Archive for November 8th, 2013

Dear foreign doctor, are you dreaming of a medical specialty in Germany? Are you learning or planning to begin learning the German language? Some good news and bad news… But is the final balance more good or bad?

During the previous weeks, I and many of my doctor friends, were very frightened by the rumors that spread like fire in the German medical specialty-related facebook groups. These rumors, to the best of the understanding of me and some of my friends, talked about language and medicine exams for ALL foreign doctors coming to German. These rumors also profoundly shacked the German Residency dreams of us because they also talked how there will be no more thing as “Temporary Working Permit”. In other words, your parents should be affording the price of your stay in German (For weeks? Months? Years?) until you can pass these tests and be eligible for a working permit. Hence, starting to receive a salary. Is this true? This is very frightening! I tried to relieve my fears by not searching about the topic. Beside, rumors are still rumors. Nothing is 100% certain. When the next year comes, things would become more and more clear.

Today, I found the following great German article which talks how one German state is doing to change how it deals with foreign doctors coming to work in it. This great article was posted at the Language Geneartion Center (LGC) facebook group by Frau Dr. Renat Asali. Dr. Asali is the head of the LGC center and a professor at the German department at the University of Jordan. Dr. Asali knows a lot about medical specialty in Germany. Moreover, I think that she has been so far teaching German in Jordan for +20 years. I am mentioning Dr. Asali’s qualifications mainly because I do not know how good the website that published the article (although it has a very excellent design like those of famous American newspapers). I cannot trust that website. However, I think that I can trust Dr. Asali! In addition to the above qualifications, I know Dr. Asali personally. Dr. Asali is now my German language teacher at LGC!

With the help of Google Translate, I think that I understood most of the very informative article chosen by my teacher (Here is a link to the article translated by Google Translate). I will try to summarize what I understood. Hopefully, you can correct any mistakes I will make. Together, we can arrive at a better understanding.

Let me start with some good news. The article confirms the shortage of physicians in Germany. The shortage of physicians is still in thousands. Certainly, this would not change in months or even years:

“In the year 2012, 6000 doctor posts were unfilled in hospitals in Germany according to the Federal Chamber of Physicians. The doctors’ union Marburger Bund in 2011 even spoke of 12,000 vacancies rising.”

Here comes the bad news. The article talks how “in the past”, foreign physicians were allowed to work in Germany without having their “Language skills” examined:

“… no one has examined whether [foreign doctors] can make themselves understood, and whether they understand patients and colleagues at all.

But one might say, are not foreign doctors requested to pass the B2 level? Is not this a language test?

“The language diploma [B2] to prove that the doctor has understood the main ideas of complex text on an abstract theme and can maintain a normal conversation without problems. Medical language or the “understanding between the lines” are not checked.

So, having passed the B2 level is no longer thought of to be a good “surrogate” marker for the ability of the foreign doctors to deal with German patients. The article mentions example about how (1) foreign physicians are not communicating well with patients, that (2) they are not as good as their German counterparts, and unfortunately enough, (3) that German patients are now forced to be treated by doctors from countries in which they would voluntarily not be treated by whom.

"If I had the chance, I would not allow such a doctor to treat me!" An angry German patient not comfortable with his foreign physician

Rheinland-Pfalz/Rhineland-PalatinateTherefore, “One” German state, wants to allow this situation no more. This German state is Rheinland-Pfalz/Rhineland-Palatinate. [Since the most of doctor graduates of Mu’tah in Germany are now in the Nordrhein-Westfalen state (~8), then it is worth to say that this state is the sate immediately south of NW.]

Rheinland-Pfalz/Rhineland-Palatinate state now has a “medical language test”. Rheinland-Pfalz/Rhineland-Palatinate has already “piloted” this medical language test. What caught my attention is the failure rate:

“About 180 language tests have been deposited in Mainz far, most of candidates from Romania, Hungary, Russia and Syria. Around forty percent of applicants fail the test.”

