German medical licence (Approbation) for doctors from India and Pakistan: steps, documents, exams, costs
If you studied medicine in India or Pakistan – for example an MBBS – and want to work as a doctor in Germany, you need a German licence to practise. For the procedure, India and Pakistan are third countries (outside the EU, the EEA and Switzerland). This page walks you through the route, explains why the apostille does not help for documents from India and Pakistan, and lists fees, visa rules and resident pay – each with an official source.
The route to the Approbation, step by step
- Check which rules apply to you. What counts is where you obtained your degree and when you apply. Applications submitted by 31 October 2026 are processed under the old rules: the authority first assesses equivalence based on your documents. For applications from 1 November 2026 with a third-country degree, the Kenntnisprüfung is the standard route (§ 9d BÄO, new version); the document-based equivalence assessment only takes place if you choose it within four weeks of applying – the choice is binding. Details: recognition reform from 1 November 2026. Sources: BGBl. 2026 I No. 225 · BMG FAQ
- Choose a federal state and apply to its licensing authority. You submit the application for the Approbation to the authority of the state where you want to work; the federal Recognition Finder shows which authority that is. If you still live abroad, the Service Center for Professional Recognition (ZSBA) advises and supports you during the procedure. Authorities, forms and fees for each state: state pages (in German).
- German: B2 and the Fachsprachprüfung. According to the key points of the 2014 Health Ministers’ Conference, you usually need general German at B2 plus a Fachsprachprüfung (FSP) oriented to C1, usually at the state medical association. According to the Federal Ministry of Health, the states may in future check the language skills of applicants with a third-country degree even before the professional qualification. Sources: GMK 2014 · BMG FAQ
- The Kenntnisprüfung. An oral-practical exam with a patient presentation on one day, 60 to 90 minutes per candidate, in German, before a state examination board. It covers internal medicine and surgery, with aspects such as emergency medicine, clinical pharmacology, imaging, radiation protection and legal questions; it can be repeated twice (§ 37 ÄApprO). Frequently reported topics: Kenntnisprüfung topics. Source: § 37 ÄApprO
- Optional: a temporary licence (Berufserlaubnis). Under § 10 BÄO the authority can grant a licence to practise on application. It can be limited to certain activities and workplaces, is revocable and may only be granted or extended for a total of at most two years of medical work in Germany (§ 10(2) BÄO; the reform act of 2026 amends other paragraphs of § 10 but not this limit). It does not prevent the later grant of the Approbation. Whether and when a state grants it is decided by the authority. Sources: § 10 BÄO · BGBl. 2026 I No. 225, Art. 1 No. 10
- Approbation. Once all requirements are met, the authority grants the Approbation – the full licence to practise medicine in Germany.
Apostille and legalisation: India and Pakistan
For documents from India and Pakistan the apostille does not help in Germany: both countries have acceded to the Hague Apostille Convention of 1961, but Germany has objected to their accession.
| India | Pakistan | |
|---|---|---|
| Accession | 26 October 2004 | 8 July 2022 |
| Entry into force | 14 July 2005 | 9 March 2023 |
| Apostille authority at home | Ministry of External Affairs (MEA), CPV Division, New Delhi | Ministry of Foreign Affairs (MOFA), Islamabad, and its liaison offices in Karachi, Lahore, Quetta, Peshawar and Gujrat |
| In relation to Germany | Germany objected – the Convention does not apply | Germany objected – the Convention does not apply |
| Legalisation by German missions | Not possible (“Germany does also not legalize Indian public documents”) | Suspended |
Sources: HCCH status table · HCCH: India · HCCH: Pakistan · Federal Foreign Office: objections (German) · Federal Foreign Office: states without legalisation (German) · German Missions in India · German Embassy Islamabad (German)
What happens instead: verification by the German mission
- Who starts it: only a German authority – for you, usually the licensing authority. Private individuals cannot request it directly. Whether a verification is necessary is at the discretion of the authority to which you submit the document.
