Employment Law2026-11-02

Foreign Healthcare Qualifications: How Does Recognition Work from 1 November 2026?

Since 1 November 2026, the knowledge test has been the statutory default route for non-EU qualifications in the healthcare professions. Anyone who wants the equivalence assessment has just four weeks from the date of application — and whoever applied before the cut-off is still covered by the old law.

You work in a hospital or a care facility, your professional qualification comes from abroad — and since 1 November the rules for recognition have been different from the ones that applied when you first set out. This is no mere formality: the choice of procedure you make in the first four weeks determines whether you have to sit a full examination or whether you can be granted a licence without any test at all. And all the while your employment contract carries on, often on a fixed term, often at a grade below your qualification.

In brief

For medical qualifications from a non-EU country, the knowledge test has been the statutory default route since 1 November 2026 (§ 9d Abs. 2 Satz 1 BÄO). The equivalence assessment, which still allows a licence to be granted without any test, is something you have to choose actively — and you can only do so up to four weeks after applying (§ 9d Abs. 2 Satz 2 BÄO); after that you are bound for the current procedure. Anyone who filed their application by the end of 31 October 2026 will still be dealt with under the old law (§ 15 BÄO). Nursing follows a different model: there, the equivalence assessment remains the starting point, but you can waive it for good (§ 40 Abs. 3a PflBG).

How I can help

Checking which law applies to your application — old or new — and what follows from that
Deciding on the choice of procedure within the four-week window, with reasons set out to the authority
Objection and legal action against decisions that assume substantial differences or refuse to accept documents
Pressing an authority that will not decide — up to and including an action for failure to act
The employment-law side: fixed terms, pay grading, back pay from the date of recognition, repayment clauses for preparation costs
For employers: legally sound contracts for the recognition phase, rather than fixed terms that come apart later

We will discuss costs openly in the initial consultation — on the basis of the RVG — and I will check whether legal expenses insurance will cover the matter.

Which law applies to your application: the 31 October 2026 cut-off

The Act of 22 July 2026 (BGBl. 2026 I Nr. 225) overhauled the recognition law for the healthcare professions; the key part has applied since 1 November 2026, and the implementing regulation setting out the details of the examination was published only a few days beforehand.

The transitional rule is drawn narrowly: for applications to recognise a professional qualification obtained in a non-EU country that were filed by the end of 31 October 2026, the old procedure continues to apply (§ 15 BÄO). What matters, then, is the date your application was received by the competent body — not when the authority regards the documents as complete, and not when it decides. If you applied at the end of October and have now received a letter calling you to a knowledge test, the first question is always: under which law is my application actually being handled? Keep your proof of receipt; in this situation it is the most important document you have.

The new default route — and your four weeks

For qualifications from a non-EU country, the procedure has now been turned on its head. As a rule, the knowledge and skills required are demonstrated by a professional-admission examination relating to the content of the state final examination — the knowledge test (§ 9d Abs. 2 Satz 1 BÄO). This is a full examination, not one confined to particular gaps.

Alongside it, the equivalence route remains open (§ 9d Abs. 3 BÄO): if your training is equivalent, the licence is granted without any test. The yardstick is whether there are substantial differences, and professional experience or documented further training can make good such differences (§ 9d Abs. 3 Satz 2 i. V. m. § 9c Abs. 5 und 6 BÄO). There are three things you need to know here:

You can only choose this route up to four weeks after applying (§ 9d Abs. 2 Satz 2 BÄO). After that, the knowledge test stands.
The decision binds you for the duration of the licensing procedure (§ 9d Abs. 2 Satz 3 BÄO). There is no provision for switching halfway through.
It is no guarantee: if the authority finds substantial differences, you will have to sit the knowledge test after all — only months later. The same applies where documents cannot be produced for reasons not within your control and the assessment would only be possible with unreasonable effort (§ 9d Abs. 3 Satz 5 BÄO).

The authority must inform you of this option and its consequences (§ 9d Abs. 2 Satz 4 BÄO). Do not rely on this being done in good time and in terms you can understand.

