rules of the federal state where you apply.
The most important practical advice is simple: choose your target state early, use official information from that state’s licensing authority, and treat blogs and forums â including this website â as practical guidance rather than a substitute for the authority’s current rules.
Last reviewed: September 2026. Licensing procedures can change and differ between German federal states. Always verify requirements with the competent Approbationsbehörde and LandesÀrztekammer.