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Recognition in human medicine

Olesia Hausmann and Larissa Zier are co-authors of the “Human medicine situation analysis” (2022). In the interview they summarize the results of the study on the recognition of doctors of medicine.

What does the “Human medicine situational analysis” cover?

Larissa Zier: Demand for doctors is increasing on the German labour market, due in particular to demographic change, and this demand could be met at least in part by employing skilled workers with foreign qualifications. Professional recognition has a key role to play in this. We have therefore taken a look at the recognition procedure and identified effective processes and obstacles. The focus was on qualifications from third countries as it is these that account for the majority of the advisory sessions provided in the Network “Integration through Qualification (IQ)”. We used our analysis to generate recommendations for optimising existing processes and regulations.

Virtual focus group interviews with experts engaged in advisory services and job training at Network IQ form the basis of the situational analysis. We also included the expertise of the IQ Competence Centre for Work-Related German Language, the Service Center for Professional Recognition (ZSBA) and the Federal Institute for Vocational Education and Training (BIBB). Additional studies and sources covering the topic were also taken into account.

Recognition in figures

With 9,636 procedures, the profession of doctor of medicine ranked second highest for recognition procedures in 2021. With 9,932 persons advised, the profession came fourth in the IQ counselling rankings for the current funding round (2019—2022). The most common nationalities of those seeking advice are Syrian (17%), Turkish (8%) and Ukrainian (7%). In IQ training measures doctors and medicine occupied first position with 1,895 participants.

Sources: Federal Statistical Office 2022, NIQ database (evaluation period: 1.1.2019 to 30.6.2022)

Where are things going well with recognition in human medicine and where are there still stumbling blocks?

Olesia Hausmann: The statutory periods for the equivalence assessment are largely adhered to in most federal states. In many places, the competent authorities and IQ regional networks are working well together. A further positive aspect worth noting is that across Germany there is a sufficient supply of preparation courses for the knowledge test, and dates for the specialist language exam and preparation courses are effectively coordinated. The process of granting authorisation to practise an occupation and the activities which follow largely occur without problems.

One issue we did identify however is that statutory requirements relating to the procedure are not always adhered to. There are instances, for example, of equivalence assessments not being undertaken until evidence is submitted. This is evidence which, under the German Federal Medical Practitioners’ Act, does not in fact become relevant until the granting of authorisation to practise (e.g. language certificates or certificate of good conduct). Or that dates for the knowledge test are not provided in a timely manner. A further issue in some cases is the very significant level of red tape involved in submitting an application, for example when, in addition to confirmation of registration, competent authorities are also demanding evidence of confirmation of a job, or when translations from abroad are not accepted.

Larissa Zier: The costs associated with the recognition procedures are also very high. Translation costs alone for the necessary documents are sometimes four figures, as are fees for assessments and the preparation courses for the knowledge test. Not all of those seeking recognition have sufficient surplus funds or are entitled to state support.

Procedural practise also differs significantly in some cases despite the recognition of doctors of medicine being regulated at federal level. This concerns, for example, application document requirements but also the equivalence assessment itself. In some cases there are huge differences between federal states as regards the option not to undertake an equivalence assessment or option to involve the Central Assessment Agency for Healthcare Professions or other external expert consultants. There are also different approaches when it comes to the knowledge and technical language tests. This heterogeneity and complexity in the procedure is hard for the skilled workers to understand, particularly if they are still abroad.

How could the procedures be standardised and application preparation be reduced?

Olesia Hausmann: Simplification of document management, standardisation of procedures and digitalisation need to be considered as one. It would make sense to clarify legal requirements regarding the format of documents to be submitted. In this case, it would need to be ensured that red tape barriers are manageable for applicants. For example, registration certificates should be sufficient for establishing the jurisdiction of the relevant authority. These clarifications could, for example, be implemented as part of the updating of the medical approbation regulation due to take place shortly.

The Central Assessment Agency for Healthcare Professions (GfG) has been including professional experience and evidence of lifelong learning in its detailed reporting since August 2022 and extending the GfG’s responsibilities in this way may also contribute to a centralisation and consistency of recognition procedures. Digital application submission launched via the Recognition Finder on “Anerkennung in Deutschland” is also an important step towards standardising the procedure.

It should be ensured at all times for all these developments that the rights set out in the German Federal Medical Practitioners’ Act, in particular the right to an equivalence assessment independent of the checking of requirements for authorisation to practise, are guaranteed. Also, in order to ensure implementation of procedures is fair, it is essential that applicants are informed about individual options and costs at an early stage. In addition to this, application forms and information material should be designed using simple language to be clear, user-friendly and transparent.

Where else is there further potential for improvement?

Larissa Zier: Improving application procedures also includes reducing waiting times for a date for the knowledge test. To make this possible, institutions responsible for conducting tests should have the necessary personnel available.

The option of not completing an equivalence assessment and sitting the knowledge test immediately ought to be managed in a more standardised and transparent way. This option is very helpful for some of those seeking recognition, e.g. for refugees who are unable to present or documents in the required format. In some federal states, however, the option is used even if it was possible to submit all the necessary documents. This practice is legally contentious and clearer legal requirements should be formulated in this regard.

Furthermore, standardisation of procedure fees and an expansion of instruments offering financial support to those seeking recognition would be very welcome. Employers could also be more involved when it comes to covering costs.

The interview with Larissa Zier and Olesia Hausmann took place in November 2022. They are co-authors of the recent study “Professional recognition of doctors of medicine with a professional qualification acquired abroad – a situation analysis from the perspective of Network IQ”. Since 2021, Larissa Zier has worked as a research assistant at the Research Institute for Vocational Education and Training (f-bb) for the IQ Competence Centre for Advisory Services and Job Training of Migrants. Olesia Hausmann has worked there as a research assistant since 2020, and from 2012 to 2018 was a recognition adviser in the regional Network IQ Berlin.

The work of the competence centre includes the supervision and support of IQ regional networks and subprojects in the areas of advice and training as well as combining practical experience of specific issues with academic expertise, and transferring this knowledge to the expert community and the general public. The findings of the situation analysis are based on experience with model projects in the Network “Integration through Qualification (IQ)” over the period from 2019–2022. From 2023, new and other projects will be trialled in Network IQ.

Contact for questions about the situation analysis:

Key information about responsibility for, and details on, the recognition procedure, e.g. for the reference occupation of “doctor of medicine” is provided in the Profi-Filter here in the professional section and in the Recognition-Finder in the Skilled workers section of “Anerkennung in Deutschland”.

Cover of the situation analysis
IQ Competence Centre for Counselling and Job Training of Migrants, 2022

Human medicine situation analysis

The study examines the experiences and challenges of professional recognition of doctors of medicine from the perspective of Network IQ.

Show study