Those who have obtained a qualification in a regulated healthcare profession abroad must demonstrate, as part of the recognition procedure, that their training is comparable to the German standard. One way to provide this proof is the equivalency assessment – a document-based administrative procedure in which the competent authority compares the foreign training with the German reference profession in terms of content. This is not an exam in the conventional sense but an official evaluation based on the documents submitted.

Target group

For professionals with qualifications from EU and EEA member states as well as Switzerland, the equivalency assessment is the standard route to the Approbation. For professionals with qualifications from third countries, the procedure has been available only in exceptional cases since the Bundestag resolution of March 2026. For them, the standard route leads directly through the knowledge exam. Those who nonetheless wish to apply for an equivalency assessment should carefully weigh the time and documentation effort involved (As of 2026).

What is assessed?

Based on the documents submitted, the authority assesses whether the training completed abroad corresponds to German training in terms of content and structure. The following documents are reviewed:

• Individualized curriculum with a breakdown of content, in the original with a certified German translation: the translation must be produced by a publicly appointed or sworn translator in Germany. Original documents in English may in individual cases be accepted without translation – whether this is possible is at the discretion of the competent recognition authority.
• Other proof of qualification, where required to establish equivalency: for example, evidence of professional experience including the type and duration of medical activities, proof of completed internships, etc.
• Evidence of the practical phase: For example internship, internatura, residency, and where applicable a logbook or curriculum.

Equivalency assessment by profession

The procedure applies in principle to all regulated academic healthcare professions as well as nursing professions, but is handled by different bodies and under different legal frameworks depending on the profession:

• Medicine: Federal Medical Practitioners Act (BÄO) in conjunction with the Medical Licensing Regulations (ÄApprO)
  
• Dentistry: Act on the Practice of Dentistry (ZHG) with the corresponding licensing regulations
• Pharmacy: Federal Pharmacists Act (BApO) with the Pharmacy Licensing Regulations (AAppO)
  
• Nursing: Nursing Professions Act (PflBG); the relevant state authorities are responsible, such as state offices for nursing or regional government bodies

The procedure is administered by the respective state authorities – generally regional government offices, state health authorities, or equivalent bodies – depending on the federal state and profession.

Language requirements

Regardless of the outcome of the equivalency assessment, German language skills at two levels are required for the granting of the Approbation: general language skills at a minimum of B2 level under the Common European Framework of Reference for Languages (CEFR), and job-related professional language skills demonstrated by passing the professional language exam. The B2 certificate must be submitted at the time of application. The professional language exam may, depending on the federal state, be taken at a later point in the process. Detailed information on the professional language exam can be found here.

Application submission

The application for the Approbation – and with it the initiation of the equivalency assessment – is submitted to the competent authority of the federal state where professional practice is to be taken up. For qualifications from third countries, the application must explicitly state whether a document-based equivalency assessment or the knowledge exam is being chosen; an individualized study plan is only required in the former case.
The following documents are required for the application. All documents that are not in German must be translated by a publicly appointed or sworn translator in Germany and, where required, accompanied by an apostille or legalization. Requirements regarding translations, certifications, and apostilles or legalizations may vary by federal state and competent authority. The requirements of the competent recognition authority should therefore be carefully checked before submitting the application:

• Diploma with certified German translation
• Individualized curriculum from the applicant’s university, in the original with certified German translation
• Proof of qualification: professional experience, internships, etc.
• Proof of practical phase: internships during training, internatura, residency
• Cost coverage declaration: a written statement confirming that the costs of the external assessment will be borne by the applicant – required only for the document-based equivalency assessment
• Health certificate

Incomplete or formally defective documents can delay the processing of the application and result in requests for additional documentation. Unless the application is rejected outright due to incomplete documents, any requested documents must be submitted within the set deadline. Otherwise the application may in individual cases also be rejected. Early coordination with the competent recognition authority is therefore recommended.

Processing time and fees

The equivalency assessment generally takes several weeks to months, depending on the authority, the volume of documents, and the complexity of the qualification. The overall process up until the granting of the Approbation can take considerably longer for foreign qualifications. Submitting all documents completely and in a structured manner at the time of application reduces follow-up queries and delays. The costs for the equivalency assessment can currently amount to up to 2,500 euros (as of 2026) – in individual cases even more. These must be paid by the applicant.

Possible outcomes

The equivalency assessment can lead to three possible outcomes:

• Full equivalency: The foreign qualification corresponds to the German reference profession. No further exam is required.
• Partial equivalency: The equivalent parts of the training are certified, but minor differences exist that can be addressed through professional practice or courses. Alternatively, a knowledge exam can be taken to demonstrate equivalency.
• No equivalency: Significant differences between the foreign and German training are identified. Equivalency can only be demonstrated by passing the knowledge exam.

Further information on the knowledge examination can be found here.

Adaptation measures

Where gaps are identified in the equivalency assessment, there are different ways to address them depending on the profession. In academic healthcare professions such as medicine, dentistry, or pharmacy, the identified gaps are specifically named in the certificate; the professional then clarifies with the competent authority or chamber through which measures – such as further training or practical work under a temporary professional license – these can be addressed. In nursing, identified gaps are addressed through an adaptation course comprising a theoretical and a practical component. Once all measures have been successfully completed and the relevant proof submitted, nothing stands in the way of full recognition.