The German Health System in a nutshell
The German system is a social security system provided by public and private health insurance. There is a general obligation for health insurance, which for workless people is provided by the state.
Payment by public health insurances is based on DRGs, confined by budgets and subject to discussion and recourse. For private health insurance billing there is the “GoÄ”, which defines a certain price to each treatment or procedure, not to the diagnose. This can be adjusted by a certain factor.
Medical service is generally provided by self-employed private practices, cooperational centers and hospitals. Outpatient specialist care can often be found in private practices as well, rather than in polyclinics or hospital-dependent practices.
For some specialist visits a referral from the general practitioner is needed, for some not. For all privately insured patients it is usually easier.
How to specialize in Germany
In Germany it is comparatively free and easy to specialize in the field you want to. The work experience you gain in the hospital or private practice is summed up. Any job in one position that you work in for at least 6 months in a row, can be accounted. The head of the department has to be legitimated for specialist training, which is usually the case at least for a certain amount of time (‘Weiterbildungsermächtigung’).
In the end or in between terms you have to fill in a log-book with practical work you have done. This has to be signed by your supervisor. For example for Neurology, you have to collect a certain amount of EEGs that you interpreted or carotid ultrasounds you have performed under supervision. For surgery of course you have to proof that you were the leading surgeon for a certain amount of each intervention.
When the log book is completed and the amount of years of expected experience is gained, an exam is held at the responsible medical association. This is usually an oral exam in front of a random committee of three specialists from the field.
Advantages
One of the best things is that you can start immediately after finishing university, which has one practical year in the end (PJ) and no further rotations. You are paid a normal salary starting at a about 3500-4000EUR (ex tax etc) depending on the hospital. You can change between fields, if you change your mind and even still make the experience count. For example one year of internal medicine is useful for almost any field.
You can work on your specialist training in an academic center with great wide expertise or in a small and more personal local hospital. Just pay attention to the training allowance (‘Weiterbildungsermächtigung’) for the head of the department. Also check if you will be able to learn and perform what you need for your log book (and personal goals and interests). Anyway sometimes a smaller hospital can be better for learning and getting the rotations you need without awaiting your turn.
It is possible to make working experience in foreign countries count. This will depend on the association and the country where you have worked and the things you can proof you have done over there. Get in touch with the local association to ask. Usually work experience inside the EU should be less problematic than anything outside.
Disadvantages
The freedom comes with the necessity to choose and organize and fight a bit. You are not in school anymore. People will try to make use of your work force and it might not be easy to fill up your log-book in time. Especially at academic centers it might take you a couple of years longer until you make it to your exam.
One thing you do not have in some other places and which can be a pain in the ass is the simple fact that you have to study for an exam at the end even though you are full time 300 hours nightshifting in your all-consuming hospital job. And believe me it is possible to fail. I have met these cases.
Another disadvantage is that education is not evenly distributed. The level can be very different. Also contracts of assistant doctors during specialization are many times not extended after examination, thus hospitals use them as cheap work force and have no interest in offering a good educational program or even free hours for further education or courses.
How to get your degree recognized in Germany
If you have a degree from an EU member state, recognition should be quiet easy, but might take a couple of months. You need to hand in documents proving your eligibility to register as a medical doctor in the state of origin, a cv, a declaration of good standing from the medical association of origin, a birth certificate, a medical certificate from a doctor in Germany, criminal records from Germany and country of origin and country of study and official translations of all diplomas and documents into German language (no – English is not accepted..). Furthermore you need a proof of settlement or contract offer for the region you apply for. If you are not a native German speaker, you have to hand in a language certificate level B2 and a medical language certificate, too. You can download the checklist and forms at the respective states health authorities.
If you have a degree from outside the EU, you will have to proof the validity and conformity of your degree according to EU standards. There will be an exam related to the state examinations of Germany on top of all other the other things mentioned above.
List of possible specialist fields
(as a general advisory from the federal medical association ‘Bundesärztekammer‘ – there might be differences according to regions (Landesärztekammern); read the detailed ‘Weiterbildungsordnung’ for information on required work experience or download the log-book pre-printed forms at the regional ‘Ärztekammer’)
Allgemeinmedizin
Anästhesiologie
Anatomie
Arbeitsmedizin
Augenheilkunde
Biochemie
Surgery
Facharzt/Fachärztin für Allgemeinchirurgie
Facharzt/Fachärztin für Gefäßchirurgie
Facharzt/Fachärztin für Herzchirurgie
Facharzt/Fachärztin für Kinderchirurgie
Facharzt/Fachärztin für Orthopädie und Unfallchirurgie
Facharzt/Fachärztin für Plastische und Ästhetische Chirurgie
Facharzt/Fachärztin für Thoraxchirurgie
Facharzt/Fachärztin für Viszeralchirurgie
Gynaecology and Obstetrics
Schwerpunkt Gynäkologische Endokrinologie und Reproduktionsmedizin
Schwerpunkt Gynäkologische Onkologie
Schwerpunkt Spezielle Geburtshilfe und Perinatalmedizin
Ear-Nose-Throat
Facharzt/Fachärztin für Hals-Nasen-Ohrenheilkunde
Facharzt/Fachärztin für Sprach-, Stimm- und kindliche Hörstörungen
Dermatology and Venereology
Haut- und Geschlechtskrankheiten
Human Genetics
Hygiene und Umweltmedizin
Internal Medicine
Facharzt/Fachärztin für Innere Medizin
Facharzt/Fachärztin für Innere Medizin und Angiologie
Facharzt/Fachärztin für Innere Medizin und Endokrinologie und Diabetologie
Facharzt/Fachärztin für Innere Medizin und Gastroenterologie
Facharzt/Fachärztin für Innere Medizin und Hämatologie und Onkologie
Facharzt/Fachärztin für Innere Medizin und Kardiologie
Facharzt/Fachärztin für Innere Medizin und Nephrologie
Facharzt/Fachärztin für Innere Medizin und Pneumologie
Facharzt/Fachärztin für Innere Medizin und Rheumatologie
Pediatrics
Kinder-Hämatologie und –Onkologie
Kinder-Kardiologie
Neonatologie
Neuropädiatrie
Kinder- und Jugendpsychiatrie und -psychotherapie
Laboratoriumsmedizin
Mikrobiologie, Virologie und Infektionsepidemiologie
Mund-Kiefer-Gesichtschirurgie
Neurochirurgie
Neurologie
Nuklearmedizin
Öffentliches Gesundheitswesen
Pathology
Facharzt/Fachärztin für Neuropathologie
Facharzt/Fachärztin für Pathologie
Pharmacology
Facharzt/Fachärztin für Klinische Pharmakologie
Facharzt/Fachärztin für Pharmakologie und Toxikologie
Physikalische und Rehabilitative Medizin
Physiologie
Psychiatrie und Psychotherapie
Schwerpunkt Forensische Psychiatrie
Psychosomatische Medizin und Psychotherapie
Radiologie
Schwerpunkt Kinderradiologie
Schwerpunkt Neuroradiologie
Rechtsmedizin
Strahlentherapie
Transfusionsmedizin
Urologie