Sunday, 22 November 2015

Some queries I recently tried to answer

Hello Dear Doctors,

Recently I was asked for my opinion by an aspiring candidate on Rxpg. I have tried to answer him with utmost sincerity and i also post this here for benefit for other candidates.

He writes...........
1.There are a lot of contradictions in the experiences of those gone there also, say for example some IMGs get paid around 600 Euros when they were being trained for approabtion whereas some where paying to the hospital for that kind of training. 

My Response : I totally agree about the wide spectrum of experiences of different people, reason for that is, different people choose different paths as there are more than one routes to get into PG here and the paths and processes are quite jumbled up. One cannot make an entire unidirectional flowchart to success in the german system. The key is step by step  targeted approach. Fact is there is nothing called Training for Approbation done by Hospitals, I think what you are reffering to is Observership,, that’s basically just being in the Hospital and seeing and learning the system. You can get it for free by sending multiple hundred email applications or pay up a reliable agent to set it for you. By the latest law which came in Feb 2015, Hospitals are required to pay around 400 Euros to Observers, to stop possible exploitation of the candidates, in response to this Hospitals have started avoiding Observers as they don’t want to pay some one who is just going to stand there, who has no german medical license and cannot do any actual doctorly work. The Training for Approbation is conducted by Institutes, its like full coaching class room sessions, as we have training institues for Pgentrance in India, also they arrange few months of Observership with some hospital by paying them the money hospital is supposed to pay the candidate by law. All of this is undertable transaction. Most of the money is retained by the Agent and by the profit making institute. All the cost is ultimately borne by the candidate.

2.The shortage of doctors are sometimes highlighted and at other instances lack of training postions are also cited. As of now there is an inflow of doctors from East Europe where pay is much lower. Being citizens of the EU, they have higher preference.

Response : That’s totally correct, at present the total number of doctors is maximum that germany has ever seen. That’s the reason they are in a choosing position and screening the right candidate now because of huge number of  applications. Vacancies are very limited in cities,, plus all good big hospitals need candidates with Approbation. Only smaller hospitals in smaller cities settle for doctors with Berufserlaubnis ( Temporary license ).

3) Regarding the choice of speciality, 4-5 yrs back you had the luxury of choosing any but now it seems to have a bit hard lined to fewer specialities like Internal Medicine et al. I honestly don't know whether that's true. 

Response : the sequence of ease of getting into a speciality from easiest to difficult : Internal medicine, Neurology,Anaesthsia, Gen Surgery, Ortho ( don’t even think about Radio or Dermat ..not practical thinking)

4)When talking of the work environment some candidates are quite unhappy with the rigid and rude system whereas some others are very happy and have no bad impressions at all.

Response : Every society is mix of different kinds of people. some are good and helpful,, some rude and arrogant. And that applies to the foreign doctors  aswell as much it applies to the locals, some try to mix up well and get friendly,,some have their own egos and prejudice. Its really a personal thing, cannot be generalised. I have personally come across people who are very friendly and make u feel part of the team and also there are some who would try to pull you down and clearly show you how much they hate foreigners. Its your tact to deal with it on person to person basis. Having a good german language is a very big help to get included.

5)Competitiveness wise - University hospitals seem to difficult for International candidates. They are often posted in peripheral centers. 

Response : True, but peripheral centres are not like what we imagine in India. They are well equipped and have good patient load as they cater to 2-3 small towns together. Just that you need to live in a smaller place.

6)I feel that all these depends on where you choose your training. Would you throw some light on the info you have about the current sitaution - like the prospects for different specialities - the ones with more vaccancies etc. That can help us in deciding how conduscive would the journey be. 
Response :  I have covered the ease of different specialities already

7)Please do mention of the approximate cost - which has to be paid in India & Germany from your research. I have a friend for whom his agent is charging around 1.5 lakhs for Documentation + Visa processing + one way Ticket. He will require to have a deposit of 6000Euros in his name in a German bank. The other preparations for his Approbation will have to be borne by himself. To save money he is trying to learn his German as far as possible from India. He will be assisted in finding a training position for which the agency will be applying at different hospitals on behalf of him. 

Response : This is a very tricky part, and I am going to share only my personal opinion in this matter. I know several aspirants duped completely in this path. Infact I personally have never heard a success story through an agent ( Success means getting a JOB CONTRACT from a  Hospital) and I have known quite a number of aspirants in last 2 years. Your friend is doing the right thing by learning maximum possible german in india itself. 1.5 Lakhs is not a huge money, so can be tried. The amount to be deposited in the bank is called Blocked account to be used by the candidate to withdraw money every month for living expenses. It is essential requirement to apply for a Student Visa. Question is what if the visa is rejected ? how much of the 1.5 Lakhs will be refunded ?? Visa processing takes some amount less than 10K ( Check german visa fees website to get the exact fees), One way ticket is around 30-35 K. And one doesn’t need any documention or translation till you actually get a job. Not even for interviews. Other question is how much is the Approbaton training institute costing ? and who pays for living costs ? when you calculate reasonable cost would go more than 10 Lakhs. They promise Visa, and training.. and this and that,,,but if someone would pay such huge amount , they should talk about JOB Contract certainty, all other things are useless talk, just business.
That’s why I personally never recommend Approbation training, its takes time and costs huge,, plus why not get a job first, apply for berufserlaubnis ( BE), get BE, start working and getting salary and then think about approbation,, I mean you have 6 months to 2 years ( diff in diff states) to take Appro Exam.
Hope I have elaborated to the required details.
Good Luck !!

Deepak Mishra


  1. Thank you very much! The information is a great help! This is not a path as commonly trodden as USMLE or PLAB or AMC, so it is difficult to find information.

    Could you please give some advice regarding the preparation for the knowledge exam- how we should study for it, what to refer to, the nature of the exam etc?

    Thank you,

    1. Hi Rujuta, Thank you for your kind words.
      About knowledge test : I have myself not taken it yet but will have to take it in next one year. From the info i have collected. This test includes 1 case : history taking, clinic exam. Case presentation and discussion same as final MBBS practical exam . After that theory questions by a panel of 3 doctors including a surgeon and one internist. Its takes around 3-4 months preparation.

      When its possible to start residency without this exam, it is only logical to focus time n energy on finding a res.position instead of preparing for this exam.which is in itself difficult to do until one is actually working in a german hospital.


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  2. Sir how do you predict the situation after five years!! Will subjects like family med still be attainable or it will be almost impossible? Thanks in advance

  3. As far as i can predict, may it be 5 years or 10 years down the line. The story of success will always be the same, some reach, most dont. one knows deep in the heart, to which group one belongs. Apologies, i tend to go vague when we talk about predictions and promises of the future, who knows in 5 years ISIS might destroy Syria and wage a war in Europe.

  4. Haha nice more doubt....what is difference between MD-PhD and residency?do we need German language for PhD too? Can one do specialization after doing PhD?

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  6. I dont know about MD-PhD, but u can do speciality training even after PhD. Language requirement is less.. may be A2 level.. i am not sure about it.

  7. I dont know about MD-PhD, but u can do speciality training even after PhD. Language requirement is less.. may be A2 level.. i am not sure about it.

  8. sir, to take patient communication test we should learn german medical terminology .right sir.......?? sir where can i learn medical terminology, will there be any books or online papers???

  9. Hi ,sorry for late response, have been preoccupied myself. I hope by now you have found what you were looking for !

  10. Hi myself Dr Ashish I am a 3rd year resident of surgery...Do u have any idea abt post pg fellowships courses in Germany...