Foreign physicians sought after facing bureaucratic challenges

In demand foreign medical professionals struggle with red tape.

In Germany, there's a shortage of doctors, especially in rural areas. Even though thousands of foreign doctors have come to the country recently, they're struggling due to bureaucracy and confusing regulations across different states. These doctors are from countries like Turkey, Syria, and Ukraine, all eager to practice their profession here. Local authorities and hospitals are happy to have them, as it's been difficult to find enough doctors to fill the gaps in medical care. However, before these foreign doctors can start working in German clinics, care centers, or practices, they must go through a lengthy process for recognition and work permits. This is causing frustration and anxiety for both them and the people who need medical attention.

Despite the demand for doctors in cities like Bad Säckingen, Baden; Aalen, Ostalb; Eisenach, Thuringia; and Bad Schwalbach, Hesse, foreign doctors are facing delays and obstacles. A Turkish doctor signed a contract to replace a gynaecologist in Bad Säckingen, but the hospital had to search for another local doctor after they couldn't get his approval fast enough. A Venezuelan doctor in Aalen has been waiting for months to work as a general practitioner, while a Ukrainian pediatrician in Eisenach just wants to practice her craft. Meanwhile, a Colombian doctor in Bad Schwalbach is frustrated that he has a contract but can't get the necessary license to practice medicine.

Despite these issues, there's been an increase in the number of foreign doctors in Germany. Last year, the number of foreign doctors reached almost 64,000. The number is expected to increase in the coming years, especially with the influx of doctors from countries like Syria (6120), Romania (4668), Austria (2993), Greece (2943), Russia (2941), and Turkey (2628). This increase has put a strain on the existing system, causing delays in processing their applications, which could affect the quality of care patients receive.

Dörfler, head of the Assessment Office for Healthcare Professions, confesses that there's a backlog of applications. She explains that the state staffing levels are not keeping up with the increasing demand. Her office requires six months, eight months, or even up to a year to assess the equivalence of the qualifications and documents submitted by these doctors. Ellen Lundershausen, Vice President of the German Medical Association, agrees that there's a risk of long waiting times due to the complex recognition process. Not only are the requirements different across the states, but sometimes they seem contradictory.

Elitsa Seidel, who runs an agency that helps applicants navigate the recognition process, reveals more practical problems. She complains about the varying requirements, from the way documents are certified to the waiting time for the specialist language test, which is also mandatory. These tests can take anywhere from two months to six months, and applicants who are not yet living in Germany often face additional hurdles. In some cases, clinics only accept fully recognized applicants, while licensing authorities demand proof of employment before they'll even process the application, creating a vicious cycle.

To address this issue, Baden-Württemberg wants to simplify the procedures by establishing a bundled contact point for all authorities. Bavaria is also using artificial intelligence to speed up the process. With more and more foreign doctors arriving in Germany, it's crucial to streamline the system to ensure that the patients receive the care they need without any delays.

Sometimes it appears quite straightforward: a clinic or MVZ wishes to employ a doctor, the doctor wants to be engaged, remarks agency manager Seidel. Nonetheless, for the candidates, collecting all the papers and comparing them with the German standards regularly evolves into a tragedy. Seidel elucidates that it takes approximately two or three additional months if the authoritative body is absent a certificate. "Recognition procedures lengthily take place if the documents are incomplete or the personnel resources at the authorities are lacking for an expedient verification," adds Lundershausen. "It's not necessarily the fault of the authorities, either, like when documents are presented at a later stage," says Dörfler. She opines: It could all be less complicated. Since, job-seekers must first have their documents inspected for suitability in Germany. Nonetheless, for about three out of four job-seekers, the certificates prove inadequate. They must undergo a physical assessment, followed by the knowledge test.

Dörfler recommends that in future, those impacted should have the prerogative to select initially whether to have their papers examined. If there is no hope of triumph, they should be able to focus instantly on the knowledge exam. Dörfler professes: "This would save an impressive amount of administrative duties."

Lauterbach disputes fiscal rewards

The professionals concur: there is potential for enhanced cooperation among the authorities, states Medical Association Vice President Lundershausen. Seidel: "It's essential to reduce bureaucratic hurdles - contrasting with the language and skill requirements that just have to be met." Nevertheless, do all doctors possess the professional skills to interact with patients? "We're managing a remarkably diverse group of applicants," cautions Bernhard Marschall, Chief of the Institute for Training and Student Affairs at the Faculty of Medicine in Münster. "It's rather infrequent for someone to possess complicated experience." Intense recognition procedures are indispensable to safeguard patients.

Federal Health Minister Karl Lauterbach conceded at the Doctors' Meeting in May that too few doctors have been taught in Germany during the years, partially due to monetary savings measures. Instead, Germany is inviting an increasing number of foreign doctors into the nation. "This is neither ethical nor sustainable."

Marschall also highlights another imbalance: because of the uneven distribution of the overall 428,000 doctors in Germany, the foreign doctors frequently conclude up in precariously weak districts. This is where employment and daily life may appear less attractive to doctors educated in Germany - and patients could perhaps already feel disadvantaged.