Plastic Surgery Residency in Germany: Best First Job for IMGs

Start in general or trauma surgery before you apply for plastic surgery in Germany. A direct job after Approbation, the full German medical licence, is possible. But a plastic surgery chief usually hires the doctor who has already handled admissions, wound checks, drains, discharge letters and night calls on a German surgical ward.

This is not because your medical degree is weak. Plastic surgery departments are small. A chief has few junior doctor posts, a busy operating list and patients after breast reconstruction, hand injuries, burns and free-flap surgery. They want someone who already knows German ward routines on Monday morning.

Can you start plastic surgery directly after Approbation?

Yes, you can apply directly after Approbation. Send applications to every Plastische, Rekonstruktive und Ästhetische Chirurgie department, especially municipal hospitals outside Berlin, Munich, Hamburg and Cologne. A direct offer is most realistic when a department needs a doctor quickly and you already have strong German, surgical work at home and an interview in Germany.

The common result is different. A department reads applications from doctors who already worked in German general surgery, trauma surgery or orthopaedics. That candidate can write an admission note, call radiology, speak to nurses and cover a night shift without learning the hospital system first. The chief picks that lower-risk hire.

A university clinic is the hardest first target. Its plastic surgery unit may focus on microsurgery, hand surgery, craniofacial cases or breast reconstruction. Doctors already in the clinic, research fellows and junior doctors with German surgical experience are visible to the chief before an outside IMG sends a CV.

Why a first surgical job changes your application

A year in a German surgical department gives you concrete lines for your CV. You can list emergency admissions, abscess drainage, wound debridement, postoperative rounds, anticoagulation plans, discharge letters and night and weekend duty. Your senior doctor can also give a German Arbeitszeugnis, the employer reference letter that chiefs expect to see.

That job also gives you people who can speak about your work. A senior doctor who watched you manage a bleeding wound at 2am is more useful than a generic reference from a hospital abroad. Plastic surgery chiefs know that person understands the German ward, electronic chart and duty rota.

Do not wait at home for the perfect plastic surgery vacancy. A surgical job is paid work, German practice and a reference letter at the same time. Apply to plastic surgery while you work there, but choose the first department with your later specialty in mind.

Which first specialties help most?

General surgery is the best broad first step. You learn emergency assessment, abdominal operations, infected wounds, drains, dressings and postoperative complications. These are daily tasks in plastic surgery, even though the operations are different.

Trauma surgery and orthopaedics is equally strong if you want hand surgery, limb reconstruction or work with fractures and soft-tissue injuries. You will see open fractures, tendon injuries, skin loss, compartment syndrome and emergency operating lists. Plastic surgery departments work closely with trauma teams on these patients.

Vascular surgery can help if you want microsurgery, because flap reconstruction depends on vessels and thrombosis management. It is a narrower first job, so choose it only when the department gives junior doctors real ward and operating-room work. A job that keeps you on paperwork all day does not build the surgical experience you need.

ENT, oral and maxillofacial surgery, and breast surgery can also fit a focused interest. They are weaker general first steps because their patient group is narrower. For an IMG with no German hospital experience, general surgery or trauma surgery gives more vacancies and a clearer story for the next application.

Will your first surgical years count toward Facharzt training?

Some of those months can count, but do not choose the first job because you expect every month to transfer. The state medical chamber, called the Landesärztekammer, decides which periods count toward your Facharzt, the German specialist qualification. It compares your contract, rotation dates, training record and the department's training licence with its state training rules.

Plastic surgery training has a defined curriculum. The German Medical Association's model rules describe 72 months of specialist training and list areas such as reconstructive procedures, burns, hand surgery and aesthetic procedures. Your state chamber applies its own binding rules, which can differ from the model rules.

General surgery and trauma surgery build a stronger application even when every month is not credited. Do not confuse a useful first job with guaranteed credit. Before you sign, ask the chamber in writing about your exact hospital, specialty and planned training period.

What to ask before you accept a surgical job

Ask one question before you sign the contract: “How many months of surgical training can the department certify under the training licence?” The training licence is called the Weiterbildungsbefugnis. One senior doctor may only be allowed to certify part of the required training time, which means you must move later.

Then ask to see the duty rota and a sample training record, called a Logbuch. Look for emergency room work, operating-room assistance, ward rounds, outpatient clinic and documented procedures. A department that offers only blood draws and discharge letters will not prepare you for plastic surgery interviews.

Finally, ask who will write your reference letter after 12 months. A named senior doctor who works with you on the ward is better than an HR letter listing only your employment dates. Your next chief wants to know what you did with patients, not only where you worked.

What to do on Monday

• Apply to plastic surgery departments, but apply more widely to general surgery and trauma surgery posts in the same week.
• Ask each surgical department in writing: “How many months can your training licence certify for junior doctors?”
• Ask your state medical chamber in writing: “Which months in general surgery or trauma surgery can count toward plastic surgery specialist training in this state?”
• Keep your contract, rota, procedure list, Logbuch entries and Arbeitszeugnis in one folder for your next plastic surgery application.

Stand: 2026-09-13. This article is orientation, not legal advice. Rules differ by Bundesland and change — always confirm with your [Landesärztekammer](https://www.bundesaerztekammer.de/aerztekammern) before acting.