You have the FSP certificate, the official German exam for your profession. A good day, and a step along the way: the licence to practise comes from the state authority, not from the medical chamber. Here you read what happens to your file now, when the knowledge test appears and which German is used in the first weeks on the ward.
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What your certificate proves
The FSP proves that you act safely in German in hospital work: the history taking with the patient, the case presentation in the team and the written doctor’s letter. The level is C1 in professional language and B2 in general German. The certificate counts as your language proof for the recognition procedure across Germany.
Your medical knowledge is looked at separately. That is what the knowledge test (Kenntnisprüfung) is for, and it appears only when the authority sees differences between your training and the German degree.
Hear how this sounds: Trial lesson in medicine, free →
The file: what goes to the authority now
The licensing authority of your federal state decides (Approbationsbehörde): depending on the state a state examination office, a regional council, a district government or a state directorate. It keeps the file; the chamber only ran your language exam.
The file usually holds:
- your FSP certificate and your general German proof at B2,
- your degree and the record of subjects or hours, certified and translated,
- your professional experience and references,
- a certificate of good conduct and a medical statement of fitness,
- for a degree from outside the European Union, the papers for the equivalence comparison.
Processing time depends on the state and on how your file arrives. Two things shorten it: complete papers in exactly the required form, and a quick answer when the authority asks for something. If you want to work while you wait, the temporary licence (Berufserlaubnis) is the step in between: it allows medical work for a limited time and under supervision, usually tied to one post and one state.
If the authority sees differences: the knowledge test
When the decision names differences, the knowledge test follows. It examines medical knowledge at the level of the third German state examination, orally and practically, with a patient case and questions from internal medicine, surgery and the cross-sectional subjects. Many states add emergency medicine, pharmacology, medical law and hygiene.
Two notes that save your timetable: the date is applied for as soon as the decision arrives, and waiting times differ clearly from state to state. And the test runs in German, close to daily ward work: whoever passed the FSP brings the language along and now trains mainly structure and content.
Since 1 November 2026 the knowledge test is the usual route for degrees from outside the European Union. Count it into your plan from the start.
From the decision to the contract
With the licence or the temporary licence you apply like your German colleagues. Three things count in the interview: your field, your experience and how you talk to patients. Expect a short practical part, for example a case presentation, and questions about shifts and specialist training.
The contract usually follows a collective agreement: in municipal hospitals the TV-Ärzte/VKA, in university hospitals the TV-Ärzte/TdL. It sets the pay group, the steps by years of practice, on-call duty and allowances. Specialist training starts with the licence, and time worked under the temporary licence is often credited when the department holds training authorisation: ask about it in the interview and ask in writing.
Your German in the first weeks
On the ward language turns into work. These are the moments where it counts:
- The round: say in two sentences what changed since yesterday, and name the plan.
- Informed consent: explain the procedure, the benefit and the risks so that the patient can decide.
- Handover and phone: short, structured, with figures and units.
- Documentation: doctor’s letter and progress note, factual and complete.
Whoever practises these four situations settles into the department faster. That is what the professional language course is built for: real cases, feedback on your sentences and immediate correction.
Keep reading
These articles continue the same path:
- Berufserlaubnis or Approbation: What You Can Work With, and When
- Working as a Doctor in Germany: What Changes Compared to Your Country
- The Fachsprachprüfung Explained: Format, Parts and What Is Assessed
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