Which to choose is a matter of weighing things up: how closely your curriculum tracks German training, how robust your evidence is, how much documented professional experience you can set against the differences — and how much time you have, for instance because a residence permit or a fixed-term contract is running alongside. One hurdle is often overlooked: the qualification must have been required in the country where it was obtained for direct access to the corresponding profession (§ 9d Abs. 1 Nr. 1 BÄO).

Nursing and EU qualifications: different professions, different mechanics

The reform model does not apply to qualifications from the EU, the EEA and Switzerland. There, the automatic recognition of certain training certificates remains in place and, where that does not apply, so does the equivalence assessment combined with an aptitude test confined to the substantial differences that have been identified (§ 9c BÄO). That is something different — and considerably less — than a knowledge test.

In nursing, too, the order is different. The starting point is the equivalence of the level of training (§ 40 Abs. 1 und 2 PflBG). If it is lacking, you have the choice between a knowledge test and an adaptation course of no more than three years with a final examination (§ 40 Abs. 3 PflBG); in doing so, the authority is to take account of the findings available, in particular the model expert opinions of the Gutachtenstelle für Gesundheitsberufe (§ 40 Abs. 3 Satz 4 PflBG). What is new is that you can waive the equivalence assessment for good and demonstrate your level of knowledge directly (§ 40 Abs. 3a PflBG) — with a duty on the authority to inform you.

A practical point on this: the three-month period that is so often cited comes from the Berufsqualifikationsfeststellungsgesetz. For nursing, that Act’s application is expressly excluded save for a single provision (§ 40 Abs. 4 PflBG), and under the Bundesärzteordnung the procedural time limits are delegated to a statutory regulation (§ 4 Abs. 5 BÄO). So it is not something you can simply insist on. If the authority fails to decide over a period of months, the route is an action for failure to act before the administrative court — there, because the licence and the permission to practise are administrative acts; such an action is as a rule admissible at the earliest three months after the application (§ 75 VwGO). And note: where the requirements are met, the licence must be granted on application (§ 3 Abs. 1 Satz 1 BÄO, and for nursing § 2 PflBG) — not an act of grace but a bound decision, one that engages the protection of occupational freedom under Art. 12 Abs. 1 GG and is fully reviewable by the courts.

What happens to your employment contract in the meantime

Recognition is a matter of administrative law, your pay is a matter of employment law — and this is where most of the conflicts arise.

Permission to practise rather than a licence: doctors can obtain a permission to practise that is restricted to particular activities and places of employment, is revocable, and is as a rule limited to a total duration of no more than two years (§ 10 Abs. 1 und 2 BÄO) — with exceptions in special individual cases or for reasons of patient care (§ 10 Abs. 3 BÄO). In all other respects you have the rights and duties of a doctor (§ 10 Abs. 6 BÄO). So anyone doing the full job should not be treated as an auxiliary.

Fixed terms: employers like to tie the contract “to the expiry of the permission to practise”. That ground does not appear in the statutory list of objective reasons; the list is admittedly not exhaustive (“in particular”, § 14 Abs. 1 Satz 2 TzBfG), but whether such a fixed term holds up is a matter for scrutiny and is anything but a given. Moreover, every fixed term requires the written form (§ 14 Abs. 4 TzBfG) — a fixed term “extended” orally or by message is as a rule invalid, in which case the employment relationship carries on indefinitely.

Grading and back pay: where you are paid during the recognition phase at a level below the target qualification, it comes down to the contract and the applicable collective agreement. What is decisive is the date from which the higher grade takes effect — often that is the date of recognition, not the date on which the HR department notices. Arrears must be claimed; watch out for contractual or collective limitation periods that cut off such claims after only a few months.

Cost coverage with a repayment clause: if the employer meets the cost of exam preparation, language courses or fees and demands a period of commitment in return, the clause has to be measured against the limits of contract review — too long a commitment, a flat-rate repayment, or repayment even where it is the employer who gives notice all leave it open to challenge.

Residence: if your permit runs under § 16d AufenthG, the scope and maximum duration of employment are governed there and are tied to the recognition procedure. A decision in the employment relationship may have a knock-on effect on your residence status — that belongs in the same assessment.

