Can Indian Doctors Work in Germany After MBBS? Approbation Guide (2026)

Last reviewed: 5 October 2026 · Researched by the Welcare Overseas team (Bengaluru) against official German sources · How we research

This guide is for MBBS graduates from India and for Indian students who completed MBBS in Russia, Georgia, the Philippines, Kazakhstan or another non-EU country. It explains the licences, the order of the steps, the exams, the documents, the costs and the visa options. It also covers what tends to go wrong. The rules come from the German Federal Medical Code (Bundesärzteordnung, BÄO) and the Medical Licensure Regulations (ÄApprO). The states (Bundesländer) apply those rules, so details such as fees and processing times differ between states.

The two licences: Berufserlaubnis and Approbation

Nobody may treat patients in Germany without a licence from the state authority, however much experience they have. For doctors with a degree from outside the EU, there are two licences.

Think of the Berufserlaubnis as a bridge. It lets you earn a salary and get used to German hospitals while you prepare for the knowledge test. It is not a long-term licence, and the authority expects you to apply for the Approbation while you hold it.

Step by step: from MBBS to Approbation

Step 1: Learn German to B2 (general)

Everything in the German system happens in German: patient talks, ward rounds, discharge letters, the exams. Most states ask for a general German certificate at B2 level from a recognised provider such as Goethe-Institut, telc or ÖSD before they process the medical side. From zero, reaching B2 takes most full-time learners 8 to 12 months. Doctors who study part-time alongside a job usually need longer.

Step 2: Collect, attest and translate your documents

Requirements vary slightly by state, but almost every authority asks for the same core file:

• Passport and, if your name changed, marriage certificate
• Birth certificate
• CV in German, signed and dated
• MBBS degree certificate
• Full transcript or mark sheets showing subjects and teaching hours. The hours matter because they are what the authority compares with the German curriculum.
• Internship (CRMI) completion certificate
• Proof that you are licensed to practise in India, such as State Medical Council or NMC registration, and a Certificate of Good Standing. Most authorities want the good-standing letter to be no more than three months old when you submit it.
• Police clearance certificate (usually no older than three months)
• Medical certificate of fitness to practise (usually no older than three months)
• B2 German certificate
• Proof that you intend to work in that state, such as a job offer, interview invitation or a short statement. Some states ask for this.

Indian documents normally need an apostille from the Ministry of External Affairs. German translations must be made by a sworn (publicly appointed) translator. Ask your chosen authority for its own checklist before you pay for translations, because some want certified copies and others accept scans first.

Step 3: Choose a state and submit your application

You apply to the authority of the state where you want to work. The name differs: a Landesprüfungsamt in some states, a Bezirksregierung or Regierungspräsidium in others. The official portal Anerkennung in Deutschland has a “Recognition Finder” that tells you exactly which office is responsible for “Arzt/Ärztin” in each state. You can apply from India. You do not need to be in Germany yet.

Step 4: Equivalence check, or go straight to the knowledge test

The authority compares your training with German medical training. This can be done as a document review (Gleichwertigkeitsprüfung), sometimes with an external expert report. For third-country degrees the review usually finds “substantial differences” or cannot be completed from paper alone. Many applicants therefore choose to waive the document review and take the Kenntnisprüfung directly, which most authorities allow. The document review can take months and often ends in “you need to take the knowledge test” anyway, so going straight to the test usually saves time.

Step 5: Pass the Fachsprachprüfung (medical German, C1)

The Fachsprachprüfung (FSP) is run by the state medical chamber (Landesärztekammer) or on its behalf. It checks whether you can handle medical German safely. You take a history from a simulated patient, write a short medical document such as a discharge-style report, and present the case to a doctor-examiner. It is pitched at C1 level for medical language. Fees are set by each chamber and are typically several hundred euros. A general C1 certificate does not replace it. We explain the format in our guide to the Fachsprachprüfung.

Step 6: Get a Berufserlaubnis and a job (optional, but common)

With B2 and the FSP, many states will grant a Berufserlaubnis if you have a job offer. Hospitals in smaller towns and in eastern and rural regions are often more willing to hire doctors at this stage. You work as an assistant doctor (Assistenzarzt) under supervision, earn a regular salary and prepare for the knowledge test in parallel.

Step 7: Pass the Kenntnisprüfung

The knowledge test is an oral-practical exam with a real or simulated patient. Under § 37 ÄApprO it focuses on internal medicine and surgery, and the authority can add further subjects or cross-cutting topics such as emergency medicine, clinical pharmacology, radiation protection and the legal rules of medical practice. Each candidate is examined for at least 60 and no more than 90 minutes, usually in a small group with a commission of doctors. You may retake it twice, so you get three attempts in total. Candidates who prepare with structured case practice in German, not only textbook revision, pass at much higher rates.

Step 8: Receive the Approbation

Once you pass, you send the result with up-to-date fitness and police documents, and the authority issues the Approbation. You can now work anywhere in Germany without supervision and start, or fully count, specialist training.

Step 9: Specialist training (Facharzt)

The Indian MD/MS is not converted. Specialist training in Germany is a paid job, called Weiterbildung, in an accredited department, under the rules of the regional medical chamber. Most specialities take 5 to 6 years and end with a specialist exam at the chamber. This is the “Medical PG in Germany” most Indian doctors mean. There is no entrance exam like NEET-PG; you apply for posts like any other job.

How long it really takes

The single biggest factor is how fast you reach usable German. Doctors who arrive with B2 and spend a few months on medical German before the FSP tend to finish in under two years. Doctors who try to work through B2 while preparing for the knowledge test usually take three.

What it costs

Germany does not charge tuition for the recognition process or specialist training, but the route is not free. Fees are set state by state, so treat the figures below as a planning range, not a quote.

