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ORTHOFELLOW GUIDE · 14 MINUTE GUIDE

Orthopaedic Fellowships in Germany: Licence & Pay

Germany has no national fellowship match. Its rules for specialist training are written around Weiterbildung, the paid, supervised training that leads to the Facharzt für Orthopädie und Unfallchirurgie. International surgeons usually come in one of three ways. The first is a Hospitation, an unpaid observership. The second is a paid clinical post, which needs a German licence. The third is a short travelling fellowship funded by a society such as the DGOU, DVSE or AO Trauma. Hands-on clinical work needs an Approbation or a Berufserlaubnis. For non-EU graduates, that means an equivalence check, often a Kenntnisprüfung (knowledge test), and German at B2 plus medical German oriented to C1. This guide covers each step and uses only official regulator, government and society pages read on 8 October 2026. Orthofellow lists 79 German programmes. Confirm every requirement with your host hospital and the authority in the federal state (Land) where it is based.

By Anissa Feby Canintika, Founder and Clinical EditorPublished · Materially updated
Educational guidance, not legal, immigration, licensing or admissions advice.

How orthopaedic training and 'fellowships' fit together in Germany

Specialist training in Germany is called Weiterbildung. The Bundesärztekammer (German Medical Association) publishes a model code, the (Muster-)Weiterbildungsordnung (MWBO). Each Landesärztekammer (state medical chamber) adopts its own version, and only that version is legally binding. Under the MWBO, Weiterbildung takes place at approved training sites, under doctors authorised to train, as part of appropriately paid medical work. So a paid post can count towards German training, but an unpaid observership cannot. The MWBO does not define a 'fellowship'. In practice, the word covers observerships, paid subspecialty posts and short society travel grants.

  • Facharzt für Orthopädie und Unfallchirurgie (MWBO 2018, version of 3 July 2026): at least 72 months in surgery under an authorised trainer. This must include 48 months in orthopaedics and trauma surgery, 6 months in the emergency department and 6 months in intensive care. Up to 12 months may be spent in other specialties.
  • Subspecialty training (Schwerpunkt) after the Facharzt: Spezielle Orthopädische Chirurgie and Spezielle Unfallchirurgie each require at least 24 months at an authorised training site.
  • Add-on qualifications (Zusatz-Weiterbildungen) include Handchirurgie (hand surgery) and Sportmedizin (sports medicine). Requirements are set in Section C of the MWBO.
  • Training periods can be split into blocks of at least three months. Part-time training usually counts if it is at least half of full-time hours.
  • Training completed outside the EU can be recognised by the Landesärztekammer if it is equivalent (MWBO §19). If it is at least a year shorter than the German minimum, there is usually a substantial difference, which you close by passing an examination.
  • You need an Approbation before you can apply to have a foreign specialist title recognised.

Three routes in: Hospitation, clinical post or society fellowship

The right route depends on whether you need to touch patients. An observership is the simplest to arrange, but you cannot operate. A paid clinical post lets you practise, but it needs a German licence, and for most non-EU doctors that takes months. Society travelling fellowships are short and prestigious. However, most are for members of the German-speaking societies who are travelling abroad, not for international doctors coming to Germany.

  • Hospitation (observership): you observe and, where the host allows, assist. Hannover Medical School (MHH) says trauma fellows have observer status there. They may not perform procedures on their own 'as long as you don't have the German board exams', but can gain experience by assisting at or observing operations. MHH reports more than 1,700 guest doctors and trauma fellows since 1970, staying from a few days to two years.
  • Clinical post: you work as an employed doctor (Assistenzarzt, Facharzt or Oberarzt) under an Approbation or Berufserlaubnis. The Bundesärztekammer says assistant-level and specialist-level work is only possible with one of these licences.
  • Society or foundation fellowship: two to six weeks at selected centres, funded by a grant. Examples include DVSE's international observership grant, the DGOU's German–South African exchange and AO Trauma fellowships (see below).
  • Research stays: Make it in Germany says doctors coming to do research can use either the research visa or the EU Blue Card, depending on which conditions they meet.