- India: the verification is carried out by the Embassy in New Delhi or one of the Consulates General; jurisdiction depends on where the document was issued, not on where you live. It usually takes about 2–4 months. The fee is typically between 400 and 550 euros depending on the mission; it is billed to the requesting German authority, which may ask you for a deposit. Verified documents receive a sticker with a reference number, so later authorities can ask for the result. Source: German Missions in India, 16 June 2026
- Pakistan: the Embassy in Islamabad and the Consulate General in Karachi can have Pakistani documents verified by way of administrative assistance, because the legalisation of Pakistani documents is suspended. Karachi is responsible for documents issued mainly in Sindh and Balochistan, Islamabad for all other provinces; documents of members of the Ahmadiyya community are always verified by Islamabad. Source: German Embassy Islamabad (German)
- Translations are a separate step; what your authority accepts is listed on our documents page.
Ask your licensing authority what it needs before you pay for an apostille or for translations.
Documents
The list of documents is the same as for other third countries: application form, CV, proof of identity, diploma with record of subjects and hours, proof that you may practise as a doctor in your country of training, certificates of good conduct, certificate of good standing, medical certificate and German certificate at B2. Exactly which ones, in what form and when is decided by the authority of your federal state. Our checklist names, for each document, who issues it and where you get it: documents for the Approbation, FSP and KP. According to the Federal Ministry of Health, for applications from 1 November 2026 you no longer need to have documents translated and certified that are only needed for the equivalence assessment – such as your university’s curricula – if you do not choose that assessment. Source: BMG FAQ
Visa and entry
- Visa for a recognition measure (§ 16d Residence Act): possible if a German recognition authority has found that adaptation or further qualification is needed for the licence to practise. The measure must be suitable, and you need German appropriate to the measure, as a rule at least sufficient German (the German Missions in India and the Consulate General in Karachi name level A2). The permit is granted for up to 24 months and can be extended by up to 12 months, to a maximum of three years; it allows employment unrelated to the measure of up to 20 hours a week and, with the approval of the Federal Employment Agency, employment without a time limit whose requirements are related to the later occupation (§ 16d(2)). Sources: § 16d AufenthG · German Missions in India · Consulate General Karachi
- India: the German Missions in India list, among the options for a recognition visa, a deficit notice (Defizitbescheid) plus registration for a course preparing for a required knowledge test. Source: German Missions in India
- Pakistan: the Consulate General in Karachi requires an assessment notice (Defizitbescheid or Zwischenbescheid) of a German authority, a suitable qualification programme in Germany and German at A2; applications at the Embassy in Islamabad go through the Consular Services Portal. Source: Consulate General Karachi
- Recruitment from Pakistan: Pakistan is listed in the annex to § 38 of the Employment Ordinance. For health and care professions, recruitment in and placement from these states may only be carried out by the Federal Employment Agency. In Pakistan there is also a Centre for Migration and Development of the German Development Ministry, a contact point for people interested in work or training in Germany. Sources: BeschV § 38 and annex · BMZ (German)
- General information on working and living in Germany: Make it in Germany, the federal government’s portal for skilled workers.
Fees for the Fachsprachprüfung and the Kenntnisprüfung by federal state
Where an official figure is published, the Fachsprachprüfung costs €400–700 and the Kenntnisprüfung €400–1,350. Fees as stated by chambers and authorities, as of 2 October 2026; each amount links to its source. Fees can change – check with the body before you pay.
| Federal state | Fachsprachprüfung | Kenntnisprüfung |
|---|---|---|
| Baden-Württemberg | €420 | €1,100 |
| Bavaria | €550 | up to €1,200 |
| Berlin | €550 | €540 (standard fee; range €250–2,000) |
| Brandenburg | €487 | €799 |
| Bremen | €530 | €730 |
| Hamburg | €550 | €900 |
| Hesse | €650 | €1,350 |
| Mecklenburg-Western Pomerania | €700 | €640 |
| Lower Saxony | €595 | €980 |
| North Rhine-Westphalia | €430 (Ärztekammer Nordrhein) €400 (Ärztekammer Westfalen-Lippe) | €1,050 |
| Rhineland-Palatinate | €470 | no official figure found |
| Saarland | no official figure found | no official figure found |
| Saxony | €590 | €850 |
| Saxony-Anhalt | €500 | no official figure found |
| Schleswig-Holstein | €700 (fee schedule of the Mecklenburg-Western Pomerania chamber, which holds the FSP for Schleswig-Holstein; the SHIBB FAQ still states €600, “as of March 2024”) | €400 |
| Thuringia | €600 | no official figure found |
Data: our state pages (FSP & KP by federal state, in German), researched from official sources up to 2 October 2026. Further costs can include translations, certified copies and, for documents from India or Pakistan, the verification by the German mission (see above).
