Germany’s bureaucracy blocks Ukrainian, Syrian doctors

Germany is facing a shortage of 50,000 doctors over the next few years, according to federal Health Minister Karl Lauterbach.

There are currently some 1.2 million Ukrainian and 972,000 Syrian refugees living in Germany, making them the two biggest groups of asylum seekers in the country. Many of them are highly qualified physicians. So why are so few able to practice medicine, even after being here for years?

Expensive, time-consuming hurdles

Oleksii Ukrainskyi, a 45-year-old anesthesiologist from Odesa, had his medical degree recognized in Germany in 2016, but he has since seen that the procedure has become much more difficult for refugees coming from Ukraine to Germany today.

According to research done by the national daily Die Welt, over 1,600 doctors have arrived since Russia invaded Ukraine in February 2022, and only 187 have been fully licensed to practice medicine.

In response to the influx, Ukrainskyi began leading free webinars and running a Telegram channel with 3,000 members seeking advice on the often confusing, overlong process.

"Back then I just had to get my diploma translated," Ukrainiskyi said. "Now they have to present these huge documents detailing every aspect of their education. And even if your university isn't in the middle of a war zone right now and you can get the documents, it can take six months and cost thousands of euros for the translation. For people who have had their homes destroyed, who have nothing, maybe one suitcase — this can be an insurmountable hurdle."

Sixteen different sets of rules

Even once your documents are translated and you have passed a German language exam, however, it's hardly smooth sailing into a practice or a hospital. The next part of the process is getting your education declared equivalent to a German medical degree. Due to differing requirements for the number of theoretical exams and the amount of practical experience in different countries, most foreign doctors must make up the difference by completing practical internships, taking exams, or both.

Health policy is a matter for the 16 federal states in Germany. Each of them has a different set of standards a foreign doctor must meet.

"Most of the people, I'd say some 80%, in my Telegram channel are women between the ages of 35 and 45 with children. Their husbands had to stay behind in Ukraine because they are of draft age," Ukrainskyi said. "They have to somehow arrange for childcare while they prepare for exams. Or take, for example, older doctors. A 50-year-old dermatologist who has been practicing for 20 years, but whose medical school days are long behind him may not very easily pass an exam in internal medicine meant for 22-year-old students in Germany."

"The process takes so long, many months or even years, and in the meantime, you can work as a nurse if you're lucky, in the supermarket or a pizzeria if you're not," the anesthesiologist said.

Germany's main doctor's union seeks less bureaucracy

The Marburger Bund, Germany's largest doctor's union, is just as critical of the system for licensing foreign doctors. The process is inexorably slow, they say, partly because there is a single office for assessing foreign medical qualifications and it is painfully underfunded and understaffed. The Assessment Body for Healthcare Professions (GfG) in Bonn needs "more staff, less bureaucracy, more digitalization of procedures" and more standardization across Germany's 16 states, according to Marburger Bund spokesman Hans-Jörg Freese.

Even after doctors endure long waits to even get an appointment for an exam, Freese added, "a professional license is often only issued to them for two years. Long delays in a [second] application process can lead to these doctors becoming unemployed after two years and living off of unemployment, even if their employer is desperate to keep them."

Calls for a single, unified process

Nibras Soubh, a cardiologist from Syria who now works at the University of Göttigen hospital, had a similar experience. Like the Marburger Bund, he has called for one unified process across all of Germany.

Foreign doctors "must apply for medical licensure through local authorities in each state, each with its own regulations. These can vary significantly across Germany, from the required documents and types of translation and legalization needed to the available licensing pathways and exam structures," Soubh said.

Soubh came to Germany in 2016 at a time when hundreds of thousands of Syrians came to Germany fleeing the civil war in their home country. According to Daniel Terzenbach, the Federal Commissioner for the Integration of Refugees into the Labor Market, 70% of them have found jobs here.

Nibras Soubh is one of them. He is a member of the SyGAAD (Syrian Society for Doctors and Pharmacists in Germany), who carried out a survey in northern Germany last year that found 30% of applicants wait at least a year to have their degree recognized.

Syrian doctors face anti-immigration backlash

Syrian doctors are also facing pressure to get licensed as calls for more deportations reach a fever pitch. Following a deadly knife attack in the city of Solingen by a Syrian asylum seeker earlier this month, some conservative politicians have called to stop accepting Syrian refugees altogether. Moderate and right-wing politicians have been increasingly vocal about what they see as the need to deport rejected asylum seekers to Syria, which is currently not possible.

Although, as German media reports have noted, there are more doctors entering the work force every year, it is not enough to keep up with demographic changes. Moreover, a huge number of doctors have begun to work part-time. According to a report by public broadcaster ZDF, in 2023 only 85% of general practitioners work full-time. In 2009, that number was 98%.

"Working full time means a doctor is usually working 50 or 60 hours a week," the Marburger Bund told public broadcaster ZDF. Only doctors who reduce their contracts to 70% of full-time may end up with the usual 40-hour work week.

Doctors are also not evenly distributed across Germany. Urban areas have a glut of specialists, whereas rural Germans may have to travel long distances and endure long waits just to see a general practitioner.

Therefore, it is "beyond unacceptable," as Freese of the Marburger Bund put it, "to put unnecessary hurdles in the way of internationally-educated doctors."

Edited by Rina Goldenberg

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