A typical case

A doctor with a qualification from a non-EU country has been working on a ward for a year and a half, on the basis of a permission to practise, her employment contract fixed-term “for the duration of the permission”. She files her application for a licence at the beginning of November. The authority announces that the knowledge test will be scheduled. She considers her training to be equivalent and has complete curricula and certificates — but she does not respond, because she takes the letter to be an interim notification. After four weeks the equivalence route is closed for this procedure. At the same time the permission expires in three months; the hospital holds out the prospect of continued employment “as an assistant”. Both matters now have to be sorted out: whether the fixed term holds up at all — the last extension was only confirmed by email — and what can still be done with the authority in the meantime. Two procedures, two branches of the courts, one strategy.

Common mistakes

Treating the authority’s letter about the choice of procedure as information rather than a deadline. Four weeks are four weeks.
“Just quickly completing” the application, even though it is the date the application was received that governs which law applies — and failing to secure proof of receipt.
Choosing the equivalence assessment without first checking whether the documents will support it. If it fails, it costs months and ends in the test anyway.
Merely asserting professional experience. Anything meant to make good a difference has to be evidenced and formally confirmed.
Signing a variation agreement that permanently lowers the grade because “recognition isn’t through yet”.
Only raising the back pay of the salary difference after recognition and running into a limitation period.
Letting a dismissal or a variation dismissal lie because the recognition procedure is to be sorted out first. The employment-tribunal deadline does not wait.

Frequently asked questions

My application was received in October — do I now have to sit a knowledge test anyway?

No, not automatically. For applications filed by the end of 31 October 2026, the previous procedure continues to apply (§ 15 BÄO). If the authority nonetheless deals with you under the new law, you should challenge this using your proof of receipt, before any examination dates are fixed.

I missed the four weeks. Is the equivalence route gone for good?

For the current licensing procedure the decision is binding (§ 9d Abs. 2 Satz 3 BÄO). What has to be examined in such cases is whether the authority discharged its duty to inform you (§ 9d Abs. 2 Satz 4 BÄO) and when the period actually began to run — on that depends whether anything can be derived from it.

May my employer pay me below my qualification until recognition comes through?

In principle you are paid for the work you are in fact permitted to carry out under your contract and your permission. Anyone practising as a doctor on the basis of a permission to practise has, in any event, the rights and duties of a doctor (§ 10 Abs. 6 BÄO). So fix in writing from which date which grade applies — and claim any differences promptly, not a year later.

The authority has gone months without deciding. Is there anything I can do?

Yes. Where a decision fails to come without sufficient reason, the route is an action for failure to act before the administrative court; as a rule it is admissible at the earliest three months after the application (§ 75 VwGO). The administrative court has jurisdiction because it is an authority that decides on the licence and the permission by way of an administrative act — whereas your pay and your contract belong before the employment tribunal.

My contract is fixed for the duration of my permission to practise. Does it simply end with it?

Not necessarily. Every fixed term requires the written form (§ 14 Abs. 4 TzBfG), and whether the fixed permission provides a tenable objective reason is a question of law, not something the employer gets to lay down. Extensions made only orally or by email, in particular, often lead in practice to the employment relationship continuing indefinitely.

Your next step

If your employer offers to continue your employment on worse terms — a lower grade, different duties, “until recognition comes through” — and ties that to a dismissal, then it is a variation dismissal, and you can accept the offer subject to reservation: you keep your job while the court examines the change. This reservation must be declared within the notice period, but at the latest within three weeks of receiving the dismissal (§ 2 KSchG) — and for the claim itself a three-week period applies from receipt (§ 4 KSchG). Anyone who misses this deadline loses their objections, however good they were.

Bring to the initial consultation whatever you have: your application and the confirmation of receipt, every letter from the recognition body, your employment contract with all its extensions, your most recent payslips and — if there is one — the dismissal or the draft contract. From these the order of play emerges: which deadline first, which route with the authority, which with the employer. I work on these cases throughout Germany, by video or telephone; on employment law you will also find the related topics there. This article provides general information and is no substitute for an examination of your case.

This article provides general information and is no substitute for legal advice in an individual case. Last updated: 2026-11-02.

Christian Czirnich, Rechtsanwalt (attorney at law), Kirchseeon near Munich

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