Should we panic? How hard is the exam? This paragraph can give an approximate idea what the exam is about:

“Patient must make X-ray neck

After twenty minutes Manoppo did it. You must now summarize the conversation in a doctor’s letter. Prior to the twenty-five year old has already delivered a note with translation exercises. Then they should translate into German 25 Latin medical terms. Only four were right, “invasive” for “derma”, “axillary fossa” or is it not occurred to German term. At the end of the doctor’s letter, the interview and the translation exercise will feed into the review.”

This exam is already decided upon. The good/bad news; it is only in this sate, but other states are expected to follow:

“Rhineland-Palatinate makes today the first federal state in Germany a language test before foreign doctors are allowed to work there, other [sates] are following.”

I personally think that the language test, if applied, would not make a big problem. Firstly, they are testing only “language skills”. Secondly, and most importantly, it is not an MCQ exam. It is only a passed/failed Oral exam! Take a history… summarize it… Translate some medical terms into German… Well, does this sound like an almost identical but shortened German-version of the USMLE Step 2 CS?

But, before one can say that foreign doctors should not be afraid, one should remember the “Academic Performance Test”. The following talks how foreign doctors are now allowed to work and get salaries in Germany:

*** Doctors from safe third countries, they can only get if the competent authority has established the “equivalence” of education, that is, when the size of classes, the variety of subjects and practical activities equivalent to those of medical education in Germany. Uniform guidelines for does not yet exist. The awarding of the license and the design of the tests is the states. So far, most authorities do not even want to know before the Candidates. *******But even if the “equivalence” was not found, a foreign doctor can get a temporary work permit for that state 🙂 🙂 🙂 ******* To be after a set period of a “knowledge test” is stored, which is also the states. Rhineland-Palatinate asks from knowledge in the subjects of Internal and General Medicine, Surgery and Pediatrics. In the German exams medical students are tested in more than twenty subjects, including pharmacy, ear, nose and throat medicine, urology, gynecology, psychiatry, occupational medicine or social medicine…..

The failure rate for the knowledge test is in Rhineland-Palatinate at around fifty percent 😦 😦 😦 😦 😦 😦 😦 :(. The test may be repeated three times****

To the best of my understanding, the article does not mention any thing about this being changed. Yes, if this “Academic Performance Exam” is to be extended to other German states, then certainly, the “around fifty percent” failure rate is VERY FRIGHTENING. However, there is a lot of “good news”:

1) Within a period of one and a half year, you are allowed to repeat the exam up to three times.

The failure rate for the knowledge test is in Rhineland-Palatinate at around fifty percent. The test may be repeated three times.

2) More than 20 subjects v.s. 3 subjects: German doctors are tested in over than 20 subjects. In RP state, foreign doctors are only tested in three subjects (Internal and General Medicine, Surgery and Pediatrics.).

“Rhineland-Palatinate asks from knowledge in the subjects of Internal and General Medicine, Surgery and Pediatrics. In the German exams medical students are tested in more than twenty subjects, including pharmacy, ear, nose and throat medicine, urology, gynecology, psychiatry, occupational medicine or social medicine.”

3) Thirdly, and this is the best piece of conclusion: You are given a “temporary working permit”. In other words, while preparing for the exam, you will be getting a “Salary”. Foreign doctors are given “a temporary work permit for that state”. The article does not mention anything about “No Wok (Salary) before passing the Language Proficiency Test and the Academic Performance Test”.

What about the situation in the rest of German states? Will their be exams there just like in Rheinland-Pfalz/Rhineland-Palatinate? The answer is in the SHORT TERM “No”. No decision has been reached yet:

The German Medical Assembly has already come out in May in Hannover for in June, the Conference of Health Ministers in Potsdam, completed in the claim. They also pleaded for an “improvement in the practice of recognition of foreign professional qualifications” means a transnational agency reports.

All in all, and to the best of my understanding, and please correct me if I am wrong, both of these tests are now confirmed in only one German state. Both of these tests are passed/failed exams. They are testing General information; whether in language or in medicine. Finally, and most importantly, you are not denied the “Temporary working permit” allowing you to work and get a salary before getting a salary. At least, you can work before passing the Academic Proficiency Test.

What do you think?