collageIf you’re planning a vacation in Europe, you may be wondering whether your doctor from home will be able to help you during your trip. This is a good thing to consider but doesn’t have an easy answer. In this article I’ll explain how doctors move between countries and whether it’s possible for them to help you with your medical needs in another country.
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can american doctors practice in europe
It is the only hospital in Europe where a doctor can practice with a U.S. medical license. American doctors hoping to work in Europe would normally have to re-do their residencies before practicing independently.
In general, students who wish to practice medicine in the U.S. must first earn a college degree that includes at least three years of what is known as pre-med education. Bachelor of Science degrees in chemistry and biology usually fit into the pre-med mold, and some schools offer programs that are straight pre-med with an eye towards gaining admission into medical school. Once admitted into medical school, the next four years will be spent in pre-clinical and clinical education periods that culminate with graduation and the granting of a Doctor of Medicine degree before heading into internship and residency.
It said that the US has high-quality standards when it comes to medical licensing. While foreign physicians may have gone through an exceptional amount of quality training overseas, the American medical industry has taken extra strides to confirm that foreign physicians looking to practice medicine in the US go through the educational training that’s set by American standards.
If you are a foreign physician interested in practicing medicine in the US, then you’ll need to prepare yourself to pass the US Medical Licensing Exams, get certified by the Educational Commission for Foreign-Trained Medical Graduates, enroll in a residency program, and then take a third licensing test.
Foreign physician, Abdelsalam Elshaikh of Sudan, reported to MPR News that all of the first year pre-med courses such as physiology, biology, etc. weren’t taught to them. This is because the curriculum for some overseas education usually focuses on what the physician will actually have to deal with when treating patients—fieldwork. US standards require that physicians are fluent in the English language and have a basic understanding of the science field in general along with understanding the core requirements set by accredited universities such as:
- Introduction to Chemistry
- General Biology
- Anatomy and Physiology
- College Algebra
- Physics
- Calculus
- Molecular and Cell Biology
- Human Embryology
- Epidemiology
- Biochemistry
- Research Writing
- Principles of Genetics
Educational Differences in the American Physician Training System
Unlike physician training programs in other parts of the world, there is no foundation training in the U.S. because medical students can choose to specialize, or not, upon getting their M.D. degree. The Bachelor of Medicine and Bachelor of Surgery programs often taught in Asian colleges, for example, are unheard of in the U.S. It is not uncommon for an American pediatrician to have earned a Bachelor of Arts in Sociology plus a Master of Health Sciences before qualifying for medical school.
US Medical Licensing Exam Requirements
With the above in mind, it is more likely for an American doctor to be able to practice overseas than for a foreign counterpart to work in the U.S., and this is a matter of licensing and education. FMGs in the U.S. must deal with the Educational Commission for Foreign Medical Graduates.
So how can foreign doctors practice in the US? These are the US medical exam requirements for any for foreign medical graduates and practicing physicians to obtain ECFMG Certification:
- Certifying that the FMG obtained a degree listed on the World Directory of Medical Schools
- Completing missing education requirements
- Medical Science Requirements – You must pass both the USMLE Step 1 and USMLE Step 2 CK (Clinical Knowledge)
- Clinical Skills Requirement – To practice medicine in the US after graduating from med school in another country, you must also pass the USMLE Step 2 CS (Clinical Skills)
- Going through a residency program
- Obtaining final ECFMG certification
Once you pass all three of these US medical licensing exams, you’re eligible for ECFMG certification. You don’t have to wait until you graduate from medical school to apply. Feel free to apply as a med student. However, you won’t receive confirmation until you provide graduation confirmation.
After you receive ECFMG certification, you can begin your residency in the US. But be sure to apply for your residency long before graduation and certification. The application process may take some time.
While it is true that many foreign physicians work and train at U.S. hospitals, they are often enrolled in special cooperation programs that may be sponsored through diplomatic exchange channels or the U.S. Agency for International Development. FMGs who may have already worked at an established practice in other countries will find the equivalency, licensing and certification program to be particularly arduous.
can american doctors practice in germany
Castles, beer, and Goethe are only some of the enticing reasons for an American physician to practice medicine in Germany. The process of transitioning to Germany is involved. It is suited for those who have committed to the move and it requires fluency in German. Here is a guide to make the transition to practicing medicine in Germany as smooth as possible.