German courses and funding
The BAMF funds a job-related German course for academic health professions up to C1; according to the BAMF, the cost of the Fachsprachprüfung is covered as part of it. The federal recognition grant (Anerkennungszuschuss) requires your main residence in Germany. Requirements, amounts and how to apply: funding for the FSP and KP.
Practice material
- 30 example cases for the Fachsprachprüfung (in German, as in the exam)
- Kenntnisprüfung: the most frequently reported exam topics
- FSP & KP preparation with KLINIKFUCHS – free
Salary: what does a resident doctor (Assistenzarzt) earn?
Pay depends on who runs the hospital: municipal hospitals usually pay under the TV-Ärzte/VKA, university hospitals in the scope of the TV-Ärzte under the agreement with the TdL (Tarifgemeinschaft deutscher Länder); church-run and private hospitals have their own rules or agreements. The tables show the gross monthly table pay in the pay group for doctors (pay group I under the VKA, Ä 1 under the TdL; specialists are in pay group II / Ä 2), for 40 hours a week, without on-call pay (Bereitschaftsdienst), standby pay or allowances. We do not calculate net pay. Overview in German, with all sources: Gehalt Assistenzarzt 2026.
| Valid | Year 1 | Year 2 | Year 3 | Year 4 | Year 5 | From year 6 |
|---|---|---|---|---|---|---|
| 1 August 2025 – 31 May 2026 | €5,609.85 | €5,927.86 | €6,154.97 | €6,548.61 | €7,018.01 | €7,211.07 |
| from 1 June 2026 | €5,722.05 | €6,046.42 | €6,278.07 | €6,679.58 | €7,158.37 | €7,355.29 |
The Marburger Bund terminated the VKA pay table in September 2026 for the 2027 bargaining round; under § 40 TV-Ärzte/VKA it can be terminated at the earliest as of 31 December 2026. Sources: VKA: TV-Ärzte/VKA · Marburger Bund: VKA tables · Marburger Bund, 22 September 2026
| Valid | Year 1 | Year 2 | Year 3 | Year 4 | Year 5 | From year 6 |
|---|---|---|---|---|---|---|
| 1 January – 31 March 2026 | €5,626.91 | €5,945.86 | €6,173.67 | €6,568.57 | €7,039.34 | €7,222.97 |
| 1 April 2026 – 31 August 2027 | €5,792.90 | €6,121.26 | €6,355.79 | €6,762.34 | €7,247.00 | €7,436.05 |
| from 1 September 2027 | €5,934.83 | €6,271.23 | €6,511.51 | €6,928.02 | €7,424.55 | €7,618.23 |
Agreement of 9 June 2026: +2.95% from 1 April 2026 and +2.45% from 1 September 2027, term until 31 July 2028. The university hospitals in Hamburg, Berlin, Mainz and Hesse are not covered by the TV-Ärzte. Sources: TdL: Anlage A · TdL: Anlage B · TV-Ärzte as amended No. 9 (table from 1 January 2026) · Marburger Bund, 10 June 2026
FAQ
Can Indian and Pakistani doctors work in Germany?▾
Yes, with a German licence to practise: the Approbation (full licence) or, in certain cases, a Berufserlaubnis (temporary licence; it is revocable, can be limited to certain activities and workplaces and is granted for a total of at most two years, § 10 BÄO). What counts in the procedure is where you obtained your degree: an MBBS from India or Pakistan is a degree from a third country (outside the EU, the EEA and Switzerland). The licensing authority of the federal state where you want to work decides.
What is the FSP exam? What does FSP stand for?▾
FSP stands for Fachsprachprüfung – the medical German language exam. According to the key points of the 2014 Health Ministers’ Conference, doctors usually need general German at B2 plus a Fachsprachprüfung oriented to level C1; it is usually held by the state medical association (Ärztekammer).
What are the FSP exam fees in Germany?▾
Where an official figure is published, between €400 and €700, depending on the federal state and chamber (official sources, as of 2 October 2026). For Saarland we found no official figure. If you take part in the BAMF job-related language course for academic health professions, the BAMF pays the cost of the Fachsprachprüfung.
