Foreign healthcare professionals

Obtaining professional recognition is challenging, as the granting of a professional license or licence is subject to high requirements. In order to work as a doctor or physiotherapist, as a health and nursing professional or occupational therapist in Germany, the professional or academic qualification must be verified. Existing professional experience can be positively included in the verification process.
Such a verification by the so-called "competent authority", in many federal states the district government, can only be carried out when the relevant documents certifying the professional or academic qualification have been submitted in full and in a legalized form. For many refugees, this complete written proof alone represents a hurdle.

Specialist language skills are important for professional integration
Once questions of residence and employment law have been clarified, the first step is to acquire comprehensive German language skills. Health professionals require a high level of linguistic competence, as language itself is one of the central working bases in diagnostics and therapy. There are numerous publicly funded German language courses, including those that explicitly seek to integrate specialist and linguistic knowledge into the learning process. It can be observed that many refugees in particular try very quickly and with great motivation to obtain the relevant language certificates in order to accelerate their professional integration, often motivated by the desire to create a safe and stable living space for their family.
The quality of the language courses and thus also the resilience of the language certificates must be assessed as very different (see the Federal Government's report on the regulations on the recognition procedures in the federal health professions.) The Conference of Health Ministers of the States already demanded in 2014 that sound language skills are essential for practicing medicine. Since then, doctors have been required to have the appropriate specialist language skills in addition to German language skills. The state medical associations in particular have been involved in quality assurance, introducing a specialist language test in the first pilot projects in 2012, in which medical colleagues as well as linguists have always participated. The medical specialist language test, administered by a state medical association commissioned to do so, can now be considered an established standard.
The exam situation is designed to be practical. Communication skills are tested in the areas of doctor-doctor communication, doctor-patient communication and the written documentation of medical actions. Targeted preparation for such a specialist language test is recommended.
Passing the specialist language test is the first milestone in integration into the medical field, because in many federal states, a passed specialist language test still allows you to apply for a medical license in accordance with Section 10 of the Federal Medical Code and to start working as an employed and appropriately paid doctor. Many doctors choose to work in this way with a professional license because, in addition to securing a livelihood, it enables them to gain their first professional experience in Germany under the supervision of a licensed colleague and is also good preparation for an upcoming knowledge test.
While doctors from the European Union already meet the essential requirements for being granted a license if they present the appropriate documents by having a comparable completed medical degree in their country of origin and a certificate of passing a specialist language test, it is often found that doctors from non-EU countries do not have enough time to check the admission requirements by providing evidence of study and work documents. The route of obtaining a medical license by means of an expert opinion, which is also often chosen by refugees, can increasingly be described as less promising, since the result of the expert opinion on previous study and professional documents often ends with the requirement to take a medical knowledge test.

Knowledge test is often the prerequisite for professional recognition
The medical knowledge test is organized by the relevant state examination office and carried out by the appropriately commissioned universities. The knowledge test is regulated by law in the Medical Licensing Ordinance. It is a state examination and is based on the requirements of the second section of the medical examination. It consists of a clinical and an oral-practical examination with patient presentation. It usually takes place in a university clinic or in a hospital commissioned to carry it out. In the clinical examination, a patient is examined under the supervision of a senior doctor who is a member of the examination committee. A period of around 30 to 45 minutes is usually made available for this examination. A doctor's report is then written on the results of the examination, which provides information on the anamnesis, diagnosis and differential diagnosis. At the same time, the doctor's report provides information on the prognosis and treatment plan as well as the epicrisis of the case. Around 30 minutes are allowed to prepare this doctor's report.
The subsequent oral-practical examination is usually a group examination, with up to 90 minutes per candidate. This mainly deals with questions from internal medicine and surgery as well as cross-sectional areas of medicine. Cross-sectional areas are emergency medicine, clinical pharmacology/pharmacotherapy, imaging procedures, radiation protection and legal issues relating to the medical profession. At the beginning of the examination, reference is usually made to the results of the physical examination of the previously examined patient.
The aim of the knowledge test is to ensure that the doctors approved in this way can communicate adequately with patients and have a good command of common medical terms. They should be familiar with common clinical examination techniques and be able to correctly record certain pathologies of the patient and also present them in writing. Appropriate therapy concepts must be recorded and presented using examples.
In addition to medical knowledge, the examination also addresses legal issues relating to the medical profession. This includes knowledge of the Medical Professions Act and professional regulations, of the rights of patients and of advance directives. The German Narcotics Act is also part of the exam, as are questions about transfusions and transplants, prescription requirements for medicines and the Radiation Protection Ordinance. Basic knowledge of criminal law issues such as intentional or negligent killing or bodily harm, failure to provide assistance, medical euthanasia and medical confidentiality complement the exam canon. The knowledge test can be taken independently of the specialist language test, i.e. before or after a specialist language test. Special intensive seminars to prepare for the knowledge test have been developed in cooperation with the state medical associations, supported by the Federal Employment Agency and other funding programs, and are carried out with medical lecturers.

