What does it take to open a medical practice in Germany?

A doctor needs an Approbation from the competent Land authority, reports the start of practice to the Landesärztekammer and follows its Berufsordnung, including professional liability insurance. Treating statutory patients needs a Zulassung from the Zulassungsausschuss, and from that day the practice has three years to put the QM-Richtlinie in place.

The Approbation, from the Land

Anyone who wants to practise medicine in Germany needs an Approbation.¹ It is granted on application to a person who has not shown themselves unworthy or unreliable, is fit to practise, has completed at least six years and 5,500 hours of medical study and passed the state examination, and has the German needed for the profession.² Each Land grants it through its own authority.

Berlin asks for the examination certificate, an official criminal record certificate, proof of identity, a declaration on pending proceedings and a medical certificate of fitness.³ Bavaria grants the Approbation without time limit and for the whole of Germany.⁴ Hamburg asks EU-trained doctors for a medical certificate from a doctor practising in Germany, no older than three months when the Approbation is issued.⁵

The Kammer, the Berufsordnung and the KV

Every doctor who practises or lives in Berlin reports the start, end and every change of practice to the Ärztekammer Berlin, within one month of starting.⁶ The model Berufsordnung ties outpatient practice to a Praxissitz, asks for a practice sign with name, specialty and hours, requires the place and date of starting to be reported to the Ärztekammer without delay, and obliges every doctor to carry adequate liability insurance.⁷

To treat statutory patients, a doctor applies to the Zulassungsausschuss for a Zulassung at the place of practice, after entry in the Arztregister the KV keeps for each district.⁸ From the Zulassung, the practice has three years to put every QM method in place and review it.⁹

1. Hold the Approbation. Apply to the Land authority for the place you studied or the Land you will work in, as its rules say.
2. Report to the Ärztekammer. In Berlin within one month of starting, on the Kammer's own forms.
3. Insure the practice. Professional liability insurance in place before the first patient.
4. Apply for the Zulassung. Arztregister entry, then the Zulassungsausschuss for the Vertragsarztsitz.
5. Start the QM clock. Diary the date three years from the Zulassung, and set the first quality goals now.
6. Set up the record. A patient file that meets § 630f BGB from the first entry.

1. Doctor ______ Approbation from ______ Dated ______
2. Ärztekammer ______ Reported on ______
3. Liability insurer ______ Policy from ______
4. Arztregister entry ______ Zulassung dated ______
5. Praxissitz ______ Practice sign ordered ______
6. QM three-year date ______ QM lead ______
7. Opening date ______

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Questions

Is an Approbation valid in every Land?

Yes. Bavaria states that the Approbation it grants is valid for the whole of Germany and without time limit.

Do we need a Zulassung for private patients only?

The Zulassung under § 95 SGB V is for taking part in statutory care. The Approbation, the Kammer and the Berufsordnung apply either way.

How soon must we tell the Ärztekammer Berlin?

Within one month of starting to practise or moving to Berlin, and within five days for short-term practice.

Can we practise at more than one site?

The model Berufsordnung allows practice at two further places beyond the Praxissitz, with proper care arranged at each.

Sources

1. 1Bundesministerium der Justiz, Gesetze im Internet, 2026§ 2 BundesärzteordnungRead source
2. 2Bundesministerium der Justiz, Gesetze im Internet, 2026§ 3 Bundesärzteordnung, ApprobationRead source
3. 3Land Berlin, Landesamt für Gesundheit und Soziales, 2026Approbation als Arzt, Erteilung, wenn Ärztliche Prüfung in Berlin abgelegtRead source
4. 4Freistaat Bayern, BayernPortal, 2026Arzt/Ärztin, Beantragung einer Approbation bei Ausbildung in DeutschlandRead source
5. 5Freie und Hansestadt Hamburg, Landesprüfungsamt für Heilberufe, 2026Approbation EU, Hinweise zur Erteilung einer Approbation, Stand 01/2026Read source
6. 6Ärztekammer Berlin, 2022Meldeordnung der Ärztekammer Berlin vom 27. November 2019, geändert am 11. Mai 2022Read source
7. 7Bundesärztekammer, 2026(Muster-)Berufsordnung für die in Deutschland tätigen Ärztinnen und Ärzte, MBO-Ä 1997, in der Fassung des 130. Deutschen Ärztetages vom 13. Mai 2026Read source
8. 8Bundesministerium der Justiz, Gesetze im Internet, 2026§ 95 SGB V, Teilnahme an der vertragsärztlichen VersorgungRead source
9. 9Gemeinsamer Bundesausschuss, 2026Richtlinie über grundsätzliche Anforderungen an ein einrichtungsinternes Qualitätsmanagement (QM-RL), Volltext, BAnz AT 19.08.2026 B4Read source

Written by the wai team from Gemeinsamer Bundesausschuss, the Kassenärztliche Vereinigungen and the Länder guidance, checked on 16 October 2026. This is guidance, not legal advice. Neither the G-BA, any KV nor any Land authority endorses wai or any software.