Society programmes: DGOU, DGOOC, DGU, AGA, DVSE, D.A.F. and AO Trauma

The Deutsche Gesellschaft für Orthopädie und Unfallchirurgie (DGOU) is the umbrella body for its two founding societies: the DGOOC (orthopaedics and orthopaedic surgery) and the DGU (trauma surgery). Its subspecialty sections include the D.A.F. (foot and ankle) and the DVSE (shoulder and elbow). The DGOU stipend page lists its travelling fellowships, and new calls appear in the DGOU newsletter. Many calls close on 31 January. The joint annual meeting, DKOU 2026, runs from 20 to 23 October 2026 in Berlin. It is a practical place to meet heads of department before asking about a Hospitation.

  • DVSE International Hospitations-Stipendium: for two foreign doctors, mainly from emerging and developing countries. The advertised prize money is €2,500. The observership must last at least four weeks, at a DVSE training centre or at a department led or co-led by a DVSE-certified shoulder and elbow surgeon. The deadline is usually 31 January (preise@dvse.info). DVSE says it can send a confirmation letter to support a visa application.
  • DGOU German–South African Fellowship: two grants of €4,000 each for about four weeks. The host country alternates: South Africa in even-numbered years, Germany in odd-numbered years. The 2026 call was for German specialists in orthopaedics and trauma surgery aged 40 or under.
  • DGOOC USA-Stipendium 2026 (outbound): three four-week research visits, to the Hospital for Special Surgery (spine), Harvard Medical School (foot and ankle) and Mayo Clinic (shoulder and elbow). €6,000 each, for residents in their last two training years or within two years of the Facharzt. The deadline was 31 January 2026.
  • ASG Fellowship (Austrian–Swiss–German): four fellows (one Swiss, one Austrian, two German) spend six weeks in England, Canada and the USA. It runs every four years. Applications for the 2028 trip close on 31 January 2027.
  • DGU Reisestipendium (trauma surgery): the 2024 call offered €5,000, which could be shared, to fund visits to trauma centres abroad by doctors in employed (non-self-employed) posts.
  • AGA (Gesellschaft für Arthroskopie und Gelenkchirurgie): advertises one-year fellowships for residents or specialists. For 2027–28 these were a shoulder research fellowship in Vail, USA, and a clinical shoulder arthroscopy fellowship in Annecy, France. Both deadlines were 15 July 2026.
  • D.A.F. (Deutsche Assoziation für Fuß und Sprunggelenk): no fellowship call was found. It offers a 'Spezielle Fuß- und Sprunggelenkchirurgie' certificate for its members. This requires a Facharzt, the D.A.F. foot surgery certificate and at least 200 foot operations performed independently, including 50 of higher difficulty.
  • AO Trauma: fellowships last 6 to 12 weeks. Applicants must be AO Trauma members and have completed the Basic and Advanced Principles courses. The 2027 call has closed, and the 2028 call opens in spring 2027. AO Trauma Switzerland also runs a two-week DACH fellowship each year in Switzerland, Austria or Germany. Past German hosts include UKE Hamburg-Eppendorf.

Licensing: Approbation versus Berufserlaubnis

Under the Federal Medical Practitioners Act (Bundesärzteordnung, BÄO), you need an Approbation to practise medicine in Germany. Temporary or restricted practice is also allowed under a permit (Erlaubnis). The Approbation is unrestricted, valid throughout Germany and has no time limit. It is issued by the Approbation authority of the Land where you intend to work. Since the Recognition Act took effect on 1 April 2012, you can apply regardless of nationality. The Berufserlaubnis is a temporary permit. It can be limited to particular activities and workplaces, can be revoked, and can only be granted or extended up to a total of two years of medical work, with narrow exceptions.