The German Health Care System
Health insurance is mandatory in Germany. Germany has public and private health insurance, with 86% of Germans enrolled in the public statutory health insurance. Statutory health insurance covers inpatient, outpatient, mental health treatment, and prescription medications. Germans with yearly earnings of more than 62,000€ can opt out of public health insurance and obtain private health insurance. Private health insurance covers 11% of the population and reimburses physicians a lot more than public insurance. Patients with private insurance may be treated separate hospital floors and often receive more specialized care compared to patients with public insurance.
German Medical Education & Post Graduate Training
After graduating high school, Germans directly attend medical school for six years. In the classic curriculum the first two years are pre-clinical, the next two years are more clinically oriented, and the last year is a sub-internship in the specialty of choice. In contrast, Americans attend 4 years of undergraduate college, then 4 years of medical school including 2 completely clinical years. In light of this discrepancy, German residency, Assistenzarzt Ausbildung, is longer – the shortest program spans 5 years, and most residencies in Germany are 2 years longer than their American counterparts. For example, Internal medicine training is 3 years in the US and 5 years in Germany. Ultimately, the total amount of training is typically the same between the US and Germany.
Once you have a medical license, Approbation, getting a resident position, Assistenzarzt, is easy in many specialties. Ortho? Anesthesia? PM&R? They all have openings and it isn’t that competitive. You can apply directly for an Assistenzarzt position at a hospital. Residency in Germany is less structured than in the US and you do not need to apply for a residency program. You do need to complete a specific amount of time in specific specialties, though you are not tied to one hospital. You can work at many different hospitals, and as long as you complete your rotation requirements, you can finish residency and sit for your specialty boards to become a Facharzt, a specialist. All first-year residents are paid a base salary of 4,500 – 5000 euros/month by the hospital. This does not include compensation for working overtime, nights, or weekends/holidays. The salary increases each year.
Medical Licensure/Registration
Practicing medicine in Germany requires medical licensure. Obtaining a full medical license, approbation, can take well over a year for a fluent German speaker to receive, and much longer for someone who is learning German. See Eight Steps to a German Medical License for details.
After you get approbation, you can apply for specialty certification through your local State Chamber of Physicians. They will evaluate your specialty and sub-specialty training and advise you if you need additional training, procedures, or exams. For more information on this see Practice Medicine as a Specialist in Germany.
Finding a Job
Hospitation, an unpaid rotation at a teaching hospital is an opportunity for foreign physicians to be immersed in the German medical system and improve their medical German. This can be done in parallel with the approbation process. Outside of this experience, you cannot see patients or apply for a job prior to having approbation. If you see patients before getting Approbation, you are practicing without a license, which is verboten, and will prevent approbation.
Physicians are in demand in Germany. Hospitals are constantly advertising vacancies on Facebook groups like “ Approbation in _ Bundesland”. You can look for positions on Jobborse, Arztestellen, or Monster. Alternatively, you can email hospitals directly for open positions in your field.
Salary & Work Culture
Doctors practicing medicine in Germany make significantly less than doctors in the USA. The salary is dependent on the length of training – the more years of training, the higher the salary. A junior attending, Facharzt, earns about €60,000-80,000 per year and then after several years of experience will become an Oberarzt, an attending. An Oberarzt can expect a yearly salary around €90,000-130,000 if taking a union position and greater than €130,000 if taking a non- union position. A Chefarzt, the department head, can expect a salary greater than €200,000. Specialists in private practice can earn more than €180,000. Only physicians in leadership positions are able to negotiate salary. Notably, medical schools are FREE and German physicians are not burdened with school debt!
You will need to complete German Residency if you want to accept public health insurance. If you prefer not to go through German residency, you can start your own private practice and choose to accept private insurance which can include TriCare (US military insurance). For those practicing medicine in Germany in private practice, you are required to share night call once or twice a month with the other private practices in your region. In order to share call, you need to be eligible to accept public health insurance which requires completion of German residency. The good news is you can sell your call shifts to other doctors, for 100-300 euros/shift so you don’t have to take your own call. Some doctors in Germany make their entire living taking other doctor’s call shifts!
If you accept government insurance you will have to see A LOT of patients to earn money. Some general practice doctors see about 50-80 patients a day, to earn about 150,000 euros a year. Here is a calculator to help you determine your expected salary. If you accept private insurance, you can see fewer patients and make more money. However, only 11% of the population has private insurance, which accounts for only 8% of health care expenditure. It might be harder to find the clientele for a private practice.
