German bureaucracy holds up foreign doctors

In the middle of a pandemic that is threatening to overwhelm Germany's health care system, Ben, a Berlin-based surgeon from Poland, spends his evenings stitching up cow intestines that he buys from his local supermarket. 

"Specialist surgery is like driving a car," the 34-year-old, who holds medical degrees from universities in Libya and Egypt, explained to DW. "When you don't drive your car for a while you forget how to drive. So I bought some intestines from the supermarket and I am stitching it in my home."

Ben, who did not want to give his full name for fear of prejudicing authorities evaluating his application, spent 10 years as a general surgeon before moving to Berlin last year. With his European Union passport, he had no trouble moving to Germany, but endless stress finding a job.

"I am an assistant lecturer," he added. "I used to teach medical students in Libya. I have a lot of experience in my field, and I am losing my experience."

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The coronavirus outbreak has injected a new urgency into the issue, as Germany's health care system faces a sharp rise in cases. Last week, Health Minister Jens Spahn wrote to three state governments urging them to reconsider a decision they made last year not to automatically accept Polish medical degrees, following an EU directive that highlighted discrepancies between the two systems.

"Independent of a final European legal assessment of this solution, I would consider a pragmatic approach from the authorities appropriate," Spahn wrote in the letter, quoted in German media.

Tough exams

But that isn't much use to Ben, who is working as a medical orderly in a hospital as he bounces between two authorities: The Berlin Health Department and the Berlin Ärztekammer, or Medical Council. At the moment he has been waiting for four months for a paper from the former to take to the latter, who will set him a German medical language exam, one of three he has to pass before he can get his license. "It is very time-consuming and money-consuming," as he puts it.

The process can take up to 18 months, according to Sameer, a Syrian doctor who came as a refugee, successfully passed and now works as a junior doctor. The long delays cause extra worries about residency and work permits, and applications can cost several thousand euros in administrative fees, language courses and exams, depending on the bureaucracy in the given German state.

"The bureaucracy gets more and more complicated," said Sameer. "In Germany, for every exam you need an appointment, but it can take a year, because there are a lot of applicants and a limited number of doctors who can do it."

But Sameer and Ben know several potential doctors who gave up and left the country.

"A friend of mine from Libya went back a month ago — he's a specialist in intensive care," said Ben. "These kinds of doctors right now are needed in Germany, but he said, 'I lost too much money waiting.'"

"Why did I come to Germany?" Ben continued. "I heard it was the best place you can achieve your dreams as a surgeon. I want to improve my skills, and I will give something back to Germany: I will give myself to treat the German people."

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Tortuous bureaucracy

There's one simple reason why the bureaucracy takes so long, said Stephan Schiele, of Tür zu Tür ("Door to Door"), a Bavarian integration project: "The appropriate authorities are hopelessly understaffed."

But there are also bureaucratic reasons: Each applicant's qualifications are assessed individually: that is, the authority appoints an assessor who has three months to decide what the foreign qualification entails, and what it might correspond to in the German system.

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There has been some recent effort to expedite the process, at least with nursing: Pilot projects have started vetting entire foreign nursing schools, rather than individual qualifications.

"We're moving in that direction with the doctors too, but of course it takes a while because you have to look more closely at the courses," said Schiele.

At the same time, as he acknowledged, "Medical training is a sensitive point: Imagine if we allowed doctors into the clinics without recognition. As soon as there was some kind of problem, people would scream blue murder."

Political urgency

Despite the impending shortage of doctors, the bureaucracy can't simply be expedited, pandemic or no pandemic. In mid-March, the Saxony medical council posted an appeal on Facebook for foreign doctors without a work permit living in the state.

In a statement to DW, the council said that about 200 foreign doctors had responded to the call, but clarified that they would not be deployed to work as doctors. Instead, they would be asked to man the coronavirus hotlines, carry out tests and work as nurses. "This is not associated with an (accelerated) recognition (of qualifications), and that isn't being planned," the statement said.

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A spokesperson for Berlin's Medical Council said in an email that the capacities of the council itself were limited because of the current situation, and therefore it was "not realistic" that foreign doctors could suddenly be fast-tracked into hospitals. The Berlin Health Department, the LaGeSo, struck a similar tone, saying that states could not unilaterally change guidelines without consulting other states. But its statement added: "We continue to be making an effort to find all helping hands for the next weeks and months, including the not-yet approved doctors."

Sameer, for his part, understands the reluctance to throw bodies at the frontline in the current crisis, but still thinks the bureaucracy is painfully slow.

"I have a lot of friends in Berlin who finished the German and are dying to do the exams, and the next appointment is in a year, or even 18 months," he said.

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