Which visa fits which stage

• Recognition visa (§ 16d Residence Act). This is for people whose recognition decision says they need a compensation measure, or who want to prepare for and sit an exam such as the Kenntnisprüfung in Germany. It is usually issued for up to 24 months, can be extended by up to 12 months (three years in total), and allows side work of up to 20 hours a week. Supervised work as a doctor on a Berufserlaubnis can be part of the measure.
• Employment residence permit or EU Blue Card. This applies once you hold a Berufserlaubnis or Approbation and a job contract. Doctors’ salaries in public hospitals are above the Blue Card thresholds.
• Opportunity Card (Chancenkarte). This lets you come to look for work. It does not give you a licence to practise, so you cannot work as a doctor on it until you hold a Berufserlaubnis or Approbation.

Visa rules change more often than licensing rules. Check the current conditions on the German Missions in India website before you book appointments.

What residents earn

Most hospital doctors are paid under a collective agreement. The best-known is TV-Ärzte/VKA for municipal hospitals. From 1 June 2026 a first-year resident in pay group Ä1 earns €5,722.05 gross per month, rising to €7,355.29 in the sixth year and beyond. Night and weekend duty is paid on top. A specialist (Ä2) starts at €8,185.40. Other employers, such as university hospitals and private chains, have their own tables at a similar level. Our resident salary guide has the full table, and this comparison of German states for residency explains where it is easier to get a first post.

A realistic example: one Indian graduate’s route

To make the steps concrete, here is a typical path. It is a composite of common cases, not a promise.

The months that stretch are almost always months 0 to 10 (language) and the wait for exam dates. Everything else is paperwork you can plan around.

Choosing a state

All states apply the same federal law, but they differ in practice. When you compare, look at:

• Waiting times for the FSP and Kenntnisprüfung. Some states have long queues for exam dates. Others schedule faster. Ask the authority or the chamber directly, or ask doctors already working there.
• Whether a Berufserlaubnis is granted easily. Some authorities are open to it with a job offer. Others push applicants straight to the knowledge test.
• Where the jobs are. Large cities get many applications. Hospitals in eastern states and rural western regions often hire international doctors faster.
• Cost of living. Rent in Munich or Frankfurt can take a large share of a first-year resident’s net pay. The same salary goes much further in Saxony-Anhalt or Thuringia.

Once you hold the Approbation it is valid in every state, so your first state does not have to be your last.

Preparing for the FSP and the knowledge test: what actually works

• Practise the patient history aloud, every day. The FSP rewards a structured history (Anamnese) in clear German more than rare vocabulary. Record yourself and compare with model histories.
• Write short reports under time pressure. The written part catches many candidates who speak well but write slowly.
• For the Kenntnisprüfung, revise German guidelines, not Indian textbooks. Examiners expect German standards of care, current guidelines and German drug names, for example for emergency management, anticoagulation and common internal-medicine cases.
• Study in a group. Doctors who prepare with others in the same state learn what that state’s examiners tend to ask.
• Use hospital time. If you hold a Berufserlaubnis, ward rounds and discharge letters are the best FSP and KP practice there is.

Your pre-application checklist

• B2 certificate (or exam date booked)
• Transcript with teaching hours per subject
• Internship certificate with departments and dates
• Council registration and a good-standing certificate (recent)
• Police clearance and medical certificate (timed to be under three months old at submission)
• Apostilles and sworn translations, in the format your chosen state accepts
• Signed CV in German
• Decision made: document review or Kenntnisprüfung directly

Questions Indian graduates ask most

Do I need NEET-PG, FMGE or USMLE for Germany?

No. Germany has its own system. NEET-PG and FMGE are Indian requirements and are not part of German licensing. If you studied MBBS outside India, Germany assesses that degree directly. You will usually need proof that you are, or could be, licensed to practise in the country where you studied, so check this early.

Does my internship count?

The authority looks at your whole training, internship included, when it compares your degree with German studies. Make sure your internship certificate lists the departments and dates.

Is an MD/MS from India recognised as specialist training?

Not automatically. Some chambers credit part of documented specialist training abroad, decided case by case and only after you have the Approbation. Most Indian MD/MS holders still complete German specialist training, sometimes in a shortened form.

Is there an age limit?

There is no legal age limit for the Approbation. Practically, the language effort and 5 to 6 years of residency matter more than age.

Common mistakes that cost months

• Starting the paperwork before the German. Your certificates and police clearance expire after about three months for submission purposes. If you collect them too early you pay twice.
• Translating everything before you have chosen a state. Some authorities accept documents others do not. Choose the state first, then translate.
• Underestimating the FSP. Doctors who are fluent in daily German still fail if they have not practised patient history and medical documentation under time pressure.
• Treating the Berufserlaubnis as permanent. It runs out. Book your knowledge test as soon as you are allowed to.
• Trusting “guaranteed residency” offers. No agency can guarantee a licence or a post. The authority and the hospital decide.

Official sources

• Federal Medical Code, Bundesärzteordnung (BÄO): gesetze-im-internet.de/b_o
• Medical Licensure Regulations, § 37 Kenntnisprüfung: gesetze-im-internet.de/_appro_2002/__37.html
• Recognition Finder for doctors, Federal Institute for Vocational Education and Training (BIBB): anerkennung-in-deutschland.de
• Residence Act § 16d (recognition measures): gesetze-im-internet.de/aufenthg_2004/__16d.html
• DAAD India, options after MBBS: daad.in
• Make it in Germany, the federal government portal for doctors: make-it-in-germany.com
• TV-Ärzte/VKA pay table valid from 1 June 2026: haufe.de