The German healthcare system faces a growing reliance on migrant doctors to maintain care levels as the population ages and chronic diseases increase. Data from late 2025 indicates that 16 percent of the country's 446,000 physicians do not hold a German passport, a figure rising to approximately one in four when naturalized citizens are included. With nearly a third of active human medical doctors aged 55 or older approaching retirement, and an increasing number opting for part-time work, the Federal Chamber of Physicians emphasizes that the system cannot sustain its current service level without immigration.
Despite this urgent need, the process for foreign-trained doctors to obtain full licensure remains lengthy. Ali Ateel Daifoladi, a 41-year-old heart surgeon who fled the Taliban in Afghanistan, arrived in Germany on August 4, 2022. Exactly four years later, he passed his final examination and was granted permission to practice again. Daifoladi, who had over a decade of experience operating on children and adults in Afghanistan, spent much of this time navigating language requirements and bureaucratic hurdles. He reached the required B2 German language level within six months and passed the specialized medical language exam at C1 level after two years, yet still faced significant delays before being allowed to take his knowledge examination.
Data analyzed by the startup Get2Germany reveals substantial disparities in processing times across different German states. While some regions review documents within one to seven months, others experience much longer waits. For instance, while North Rhine-Westphalia offers exam appointments within eight weeks, doctors in Saxony and Thuringia have reported waiting 18 months or more for their knowledge exams. In Bremen, waiting times for the specialized language exam can exceed six months. These delays are attributed to a combination of factors, including the time required for candidates to achieve necessary language proficiency, the thoroughness of qualification checks to protect patients, and a shortage of available examiners, often university professors.
To address these bottlenecks, the Federal Chamber of Physicians is calling for consistent digitalization and a central federal office to bundle and preliminarily review applications. Meanwhile, a legislative amendment effective in November has made the knowledge examination the standard procedure, aiming to replace the more complex equivalence assessment used previously. However, it remains uncertain whether this shift will accelerate the overall process or simply increase waiting times due to higher demand for exam slots. Although states are legally obligated to offer an exam appointment within six months of notification, this right is frequently violated, with some authorities citing candidate delays or language deficits as reasons for postponements.
Daifoladi expressed mixed feelings about the lengthy procedures, noting frustration at being treated as a novice despite his extensive experience, yet acknowledging the necessity of rigorous checks. He received a temporary professional permit in early 2025, allowing him to work under supervision before achieving full licensure in August. Now employed in trauma and abdominal surgery, he is seeking further training to return to heart surgery, a field where he notes that skills must be maintained through practice much like piloting an aircraft. While political shifts and rising anti-migration sentiments have caused some anxiety among international medical professionals regarding their welcome in Germany, Daifoladi reports positive interactions with patients who are patient with his remaining dialect challenges.
Sources: FAZ.