The 5 Hardest Specialties to Get in Germany as a Foreign Doctor

On paper, every specialty in Germany is open to you. Once your Approbation is granted, you can apply anywhere. In practice, five of them are far harder to get into than the rest — and usually not because there is anything wrong with your application.

The reasons are structural: departments too small to have a vacancy, fields where the work is almost entirely spoken German, fields where the hospital hires the student it already knows. Once you can see the actual bottleneck in each one, you can decide whether it is worth fighting for, or whether you are better off starting somewhere else and moving across later.

Counting down from five.

5. HNO — the department is too small to have a vacancy

HNO (Hals-Nasen-Ohrenheilkunde, ear, nose and throat) departments are among the smallest in a German hospital. Four doctors in total is not unusual.

That size is the entire problem. A team of four does not open a training position every year — it opens one when somebody finishes or leaves, which might be once every couple of years. There is nothing personal in the rejection. There is simply no slot.

Where it opens up: smaller hospitals outside the big cities. Same small departments, far fewer applicants, and they are generally used to hiring internationally trained doctors.

4. Radiologie — the entire job is spoken German

Radiology looks like an obvious target: good pay, no ward rounds, no relatives in the corridor at midnight. The catch is what the work actually consists of.

You sit and you dictate the Befund — the report — for hours, in German, in precise terminology, and a colleague then acts clinically on exactly what you said. There is no part of the day where you can lean on procedures instead of language.

So departments filter hard on German, and they are right to. Radiology is rarely a realistic first post in Germany. If you want it, the language is the application; the CV comes second.

3. Augenheilkunde — they hire the student they already know

The bottleneck in ophthalmology is not competition in the ordinary sense. It is that most eye medicine in Germany happens in a Praxis rather than a hospital, so there are very few hospital training positions in the first place.

The few that exist tend to go to students who did their PJ — the final practical year — in that department. By the time a post is advertised, the team often already has somebody in mind.

Where it opens up: this is the specialty where being physically present counts most. A hospitation, a direct letter to the Chefarzt, anything that turns you from a CV into a person they have actually met.

2. Dermatologie — the German students' dream job

Dermatology has good hours, good earnings and almost no emergencies at three in the morning. That combination makes it one of the most sought-after fields for German graduates, and the strongest of them take the places first.

At the same time, a number of hospitals have closed their dermatology departments altogether and moved the work into outpatient practices. Fewer training places, no fewer applicants.

1. Plastische Chirurgie — the clinic with the work is not the clinic allowed to train you

Plastic surgery is the hardest entry on this list, for a reason most people never hear until they have already lost a year to it.

Most plastic surgery in Germany happens in private aesthetic clinics. Those clinics generally do not hold a Weiterbildungsermächtigung — the formal authorisation a department needs before your time there can count toward a Facharzt title.

So the places where the work most visibly is are, for training purposes, dead ends. The hospitals that can train you are very few, and most expect several years of general surgery before you get near a plastics rotation.

The clinic where the work is is not the clinic that is allowed to train you.

What to actually do with this list

• Check the Weiterbildungsermächtigung before you fall in love with a job ad. Ask how many years that department is authorised to sign off, not just whether they are hiring.
• Look outside the big cities. Every one of these five is more reachable at a smaller hospital in a smaller town.
• When the barrier is language rather than competition — as in radiology — treat the German as the real application.
• Consider entering through an adjacent field and moving across later. Time inside the German system is worth more than another round of applications from outside it.

None of these are impossible — they are just slow

Every specialty on this list has internationally trained doctors working in it. What they mostly have in common is that they did not get there in one step: they got the Approbation, took a post where the door was open, built German and contacts inside the system, and moved.

If you would rather start where the doors are already wide open, that is the other half of this series — the five easiest specialties to get in Germany. And if what you actually want is a specialty that leaves you with your evenings, be warned that the best work–life balance list overlaps with this one more than you would like. Klaro itself is paused for a rebuild at the moment — the guides stay free to read with no account, and you can leave your email on the homepage to hear when the job search reopens.