  • EU, EEA or Swiss training: qualifications listed in the annex to the BÄO are recognised automatically. Other EU training is checked for equivalence. Where there are substantial differences, Service Berlin says you can take an aptitude test, which is oral and practical. The BÄO does not grant a Berufserlaubnis to holders of EU, EEA or Swiss qualifications, except where a special interest is shown.
  • Non-EU (third-country) training: the authority checks whether your training is equivalent to the German medical degree (Gleichwertigkeitsprüfung). If it finds substantial differences that your experience cannot make up, you prove your knowledge in the Kenntnisprüfung.
  • Kenntnisprüfung (ÄApprO §37): an oral and practical state exam in German, held on one day, with a patient presentation. It covers internal medicine and surgery, plus emergency medicine, clinical pharmacology, imaging, radiation protection and medical law. It lasts 60–90 minutes per candidate, with up to four candidates. It is offered at least twice a year and can be retaken twice.
  • The BÄO says equivalence should be checked before the other requirements, and the authority will issue a separate equivalence notice if you ask.
  • Typical documents (LAGeSo Berlin, third-country route): CV, ID, certificates of good conduct and good standing (no older than three months), a medical certificate from a doctor licensed in Germany, proof of training, a B2 certificate and a C1 medical-language exam result.
  • Specialist title: after the Approbation, you register with the Landesärztekammer. Its training department decides whether your foreign specialist training can be credited.

German language: B2 plus medical German at C1

The BÄO makes German proficiency a condition of the Approbation. Make it in Germany says every Land requires at least general German at B2. Most also require a medical German exam (Fachsprachprüfung) oriented to C1. Regierungspräsidium Stuttgart traces this to a decision of the 87th Conference of Health Ministers on 26–27 June 2014. You must show both spoken and written German, including taking a history and discussing complex medical topics. Details vary by Land, so check where your host is based.

  • B2 certificate: Baden-Württemberg asks for a certificate from an ALTE full-member provider such as the Goethe-Institut, telc or ÖSD. Berlin lists telc, TestDaF or the Goethe-Institut, no older than three years.
  • The Fachsprachprüfung is run by the Landesärztekammer. In Baden-Württemberg it is held on behalf of Regierungspräsidium Stuttgart, with an administration fee of €420, and the result is generally valid for three years.
  • In Baden-Württemberg, you need the exam unless you have a degree from a German-language university, at least ten years of schooling in German, or at least three years of vocational training in German.
  • Some private exams are accepted in some Länder. Baden-Württemberg accepts FaMed and telc Deutsch B2/C1 Medizin for medicine, but only if submitted with the application. The Marburger Bund publishes a state-by-state table.
  • A Fachsprachprüfung passed in one Land is generally accepted in another if it was taken as part of a licensing procedure there.
  • Observerships: no statutory language level applies, because you are not practising. Ask your host what level they expect.

Observerships (Hospitation): what you can and cannot do

A Hospitation does not give you a licence to treat patients. The BÄO reserves medical practice for holders of an Approbation or a permit. Hospitals therefore treat observers as non-practising guests. Each hospital sets its own rules for applications, insurance, vaccinations and clothing. The points below come from official pages. Ask your host for its written terms before you book travel.

  • Scope: at MHH, trauma fellows hold observer status. Without the German board exams, in MHH's words, they may not perform procedures on their own, but may assist at or observe operations.
  • Applying: MHH asks for a detailed CV, a rough timetable, your areas of interest and your language skills, sent to its trauma fellowship coordinator.
  • Entry: nationals of visa-exempt countries may generally stay up to 90 days in any 180-day period, but may not take up gainful employment (Federal Foreign Office). Check the Federal Foreign Office list for your nationality and ask the German mission which visa fits an unpaid observership.
  • Funding: some grants pay a fixed sum. The DVSE international grant says its prize money is usually handed over in cash at the first host centre. The AO Trauma stipend contributes to costs but may not cover them all, and travel and insurance are the fellow's responsibility.
  • Training credit: because MWBO Weiterbildung must be appropriately paid medical work, an unpaid Hospitation is unlikely to count towards German specialist training.

