From the recognition certificate to the Approbation, international healthcare professionals pass through several successive stages: from the knowledge exam or equivalency assessment, through the professional language exam, to the provisional license. This article provides an overview of the entire professional recognition process in Germany.

The knowledge exam as the standard pathway

A resolution passed by the Bundestag on March 26, 2026 introduces a fundamental reform of the recognition framework for regulated healthcare professions. The knowledge exam becomes the standard pathway for professionals with qualifications from third countries – that is, outside the EU, the European Economic Area (EEA), and Switzerland. This applies to physicians, dentists, pharmacists, and midwives. It is explicitly a professional licensing exam that applies uniform standards to all candidates and is not limited to individual gaps identified in the recognition certificate. The previous document-based equivalency assessment will only be available in exceptional cases going forward. For qualifications from EU and EEA member states as well as Switzerland, existing EU legal provisions continue to apply. The new rules take effect on November 1, 2026, following approval by the Bundesrat. As the details are still being specified by individual federal states, it is advisable to check current requirements directly with the relevant recognition authority.

Pathways to Approbation

The starting point for all further steps is the recognition certificate issued by the competent authority, which documents the outcome of the comparison between the foreign qualification and the German reference profession. Depending on the qualification and country of origin, two pathways to Approbation are available.
The equivalency assessment is the standard route for professionals with qualifications from EU and EEA member states as well as Switzerland. If the training is assessed as equivalent, no further proof of professional competence is required.

The knowledge exam is an oral and practical professional examination administered by the competent state authorities or medical associations.

Switching federal state during the recognition process

Although the recognition application is submitted in a specific federal state, changing place of residence or federal state during the process is generally possible. Changing before the professional language exam involves considerably more administrative and financial effort than doing so afterward. Having a language certificate already in hand significantly eases the transition. Further information on changing federal state can be found here.

The professional language exam

Regardless of which pathway to Approbation is chosen, the professional language exam is mandatory for almost all international healthcare professionals. It is administered by the state medical associations and assesses whether subject-specific communication is at the C1 level required for professional practice. General German language skills at B2 level are a prerequisite for admission. Detailed information on registration and all further formalities relating to the professional language exam can be found here.

The temporary professional license

Those already living in Germany and preparing for the examinations can apply for a professional license in the meantime. It permits the temporary practice of the profession under supervision, making it possible to gain practical experience in the German healthcare system before the Approbation is granted. The temporary professional license is not a substitute for the Approbation but a time-limited intermediate step. Detailed information on the provisional license can be found here.

The work permit

After successfully completing the recognition process, one formal step often remains: the visa used during the process does not automatically grant full authorization to work. In order to work as a healthcare professional in Germany, a change of status and an application for a work permit is therefore generally required – the final step on the path to full professional practice in Germany.