Germany has become an increasingly popular destination for international medical graduates (IMGs) seeking residency training due to its world-class healthcare system, structured specialist training programs (Facharztausbildung), and the opportunity for a stable and well-paying career.
But not all German states are created equal when it comes to medical residency opportunities. Factors like availability of training positions, language requirements, cost of living, job market conditions, and bureaucratic efficiency can significantly vary across the 16 federal states (Bundesländer).
In this blog, we’ll explore the best German states for medical residency based on key criteria to help you make an informed decision.
🧩 Key Factors to Consider When Choosing a State
Before we list the best states, here are the main factors that affect where you might want to apply for residency:
| Factor | Why It Matters |
|---|---|
| 🏥 Number of hospitals and university clinics | More hospitals = more training positions available |
| 🌍 Urban vs. rural | Rural areas have a higher demand for doctors and faster job placement |
| 💶 Cost of living | Major cities like Munich are expensive; smaller cities offer affordable living |
| 📄 Processing time for Approbation | Some states have faster licensing processes |
| 🗣️ Language exam requirements | Varies by state: different rules for Fachsprachprüfung |
| 🤝 Support for international doctors | Mentorship, integration programs, and language help vary |
⭐ Best German States for Medical Residency
Based on these criteria, here are some of the top German states for medical residency:
1. Saxony (Sachsen)
Capital: Dresden
Why it’s good:
- High demand for doctors, especially in rural areas
- Quick and transparent Approbation process
- Lower cost of living
- Friendly to international doctors
- Multiple large hospitals in Dresden, Leipzig, and Chemnitz
Insider Tip: Hospitals in Leipzig and Dresden often accept international candidates and offer Hospitation (observership) opportunities to build experience.
2. Brandenburg
Capital: Potsdam
Why it’s good:
- One of the most underserved regions in Germany for doctors
- Great for those who prefer quieter cities or rural environments
- Often easier to get temporary licenses (Berufserlaubnis) while preparing for Approbation
- Close to Berlin — live in Berlin, work in Brandenburg
Insider Tip: Brandenburg is actively looking to internationalize its healthcare workforce.
3. Lower Saxony (Niedersachsen)
Capital: Hanover
Why it’s good:
- High number of district hospitals needing doctors
- Decent balance of urban and rural areas
- Faster processing times for Approbation in some regions
- Affordable housing and living
Insider Tip: Hospitals in cities like Oldenburg and Osnabrück are often looking for residency candidates in Internal Medicine and General Practice.
4. Mecklenburg-Western Pomerania (Mecklenburg-Vorpommern)
Capital: Schwerin
Why it’s good:
- One of the top choices for fast Approbation
- Lower competition due to rural geography
- State has active programs to recruit foreign doctors
- High chance of getting residency in popular specialties like Internal Medicine, Psychiatry, and Anesthesia
Insider Tip: While rural, this state has beautiful coastal areas and nature — great for those seeking work-life balance.
5. Thuringia (Thüringen)
Capital: Erfurt
Why it’s good:
- Affordable state with a good number of hospitals
- Willingness to train foreign medical graduates
- Lower bureaucracy and less competition
- Erfurt and Jena are emerging healthcare hubs
Insider Tip: Jena has one of the oldest universities in Germany with a strong medical faculty — and hospitals often open to international residents.
6. North Rhine-Westphalia (Nordrhein-Westfalen)
Capital: Düsseldorf
Why it’s good:
- Most populous state in Germany — many hospitals, many training positions
- Huge cities like Cologne, Düsseldorf, and Dortmund offer diverse options
- Numerous university hospitals and teaching centers
- Support programs for IMGs in some clinics
Caution: Competition is higher, and cost of living is higher in big cities.
7. Rhineland-Palatinate (Rheinland-Pfalz)
Capital: Mainz
Why it’s good:
- Reasonable processing time for Approbation
- Medium-sized cities with a good quality of life
- Open to foreign-trained doctors
- Less crowded than neighboring NRW and Hesse
Insider Tip: Specialty training in Family Medicine and Internal Medicine is particularly in demand.
🏙️ States to Approach With Caution
These states also offer excellent training and facilities but may pose challenges such as high living costs or bureaucratic delays:
| State | Challenges |
|---|---|
| Bavaria (Bayern) | Very competitive, long Approbation process, expensive cities like Munich |
| Berlin | High competition, bureaucracy can be slow |
| Hesse (Hessen) | Frankfurt and Wiesbaden are expensive, high competition |
| Hamburg | Limited positions compared to applicants, but good salaries |
| Baden-Württemberg | Strong system but very competitive and long wait times |
🏥 Popular Specialties Available Across States
No matter where you apply, the following specialties often have good availability and high acceptance rates for international doctors:
- Internal Medicine (Innere Medizin)
- General Medicine (Allgemeinmedizin)
- Psychiatry (Psychiatrie)
- Neurology (Neurologie)
- Surgery (Chirurgie)
- Anesthesia (Anästhesiologie)
More competitive specialties include Dermatology, Radiology, and Ophthalmology.
📋 Final Tips Before Choosing a State
- ✅ Apply to multiple states to increase your chances
- ✅ Look for hospitals in rural areas — less competition, more open positions
- ✅ Prepare well for Fachsprachprüfung and Kenntnisprüfung if required
- ✅ Don’t just focus on cities — small towns can offer quicker job placements and better training environments
- ✅ Reach out to Hospitals’ HR departments directly for Hospitation opportunities
🧭 Conclusion
Choosing the right German state for your medical residency is one of the most important decisions in your medical career. While urban areas like Berlin or Munich are attractive, rural and mid-sized states like Saxony, Brandenburg, and Thuringia often offer faster processing, more support, and less competition — making them ideal for international medical graduates.
No matter where you apply, be prepared with strong German language skills (B2–C1), certified documents, and patience to navigate the process.