Visas and residence for clinical posts

EU and EFTA citizens need no visa or residence permit to work in Germany. Third-country nationals need a residence title for employment. For regulated professions such as medicine, Make it in Germany says the licence to practise (Berufsausübungserlaubnis) must be obtained before a residence permit for employment can be issued. The Residence Act (Aufenthaltsgesetz, AufenthG) offers several routes. Which one fits depends on how far you are through recognition.

  • Skilled-worker permit (§18a / §18b AufenthG): you need a recognised qualification and a concrete job offer. The Federal Employment Agency usually has to approve the job, and the permit lasts up to four years. If you are over 45 and coming to work in Germany for the first time, you need a gross salary of at least €55,770 (2026) or adequate pension provision.
  • Recognition visa (§16d(1) AufenthG): for when the authority has found your qualification partly equivalent and you need adaptation measures. You need a place on a qualification measure, German usually at A2 (higher for some measures) and proof of funds. That means €1,091 net per month for school-based measures, or pay of at least €1,200 gross per month for company-based ones (2026 figures). The permit lasts up to 24 months and can be extended by 12 months, to a maximum of three years.
  • Under §16d(1), you may work up to 20 hours a week in unrelated jobs. Work related to your target occupation is unlimited if the Federal Employment Agency approves it. After full recognition, you can stay up to 12 months to look for a job.
  • Recognition partnership (Anerkennungspartnerschaft, §16d(3)): you enter with an employment contract and start recognition after arrival. The permit is issued for one year at first and can be renewed a year at a time, up to three years. German at A2 is required. For regulated professions, the employer must, for example, be bound by a collective agreement. You work in support roles until you hold the licence. Employers can pay €411 for the fast-track procedure.
  • EU Blue Card or research visa: Make it in Germany names both as options for doctors doing research. Check the current conditions on its pages.

Pay: TV-Ärzte/VKA salary tables

Salaried hospital doctors in Germany are usually paid under a collective agreement. For municipal hospitals, the agreement is the TV-Ärzte/VKA. The doctors' union Marburger Bund publishes its pay tables, and the figures below are from that table. Other employers, such as Helios and Asklepios, have their own tables, which the Marburger Bund also publishes. University hospitals and church-run hospitals were not verified here. An unpaid Hospitation is not employment, so no table applies to it.

  • Table valid from 1 June 2026 to 31 December 2026 (a 2.0% increase): monthly gross basic pay.
  • Ä1 Arzt (doctor in training): €5,722.05 in year 1, rising to €7,355.29 from year 6.
  • Ä2 Facharzt (specialist): €7,552.19 in year 1, rising to €9,698.91 from year 13.
  • Ä3 Oberarzt (senior consultant): €9,459.56, rising to €10,810.95.
  • Ä4 CA-Vertreter (deputy head of department): €11,127.50, rising to €11,922.95.
  • On-call duty (Bereitschaftsdienst) is paid separately at hourly rates in the same document.
  • Ask your employer which agreement and pay group applies to your post, and how your previous experience will be credited.

Timelines and application steps

For a short observership, two or three months' planning may be enough. For a licensed clinical post, plan in months to years. That is because recognition, language exams and the visa run one after another. The sequence below is a cautious outline built from official pages. Processing times vary by Land and by how complete your file is.

  • 1. Choose your route (observer, clinical post or society grant) and the Land where your host is based. That Land's authority handles your licence.
  • 2. Clinical route: apply to the Approbation authority. You can start from abroad. Service Berlin quotes about three to four months if all documents are complete. Make it in Germany gives three to four months as a typical time for a recognition decision.
  • 3. Take B2 German and then the Fachsprachprüfung. In Baden-Württemberg, the authority registers you for the chamber exam automatically.
  • 4. If the authority asks for a Kenntnisprüfung, the ÄApprO requires Länder to make sure you can sit it within six months of that decision.
  • 5. Use the result to apply for the right residence title (§18a/b, §16d(1) or §16d(3)) at the German mission. Employers can request the fast-track procedure.
  • 6. Society grants: most DGOU, DGOOC and DVSE calls close on 31 January. The AGA's one-year fellowships closed on 15 July 2026, and the 2028 AO Trauma call opens in spring 2027.
  • 7. After arrival: register with the Landesärztekammer and ask it to assess any foreign training for credit.
EVIDENCE AND ACTIONS

