Approbation is the full German licence to practise medicine. How long does it take if you studied medicine outside the EU, and what does it cost? We couldn't find an overview anywhere that compares this for all 16 German states. So we spent a lot of time gathering the information ourselves: from authority websites, fee regulations, answers given to state parliaments and the medical chambers' annual reports. We checked every figure against the original source and bundled everything in the Anerkennungsmonitor 2026, our comparison of all 16 German states. This article is the short version, and for each figure it tells you who gives it and how old it is.
In short: where a ministry or state government states the total duration, it is one and a half to two years. But only three of the 16 states do that. Costs are clearer. The Kenntnisprüfung, the medical knowledge exam you take in front of an examination board, costs between €400 and €1,350 depending on the state. For the Fachsprachprüfung (FSP), the German exam at doctor level run by the medical chamber, you usually pay between €400 and €700.
How long does Approbation take? Only three states give a total duration
For qualifications from third countries, meaning countries outside the EU, the EEA and Switzerland, there are only three officially documented figures for the total duration:
- Brandenburg: Total duration (third countries): "one and a half to two years"; Source: Brandenburg Ministry of Health
- Saxony-Anhalt: Total duration (third countries): around 18 months from arrival to practising; Source: Landesverwaltungsamt Sachsen-Anhalt (state administration office)
- Thuringia: Total duration (third countries): up to 671 days, so around 22 months; Source: State government's answer to a parliamentary question (data from December 2025)
With an EU qualification it is much faster: Brandenburg gives around 4 months, Saxony-Anhalt around one month, Thuringia an average of 237 days.
Three more states only give one part of the process. Berlin writes that a recognition procedure "can also take several years", but gives no average. In Schleswig-Holstein, according to the state office, you wait 12 months on average just for the Kenntnisprüfung. In Baden-Württemberg, an expert report on your medical knowledge currently takes around 15 months, according to the Regierungspräsidium Stuttgart, the regional authority. The other ten states give no reliable figure for the total duration.
Why "three months" on the authority's website is not your waiting time
Many authorities write "three months" or "four months". That is usually the legal deadline, and it only starts once all your documents are complete. The Landesdirektion Sachsen, for example, says "usually four months after all documents have been received". Bremen and Hamburg write "depends on the individual case" on their service pages.
What these figures leave out is the months before that: getting your documents and having them translated, waiting for the Fachsprachprüfung, waiting for an expert report or a date for the Kenntnisprüfung. So when you compare states, always ask where the clock starts. Otherwise you end up comparing one deadline for a single step with a total duration.
In our survey of 302 international doctors, 41.7% named exactly this as one of the biggest burdens: not knowing how much longer it will take.
For the exams, the states differ mainly in waiting time, fee and pass rate.
Waiting times for the FSP and Kenntnisprüfung by state
For some states there are official statements on how long you wait for an exam date. They come from authorities, medical chambers or answers given to state parliaments, and they date from different times.
For the Fachsprachprüfung, you wait around three to four months in four of the five states that publish anything on it: Rhineland-Palatinate says "around three months", the Thuringia state medical chamber 3 to 4 months from your application, the state office in Schleswig-Holstein about 3½ months, and the Hamburg chamber about 3 months as a guide. The Berlin Senate said four to eight weeks in October 2024.
For the Kenntnisprüfung, the figures vary more. In Berlin, according to the Senate, it takes between five and nine months until the exam, with two exam phases a year and 80 to 100 places each. Schleswig-Holstein gives 12 months on average. The Regierung von Oberbayern, the Upper Bavaria authority, invites you to a date within 1 to 6 months. Baden-Württemberg gave 4 to 5 months in reply to a freedom-of-information request, and Lower Saxony speaks of "several months".
In North Rhine-Westphalia, the Westphalia-Lippe medical chamber gives Kenntnisprüfung dates soon after admission. The monitor lists a waiting time of 0 to 8 weeks for this. For the remaining states, we found no public source with a specific waiting time. You can find the exact values and the date of each source in the state comparison of waiting times and fees by clicking on the state.
What do the Kenntnisprüfung and Fachsprachprüfung cost?
Each state sets its own fees. These are the official exam fees, without preparation courses, translations or travel costs. Most values come from the Marburger Bund overview (as of September 2025), the doctors' union, and some come directly from the chamber or authority:
- Hesse: Kenntnisprüfung: €1,350; Fachsprachprüfung: €650
- Baden-Württemberg: Kenntnisprüfung: €1,100; Fachsprachprüfung: €420
- Rhineland-Palatinate: Kenntnisprüfung: €1,100; Fachsprachprüfung: €470 (as of 1.1.2026)
- North Rhine-Westphalia: Kenntnisprüfung: €1,050; Fachsprachprüfung: €400 (Westphalia-Lippe) to €430 (Nordrhein)
- Lower Saxony: Kenntnisprüfung: €980 (from 1.1.2026); Fachsprachprüfung: €595 (from 1.1.2026)
- Hamburg: Kenntnisprüfung: €900; Fachsprachprüfung: €550
- Saxony: Kenntnisprüfung: €850; Fachsprachprüfung: €590
- Brandenburg: Kenntnisprüfung: €799; Fachsprachprüfung: €487
- Saxony-Anhalt: Kenntnisprüfung: €771; Fachsprachprüfung: €500
- Bremen: Kenntnisprüfung: €730; Fachsprachprüfung: €530
- Mecklenburg-Western Pomerania: Kenntnisprüfung: €640; Fachsprachprüfung: €700
- Berlin: Kenntnisprüfung: €540; Fachsprachprüfung: €550
- Bavaria: Kenntnisprüfung: approx. €520; Fachsprachprüfung: €550
- Saarland: Kenntnisprüfung: €500; Fachsprachprüfung: not clearly documented
- Thuringia: Kenntnisprüfung: up to €450; Fachsprachprüfung: €600
- Schleswig-Holstein: Kenntnisprüfung: €400 (first exam), €750 (retake); Fachsprachprüfung: exam via the Mecklenburg-Western Pomerania medical chamber
That gives Hesse the highest Kenntnisprüfung fee in Germany. According to hessenschau, 1,209 applications there were also waiting for a decision in March 2026. Before you pay, check the current fee with your authority or chamber, because fee regulations change. Lower Saxony, for example, introduced new fees on 1 January 2026.