How much does the Kenntnisprüfung cost?▾
Where an official figure is published, between €400 and €1,350, depending on the federal state (as of 2 October 2026). For Rhineland-Palatinate, Saarland, Saxony-Anhalt and Thuringia we found no official figure.
Do I need an apostille for Germany for documents from India or Pakistan?▾
Not in the sense of the Hague Convention. India and Pakistan have acceded to the Apostille Convention, but Germany has objected to their accession, so the Convention does not apply between Germany and India or Pakistan. German missions do not legalise Indian or Pakistani documents either. Instead, a German authority can have a document verified by the German mission by way of administrative assistance; whether that is necessary is decided by the authority to which you submit the document.
Can I take the Kenntnisprüfung in English?▾
No. Under § 37(4) of the Medical Licensing Regulations (ÄApprO) the Kenntnisprüfung is taken in German before a state examination board. It is an oral-practical exam with a patient presentation on one day, lasting 60 to 90 minutes per candidate, and can be repeated twice.
What changes for applications from 1 November 2026?▾
For applications from 1 November 2026 with a third-country degree, the Kenntnisprüfung is the standard route to the Approbation (§ 9d BÄO, new version). The document-based equivalence assessment only takes place if you choose it within four weeks of applying; the choice is binding. Applications submitted by 31 October 2026 continue under the old rules.
Can I apply while I still live in India or Pakistan?▾
Yes. The federal Service Center for Professional Recognition (ZSBA) advises and supports people who are still abroad and want to apply for recognition from there. The application itself goes to the licensing authority of the federal state where you want to work.
Which visa do I need for the recognition procedure?▾
If a German authority has found that you need further qualification – for example in a deficit notice (Defizitbescheid) – a residence permit for a qualification measure under § 16d of the Residence Act is possible. It is granted for up to 24 months and can be extended by up to 12 months, to a maximum of three years. The German missions in India and in Karachi name German at level A2 as the usual minimum for this visa.
Can a private agency in Pakistan place me in a German hospital?▾
Pakistan is listed in the annex to § 38 of the German Employment Ordinance (BeschV). For jobs in health and care professions, recruitment in these states and placement from these states may only be carried out by the Federal Employment Agency (Bundesagentur für Arbeit).
How much does a resident doctor (Assistenzarzt) earn in Germany?▾
It depends on the employer’s pay agreement. In the first year, the gross monthly table pay in the pay group for doctors (pay group I / Ä 1; specialists are in pay group II / Ä 2) is €5,722.05 at municipal hospitals (TV-Ärzte/VKA, from 1 June 2026) and €5,792.90 at university hospitals covered by the TV-Ärzte (TdL, from 1 April 2026), each for 40 hours a week and without on-call pay or allowances. We do not calculate net pay.
Sources
All links opened on 23 October 2026 (HTTP 200). Fees by state: as of 2 October 2026. Many sources are in German. The Make it in Germany portal is linked for general information only; its pages could not be read automatically (browser check).
- HCCH: status table of the Apostille Convention (India: accession 26 October 2004, in force 14 July 2005; Pakistan: accession 8 July 2022, in force 9 March 2023; both marked “A**” = objection)
- HCCH: competent authority for India (Ministry of External Affairs)
- HCCH: competent authorities for Pakistan (Ministry of Foreign Affairs)
- Federal Foreign Office: states for which the apostille applies in relation to Germany – Germany objected to the accession of India and Pakistan (German)
- Federal Foreign Office: states in which the conditions for legalisation are not met – lists India and Pakistan (German, 2 May 2025)
- German Missions in India: Verification of Indian Documents (16 June 2026)
- German Embassy Islamabad: document verification and lawyers’ lists (German, 18 September 2024)