Sources checked and applicant checklist

Every rule, exam detail and euro figure in this guide comes from a federal statute, a federal or state government page, the Bundesärztekammer, the Marburger Bund's published pay table, or an official society or foundation page opened on 8 October 2026. Requirements differ between the 16 Länder and their Landesärztekammern. Baden-Württemberg and Berlin are used as worked examples, not as national rules. Visa fees, embassy processing times, the TV-Ärzte/TdL (university hospital) and church-hospital pay tables, and any D.A.F. fellowship call could not be verified and are omitted. Grant amounts and deadlines are from the latest published call and may change. Confirm every requirement with your host hospital, the Approbation authority and Landesärztekammer in your Land, and the German mission before you act.

Before you act

  • Confirm with your host whether the post is an observership (Hospitation) or paid clinical work, and get the scope of what you may do in writing.
  • For clinical work, identify the Approbation authority in the host's Land and check its document list, the B2 and Fachsprachprüfung rules, and whether a Kenntnisprüfung is likely for your training.
  • Agree the residence route (visa-free short stay, §18a/b, §16d(1) or §16d(3) recognition partnership) with your employer and the German mission before booking travel.
  • For paid posts, ask which collective agreement and pay group applies (for example TV-Ärzte/VKA Ä1 or Ä2) and how prior experience is credited; for grants, note the 31 January society deadlines.

Official sources

Sources reviewed 8 October 2026. Recheck the linked source because cycles and regulatory requirements can change.
COMMON QUESTIONS

Frequently asked questions

Can I operate during a Hospitation in Germany?

No, not independently. Practising medicine requires an Approbation or a temporary permit under the Bundesärzteordnung. Hannover Medical School, for example, says observers may assist at or observe operations but may not perform procedures on their own. Confirm the exact scope with your host in writing.

What is the difference between an Approbation and a Berufserlaubnis?

The Approbation is a permanent licence to practise, valid across Germany. The Berufserlaubnis is temporary. It can be limited to particular activities and workplaces, can be revoked, and normally covers no more than two years of medical work in total. Under the BÄO it is not granted to holders of EU, EEA or Swiss qualifications, except where a special interest is shown.

Do I have to pass the Kenntnisprüfung?

Only if you trained outside the EU, EEA and Switzerland and the authority finds substantial differences that your experience does not make up. It is an oral and practical exam in German, covering internal medicine and surgery, with a patient presentation. It can be retaken twice.

What level of German do I need?

For a licence, every Land requires at least general German at B2. Most also require a medical German exam (Fachsprachprüfung) oriented to C1, usually run by the Landesärztekammer. For an unpaid observership there is no statutory level, but hosts may set their own.

Will a German fellowship count towards my Facharzt?

Only paid medical work at an approved training site, under a doctor authorised to train, counts as Weiterbildung under the MWBO. The binding rules are those of your Landesärztekammer, which also decides whether foreign training can be credited.

How much does a doctor in a German hospital earn?

Under the TV-Ärzte/VKA table for municipal hospitals (1 June to 31 December 2026), monthly gross basic pay is €5,722.05 to €7,355.29 for doctors in training and €7,552.19 to €9,698.91 for specialists. On-call pay is extra. Other employers have their own agreements.

Are there grants for international surgeons to visit Germany?

A few. DVSE offers an international observership grant for two foreign doctors, mainly from emerging and developing countries, with an observership of at least four weeks. AO Trauma fellowships and the DGOU's German–South African exchange (Germany hosts in odd-numbered years) are other options. Most DGOU, DGOOC and DGU grants fund German members travelling abroad.

Which visa do I need for a paid clinical post?

Usually a skilled-worker permit under §18a or §18b AufenthG. You need the licence to practise before the permit can be issued. If your qualification is only partly recognised, the §16d recognition visa or a recognition partnership may fit. EU and EFTA citizens need no visa.

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