The path to medical licensure
The mibeg Medical Institute, together with recognition experts, has developed a diagram that outlines and helps to understand the path to recognition for foreign doctors in Germany, supplemented with important tips for rapid and successful integration into the medical labor market.
The mibeg Medical Institute has developed model courses to prepare for recognition examinations under the project title IQuaMed, supported by the IQ funding program with funds from the Federal Ministry of Labor and Social Affairs and the European Social Fund. The evaluation data show that a high pass rate of the demanding knowledge test can be achieved with just four-week qualification seminars. The prerequisites for success include the use of professionally competent medical lecturers and supporting specialist literature as well as pedagogical support with extensive professional knowledge.

Licensing for foreign dentists and pharmacists
In analogy to obtaining a medical license, comparable paths can also be found for dentists and pharmacists. For these academic medical professions, specialist language tests are also taken before the relevant professional chambers. Appropriate preparatory courses have been developed and successfully established through the IQuaMed project. These programs have also already been transferred to regular funding and can therefore be available on a permanent basis. For both dentists and pharmacists from non-EU countries, it can be seen that, regardless of the specialist language test, the path to German licensing is increasingly via the knowledge test rather than the report. While the job market for pharmacists shows a consistently high demand, the dental job market is much more differentiated when it comes to accepting foreign health professionals.
Overall, it is becoming apparent nationwide that there is an increasing unification and standardization of recognition procedures. This not only simplifies the path to professional integration for refugees, as possible "licensing tourism" can be replaced in favor of a clearly structured and high-quality recognition process.
For the academic medical professions, it can be summarized that: The application for a license can be submitted from abroad as well as in Germany. Documents should be as complete as possible at the time of application. The portal anerkennung-in-deutschland.de and the information blog anerkennung-medizin.de provide help with the application, and there is support from numerous recognition advice centers. In North Rhine-Westphalia, the one-day seminar "Paths to Recognition" was set up, which regularly shows paths to professional recognition and opportunities for qualification in exam preparation several times a month free of charge.
Applicants who choose exam preparation should seek advice on whether, based on their knowledge of the German language and their knowledge of the medical, dental or pharmaceutical professions in Germany, an intensive seminar lasting several weeks is sufficient or whether a preparation period lasting several months, which includes a clinical internship, makes sense. Such preparatory courses are available in a publicly supported form.

The path to professional licensing for health and nursing professionals
The specialists who are currently welcomed into the German health care system and for whom there are numerous job prospects include, above all, health and nursing professionals. Here, too, a separate professional license is required, which is granted by the responsible authorities after an application for professional recognition. Comparable to academic medical professions, professional recognition includes an equivalence test in technical language and technical terms. In analogy to academic medical professions, the previous procedures nationwide are characterized by the fact that there are also numerous different procedural handling and processing times for professional recognition.
The study and training courses of nurses from other countries, which differ from the German reference profession of health and nursing, often result in recognition notices that state that there are considerable theoretical and practical deficits that need to be compensated for.
In particular, refugees who want to quickly return to their traditional profession face major hurdles here, as hospitals and nursing schools must be found for so-called individual adaptation courses, in which applicants are sometimes required to complete more than 1,500 hours of theory and practice.

Model integration paths for nursing in North Rhine-Westphalia
These decisions place high organizational demands on both nursing schools and nursing directorates in hospitals. The IQuaMed project has opened up new paths in this area. Clinics were specifically approached and motivated to carry out individual adaptation courses under the direction of a nursing school. The advisory and preparatory services provided by the project and the financial support provided by the IQ funding program made it possible to establish regular offers of individual adaptation courses in clinics.
In addition, modular adaptation courses were designed in which the essential theoretical content from several individual adaptation courses was summarized in a way that was practical for the nursing schools. This created a more efficient and economically viable form of teaching and learning for professional recognition in the field of nursing.
Finally, "practical nursing seminars" were set up as a clearly structured path to recognition with the help of established nursing schools, in which those seeking recognition can prepare specifically for the knowledge test regardless of the individual requirements of their decision. The seminars, designed by the mibeg Institute for Medicine together with nursing experts, are designed for a period of six months. In three-month theoretical and practical phases, there is a targeted introduction to the field of health and nursing, and the knowledge test integrated at the end of the seminar enables professional recognition on an equal footing, as this standardized procedure can objectively confirm professional knowledge that is essential for practicing health and nursing in Germany. At the same time, this seminar enables a manageable time frame in which to start a career.
This ability to plan the time and content to achieve professional recognition is an important criterion for applicants when deciding on professional recognition and a job in the German health system.
For North Rhine-Westphalia, all model projects were coordinated with the responsible district government; the state examination office is responsible for the proper acceptance of the examination. The paths outlined for health and nursing, via individual adaptation courses, modularised adaptation courses and structured seminars to prepare for the knowledge test, are in principle being prepared for all other regulated health professions or are already being successfully implemented.

Qualifications for numerous regulated health professions
Through the IQuaMed project, the mibeg Institute for Medicine has also opened up such paths for physiotherapists, midwives, occupational therapists, medical-technical radiological assistants and pharmaceutical-technical assistants. With the support of the IQ funding program, numerous other projects for regulated health professions have also been successfully established nationwide.
For the model region of North Rhine-Westphalia, the IQuaMed project shows that rapid, high-quality and cost-effective professional recognition can be achieved with over 2,000 health professionals advised and over 700 graduates. According to the evaluation of this model project, the pass rate in recognition tests and subsequent successful integration into the health job market is 79%.

Source: asu-arbeitsmedizin