Immigration
You will need a visa to work and live in Germany. The Blue Card EU Visa is applicable to those with a recognized university degrees, inclusive of a medical degree, with a job-offer in hand and a minimum annual salary of 43,056 euros. The Job Seeker (academic) visa enables a physician to stay in Germany for up to 6 months while finding a job. Once you find a job you can obtain a residence permit. For those with familial connections to Germany there are several visa options for joining a parent, a partner, or a child. There are also some German citizenship options for those of German Ancestry.
can american doctors practice in italy
There are 3 steps to having your US medical credentials recognized in Italy. First, you need to have your non-EU medical degree recognized; second, you need to pass the “National Exam”, or Esame Di Stato, to obtain your official Italian medical license; and third, you will need to have your specialty recognized.
If you want to work in the public health system, you will need to complete all three steps. If you are interested in working in the private sector, you might be able to do that by completing the first two steps. For most people, the process of having your credentials recognized can take a couple years.
Fluency in Italian is Required
To practice medicine in Italy, fluency in Italian is required. You might want to start learning Italian sooner rather than later since even the instructions on how to apply for the recognition of your medical credentials on the website of the Ministry of Health are in Italian. If you don’t know the language, Google translate may be helpful initially, but you will need an Italian friend or a certified translator to help you along your way.
The Ministry of Health is in the process of translating the instructions and documents on the website into English, but the time frame for this translation is unclear. In general, the documents you provide throughout the process need to be translated into Italian and must be certified to be a true translation.
Step One: Recognition of Medical Degree
For those who attended medical school in the US (or another non-EU country), you will need to apply to the Italian Health Ministry or Ministero della Salute, for assessment and approval of your medical degree. The application typically involves:
- Proof that you are licensed to practice medicine in the United States
- A certificate of good standing, typically from your state medical board
- A criminal background check
- A Certified copy of your medical diploma as well as a detailed curriculum indicating the duration of medical school, content of courses, number of hours of theoretical and clinical teaching, and the results of exams taken during medical school.
- A Declaration of Value, Dichiarazione di Valore, by the Italian embassy in the country where the medical degree was obtained, certifying, amongst other things, that the medical degree was awarded by a competent authority and that the medical degree awarded is valid and qualifies an individual to practice medicine in the country of origin.
- Certificate of any training detailing the clinical work carried out after issuing the medical degree
- Application fee, currently 16 euros
Gathering appropriate documentation for recognition of your medical degree can take a very long time, though once submitted, the Ministry of Health states that they will come to a decision within 4 months. The Ministry of Health may accept your application outright or, more commonly, they may require you to obtain additional training, demonstrate proof of fluency in Italian, and take a medical knowledge exam at an Italian University.
Step Two: Esame Di Stato and Registration
Once your medical credentials are recognized by the Ministero, you might be asked to complete a National Exam, Esame Di Stato, to get your official Italian medical license. This exam is offered twice a year and consists of a three-month internship (one month each in Internal Medicine, Family Medicine and Surgery), followed by a written test. ***Update: For now, the written test has been eliminated due to the COVID-19 pandemic but it remains unclear if it will be reinstated at some point in the future.***
When you pass this exam, the Ministry then grants you the right to practice medicine in Italy, and you will be asked to register to your local medical board, the albo, of practicing providers (you will have to pay a recurring fee to them). ***Due to the COVID-19 you can be abilitato with the three-month internship only, which is offered three times a year now. *** You must register to the local board of where you have your primary residence or place of work but that doesn’t prevent you from working in other Italian regions as well. Once you are registered, you might be able to moonlight and/or work for some private clinics, but it is best to check with the local Albo and the private practice to make sure you are in compliance.
Step Three: Recognition of Medical Specialty
Once your medical degree is recognized, you can then apply for recognition of your specialty. This application typically requires:
- Proof of current Italian medical registration
- Certified copy of your residency and or fellowship qualification. This should include a detailed description of the clinical training, location, duration, curriculum, and examinations.
- Declaration of Value, Dichiarazione di Valore, by the Italian Embassy in the country where the specialist degree was obtained, certifying, amongst other things, that the specialist qualification was awarded by a competent authority and that the qualification is valid and qualifies an individual to practice within that specialty in the country where the training was obtained.
- Certification of all clinical activity since training
- Certificate of good standing within your specialty
- Current CV
- Application fee, currently 16 euros
Once again, gathering these documents to the standards stipulated by the Ministry of Health may take a long time. Once submitted the Ministry states that they will reach a decision within 4 months.
Bottom Line
For most people, the process of having your medical credentials recognized can take a couple years. Given the many barriers to practicing medicine in Italy, it can be the right career move for those physicians that are committed to living in Italy for the long-term. For more information on the Italian Health Care system, the work culture, and immigration, check out our Ultimate Guide to Practicing Medicine in Italy. I hope you find this information useful and wish you the best in your next career and life move!
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