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How are foreign doctors faring in Germany?

April 27, 2024

Germany is welcoming an increasing number of foreign doctors, which the country needs. But how rewarding is it for doctors to work in the German health care system, and what challenges do they face?

A young doctor stands beside an elderly patient in the hallway of a hospital.
Germany's healthcare system faces a dual challenge due to its aging population: There's a growing demand for closer medical attention for the elderly, while doctors are retiring without adequate replacements.Image: Andreas Arnold/dpa/picture alliance

Germany is emerging as a favored destination for migrating doctors, a boon for a nation grappling with a shortage of healthcare workers.

The number of foreign doctors in Germany has surged. According to the German Medical Association, approximately 60,000 doctors without German citizenship currently work in the country, about 12% of the medical workforce.

The majority of foreign-born doctors in Germany originate from other European countries or Middle Eastern nations, with the largest group coming from Syria.

Doctors who relocate to Germany must undergo a rigorous approbation procedure to receive a medical license before they can start working at a hospital. This includes two exams to demonstrate proficiency in general and professional German language skills.

Many believe that the process is so demanding that doctors wanting to work in Germany need more support. Otherwise, the German healthcare system could suffer.

Jürgen Hoffart, general manager of the Rhineland-Palatinate State Medical Association, told DW that doctors shouldn't be treated as cheap labor, but should be integrated into the system as quickly and effectively as possible.

Why is there a shortage of doctors in Germany?

International health organizations have warned that medical staff shortages are so acute worldwide that access to nearby professionals could soon become a luxury in many countries. This is particularly acute in low-income nations, many of which do not reach the World Health Organization's recommended ratio of one doctor per 1,000 people.

According to federal data, Germany has 4.53 practicing doctors per 1,000 and accounts for 30% of the 1.82 million doctors in Europe. That leaves the nation with enough doctors, but their number is rapidly declining.

Like its fellow European Union members, Germany will soon face a major shortage of medical staff, an issue compounded by an aging population that requires more medical attention. Retiring doctors are not being replaced at the necessary rate, an additional strain on healthcare professionals, particularly in the public sector.

As of 2023, 41% of practicing doctors in Germany were over 60 years old, as were 28% of specialists. Over the next three years, an estimated 5,000 to 8,000 doctor's practices are expected to close, largely due to retirements.

Since there are not enough graduates to replace retiring doctors, recruiting doctors from abroad is the only short-term solution if the healthcare system is to continue functioning at the same standard it currently enjoys.

How are foreign doctors faring in Germany?

"In Germany, all medical professionals, including non-native ones, are trusted and valued," said Fabri Beqa, who has worked in Germany for more than 18 years. "Foreign doctors, in my experience, are motivated people who are willing to learn and deal with the challenges of working in another country's health system."

"Germany's healthcare infrastructure is significantly better funded than many other countries, including Kosovo, my home country," he added. "For a medical professional, this translates to working with more advanced tools and benefiting from high-quality professional development."

He pointed out that "foreign doctors often have to work in emergency rooms or have hospital-based roles, where the workload is comparatively higher."

However, he said this was worth it because of the good work-life balance: "You earn enough and have sufficient time to enjoy life."

Beqa said that, due to a lack of proper structural support, foreign doctors need to put more effort into their career development than their German peers.

For example, establishing their own clinic or medical practice takes significantly longer for foreign practitioners than their native counterparts, primarily due to a pitfall in German laws.

"Germany only recognizes the basic medical training, so if a specialist wants to practice in Germany, they need to undergo specialization training again," Beqa said, emphasizing that this entails investing additional years of study.

How big is the language barrier for foreign doctors?

Hoffart said there were sometimes complaints from patients who said they did not always understand non-native doctors.

"Time and again, I receive patient calls with the question: 'Can you tell me a hospital where the doctors speak proper German?'" he said, suggesting that sometimes the criticism of somebody's language skills might be justified. "I repeatedly receive medical reports that are at least partly very difficult to understand."

He said foreign doctors had to take language tests during the approbation process focused on standard German, but this did not help people understand local dialects or accents.

A 2016 Ludwig Maximilian University of Munich study found that many migrant physicians struggled with German language problems and a lack of knowledge regarding culture and the clinical system in Germany. Another study published by the University of Basel in 2022, which surveyed two large university hospitals in Germany, showed that many migrant healthcare professionals, including nurses and physicians, experienced discrimination related to language, nationality, race, and ethnicity.

Beqa hasn't observed any problems with the integration of doctors and their ability to learn German. "In my experience, most doctors pick up the language quickly," he said. "Besides, even if you speak German well, there are always patients who don't, so the language barrier isn’t just a problem for doctors."

Hoffart said one way to resolve communication problems would be for more established doctors in Germany to take better care of their new colleagues from abroad and give them detailed information about the specifics of the German system.

"If necessary, they can take additional language and communication courses," he advised.

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Edited by: David van Opdorp

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