- Ministry of External Affairs, India: apostille
- Federal Law Gazette 2026 I No. 225: Act to Accelerate Recognition Procedures in the Health Professions (from 1 November 2026)
- Federal Ministry of Health: FAQ on professional recognition in the health professions
- § 10 Federal Medical Code (BÄO): Berufserlaubnis
- § 37 Medical Licensing Regulations (ÄApprO): Kenntnisprüfung
- Key points of the 87th Health Ministers’ Conference 2014 on German language skills (cited by the Saxon State Chamber of Physicians)
- Recognition Finder of the federal government: doctor (Arzt/Ärztin)
- Recognition in Germany: Doctor of medicine
- Recognition in Germany: Service Center for Professional Recognition (ZSBA)
- § 16d Residence Act (AufenthG): recognition of foreign professional qualifications
- German Missions in India: Employment – Recognition of Professional Qualifications
- German Consulate General Karachi: Recognition Measure for a Foreign Qualification
- Make it in Germany: the federal government’s portal for skilled workers (general information)
- Employment Ordinance (BeschV), § 38 and annex
- Federal Ministry for Economic Cooperation and Development: Centres for Migration and Development (German)
- VKA: TV-Ärzte/VKA, reading version of amendment No. 10 (pay tables from 1 July 2024, 1 August 2025 and 1 June 2026)
- Marburger Bund: pay tables TV-Ärzte/VKA, 1 July 2024 – 31 December 2026
- Marburger Bund: member information of 22 September 2026 – pay table of the TV-Ärzte/VKA terminated (German)
- TdL: TV-Ärzte pay table (Anlage A), valid 1 April 2026 – 31 August 2027
- TdL: TV-Ärzte pay table (Anlage B), valid from 1 September 2027
- Marburger Bund: TV-Ärzte (TdL) as amended by amendment No. 9 – pay table from 1 January 2026
- Marburger Bund: press release of 10 June 2026 on the agreement with the TdL
- Marburger Bund: collective agreements (overview, including private hospital groups)
Fee sources by federal state (22 links)
- https://www.aerztekammer-bw.de/fachsprachenpruefung
- https://rp.baden-wuerttemberg.de/fileadmin/RP-Internet/Themenportal/Schule_und_Bildung/Berufliche_Ausbildung/Aerztin_Arzt_Ausbildung_Approbation/_DocumentLibraries/Documents/LPA_Arzt_Appr_Antrag_nonEU_Anl1.pdf
- https://www.blaek.de/wegweiser/fachsprachenpruefung
- https://www.regierung.oberbayern.bayern.de/service/berufsqualifikation/approbationsberufe/faq-kp-aerzte/index.html
- https://www.aekb.de/aerzt-innen/aus-dem-ausland-ins-ausland/fachsprachpruefung
- https://www.berlin.de/lageso/_assets/gesundheit/berufe-im-gesundheitswesen/neue-gebuehrenordnung_11_2021.pdf
- https://www.laekb.de/aerztin-und-arzt/qualifikation/fachsprachtests
- https://www.laekb.de/aerztin-und-arzt/qualifikation/kenntnispruefung
- https://aekhb.de/wp-content/uploads/2023/12/ae_eth_rq_gebuehrenordnung.pdf
- https://aerztekammer-hamburg.org/wp-content/uploads/2025/01/Gebuehrenordnung_10_06_2024_CD.pdf
- https://www.laekh.de/fuer-aerztinnen-und-aerzte/fachsprach-und-kenntnispruefungen
- https://www.aek-mv.de/fileadmin/user_upload/aek-mv/kammer/Gebuehren/AEKMV_Gebuehrenverzeichnis_ab_01_01_2025.pdf
- https://www.nizza.niedersachsen.de/startseite/aktuelles/kosten-fachsprachprufung-und-kenntnisprufung-arzte-arztinnen-neu-246731.html
- https://www.aekno.de/aerzte/fachsprachpruefung
- https://www.aekwl.de/fuer-aerzte/weitere-themen/fachsprachenpruefung/
- https://www.aekwl.de/fuer-aerzte/weitere-themen/kenntnispruefung/
- https://www.aerztekammer-mainz.de/weiterbildung/aerztliche-fachsprachenpruefung
- https://www.slaek.de/de/arzt/auslaendische-aerzte/fachsprachenpruefung.php
- https://www.revosax.sachsen.de/vorschrift/19330-Zehntes-Saechsisches-Kostenverzeichnis
- https://www.aeksa.de/www/website/PublicNavigation/arzt/mitgliedschaft/sprachtest/
- https://www.aeksh.de/fileadmin/content/user_upload/son_2025-12-04_konsolidierte_Fassung_Gebuehrensatzung_Homepage.pdf
- https://www.laek-thueringen.de/aerzte/weiterbildung/fachsprachenpruefung/
Not legal advice. All information without guarantee, summarised from official sources (as of 23 October 2026; fees by state: as of 2 October 2026). Only the information provided by the responsible authorities is binding.