Fail rates: how many pass the FSP and the Kenntnisprüfung?
For the Fachsprachprüfung, some medical chambers publish their figures in their annual reports. These rates (share who did not pass) are documented:
- Bavaria: FSP not passed: 52% (2025), 48% (2024); Note: Annual report 2025, 3,557 exams
- Bremen: FSP not passed: 48.6% (54 of 111 exams); Note: Annual report 2023
- Saxony: FSP not passed: 45.42% (2024); Note: 362 exams not passed
- Nordrhein: FSP not passed: 37% (2024), 36% (2023), 33% (2022); Note: 2,823 exams in 2024
- Saxony-Anhalt: FSP not passed: 32.8% (2024), 30% (2025); Note: according to the Saxony-Anhalt medical chamber
- Berlin: FSP not passed: 31.3% (2024), 38.7% (2023), 33.9% (2022); Note: Annual report 2024
- Thuringia: FSP not passed: 23.4% (86 of 368 exams); Note: Annual report 2024
The Brandenburg state medical chamber gives a national average of "around 40 percent" and, for Brandenburg, "a significantly higher fail rate by comparison", but no figure of its own.
For the Kenntnisprüfung, there is less data. In Bremen, 17 of 54 candidates did not pass (31.5%, annual report 2023). Berlin reported fail rates of 23%, 21% and 12% for 2019 to 2021. The Landesdirektion Sachsen gives 13.66% who failed for good, meaning after all attempts. For the remaining states, we do not list verified rates here.
The same rule applies everywhere: you can retake the Kenntnisprüfung twice, so you have three attempts at most.
What has changed since 1 November 2026
The figures in the monitor date from September 2026, so they describe the procedure before the reform. Since 1 November 2026, the Kenntnisprüfung has been the standard route for new applications with a qualification from a third country. If you would rather have the authority check your training for equivalence based on your documents, you have to decide within four weeks of your application. That decision then applies to the whole procedure. The authority has to explain this choice and its consequences to you.
Even after an equivalence check, you may still need a Kenntnisprüfung if substantial differences are found. If you submitted your application by 31 October 2026, the old rules on equivalence still apply to you. The figures so far don't yet show whether or how the reform will change waiting times for the Kenntnisprüfung.
Which state is right for you?
You can't seriously name a "fastest state" from this data, because ten states give no total duration at all and the others measure differently. But you can compare specific things: how long will you wait for the FSP and Kenntnisprüfung in the state you want, what do both cost together, and how many people pass there?
Where you want to live and work matters too, because you apply in the state where you want to practise. For the personal side of the decision, our guide Which federal state for Approbation? helps. The individual steps are explained in the guide to Approbation in Germany, and how to prepare is covered in our articles on the Fachsprachprüfung and the Kenntnisprüfung. You'll find all our services for your route in the overview for doctors from abroad.
How long does Approbation take for a foreign doctor?
With a qualification from a third country, Brandenburg, Saxony-Anhalt and Thuringia give a total duration of between around 18 months and two years. The other 13 states give no reliable total duration. With an EU qualification it is much faster: around 4 months in Brandenburg.
How much does Approbation cost in total?
There is no fixed total, because each state has its own fees. The Kenntnisprüfung alone costs between €400 in Schleswig-Holstein (first exam) and €1,350 in Hesse, and the Fachsprachprüfung usually between €400 and €700. On top of that come other administrative fees, for example for the Berufserlaubnis (the temporary permit to practise), plus costs for translations and preparation.
What is the fail rate for the Kenntnisprüfung?
Public figures exist for only a few states: in Bremen, 31.5% did not pass (2023), and in Berlin the rates for 2019 to 2021 were 23%, 21% and 12%. Saxony gives 13.66% who failed for good after all attempts. You have three attempts in total.
How many people fail the Fachsprachprüfung?
It depends a lot on the state. Documented figures include 23.4% in Thuringia (2024), 37% in the Nordrhein chamber area (2024) and 52% in Bavaria (2025). The Brandenburg state medical chamber gives a national average of around 40 percent.
Which state gives you a Kenntnisprüfung date fastest?
In North Rhine-Westphalia, according to the Westphalia-Lippe medical chamber, dates are given soon after admission. In Bavaria, the Regierung von Oberbayern invites you within 1 to 6 months, and in Berlin it takes five to nine months. Many states publish no waiting time, and the reform of 1 November 2026 may change the picture.
Where do the figures come from, and how up to date are they?
All values come from Get2Germany's Anerkennungsmonitor 2026, as of September 2026. We checked every figure against fee regulations, answers given to state parliaments, chamber reports or authority websites. In the Anerkennungsmonitor you'll find the original source for every value along with our verification result.
