Medical Graduates Per 100,000 Population (2017): 12.0
Nursing Graduates Per 100,000 Population (2017): 54.5
Percent Share of Foreign-Trained Doctors (2017): 11.9%
Percent Share of Foreign-Trained Nurses (2017): 7.9%

Source: OECD (2019), Health at a Glance 2019: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/4dd50c09-en.

Annual Average (Or Most Common) Tuition Fees Charged By Tertiary Public Educational Institutions to National Students, By Level of Education, 2017/2018 (USD Converted Using PPPs):
Bachelor’s*: $136
*Note: “Bachelor’s programmes refer to bachelor’s, master’s and doctoral academic programmes combined.”

Source: OECD (2020), Education at a Glance 2020: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/69096873-en.

“The major criterion for a successful application and matching in one of the medical programs is the grade point average, or GPA (Abiturschnitt), after leaving high school (Gymnasium). It is calculated based on a student’s performance during 11th and 12th grade of school, a brief research paper, and their final school examinations. 1.0 is considered best while 4.0 is the minimum GPA required to graduate from high school. In addition to that, a large number of universities provide bonuses for participating and passing an exam called TMS (Test für Medizinische Studiengänge) [17], which is similar to the American Medical College Admission Test (MCAT) and can improve a GPA up to 0.8 points depending on a student’s percentile. Furthermore, minor GPA improvements can be achieved for prior military/civil service or completion of a nursing degree apprenticeship. Certain faculties even provide additional GPA credit for superior performance in scientific classes during high school. During the application process, the high school graduates need to choose up to 6 universities they are planning to apply for and rank them in order of preference. Moving on, the Stiftung fuer Hochschulzulassung distributes the available over 9,000 spots in German medical schools threefold [18]: 20% of all spots are given to those with the highest GPAs in state rankings. 60% are accepted via the internal process of medical faculties which is based on the final GPA including bonuses and occasional personal interviews. The final 20% are admitted by the number of “waiting semesters” (Wartesemester), meaning those who have waited the longest since high school graduation, without enrolling in a public university, have the greatest chance for sucessful application to medical school. For the medical year of 2016/17, the GPA cutoff for the first 20% via state rankings was either 1.0 or 1.1 depending on the home state. Cutoffs for GPA with bonuses via the internal distribution process were around 1.3. Acceptance for the last group (20% of spots) via waiting list required a minimum wait of 14 semesters (7 years) since high school graduation [19]. Defining ideal admission criteria will remain a subject of ongoing debate between students, medical faculties, and politics [14].

“Overall, the process is not without some intricacies. Three rounds of ranking and matching are typically needed to assign all the available spots and the last students are informed about their successful acceptance as late as October – at which point most universities have already begun orientation and first lectures.”

Source: Zavlin D, Jubbal KT, Noé JG, Gansbacher B. A comparison of medical education in Germany and the United States: from applying to medical school to the beginnings of residency. GMS Ger Med Sci. 2017;15:Doc15. DOI: 10.3205/000256, URN: urn:nbn:de:0183-0002568

“The public universities and their respective medical faculties discussed in this report are predominantly government- and thus tax-funded, as it has been the norm for many decades in Germany. After a short period of tuition charges of 500 Euros per semester (1,000 Euros per year) [28] starting around 2005 in various German states, these fees were all abolished again by the winter semester of 2014/15 [29] due to massive protests from students and the general public and shifts in the political atmosphere. Today, merely administrative fees exist ranging around 50–90 Euros per semester as well as discounted tickets provided by the universities for unlimited use of public transportation ranging from 50 to 200 Euros per semester. Generally, cost of living, particularly housing [30] in the more expensive cities, has been the major financial burden for students in Germany. For these reasons, many scholarship offers are more focused on specific student groups, such as political parties or religious communities rather than reaching out to the general student body [31]. The largest providers of collegiate financial support are the so-called Deutschlandstipendium, which reached merely 0.84% of all students [32] in Germany, the Studienstiftung des deutschen Volkes with similar scholarship figures [33], and the national Bundesausbildungsförderungsgesetz (BAföG) [34], that provides monetary aids up to 670 Euros per month to qualifying low-income students – half as a scholarship, half as a student loan. Altogether, only 4% of all German students received scholarships according to a recent survey [35].”

Source: Zavlin D, Jubbal KT, Noé JG, Gansbacher B. A comparison of medical education in Germany and the United States: from applying to medical school to the beginnings of residency. GMS Ger Med Sci. 2017;15:Doc15. DOI: 10.3205/000256, URN: urn:nbn:de:0183-0002568

“Many German universities offer degrees in medicine (38 state universities and 3 private universities in April 2020), dentistry (29 state, 1 private) and/or pharmacy (22 state) (Stiftung zur Förderung der Hochschulrektorenkonferenz, 2020). Candidates require a higher education entrance qualification (Allgemeine Hochschulreife) after 12 or 13 years of school. The limited study places for these three degrees are allocated as follows for the state universities: 30% of the places are allocated according to the higher education entrance qualification grade, 10% of the places according to aptitude (defined by each university, e.g. vocational training in a health profession, success in competitions) and 60% of the places are allocated through a selection procedure conducted by the universities (Auswahlverfahren der Hochschulen – AdH) (Stiftung der Hochschulzulassung, 2020). The “Master Plan for Medical Studies 2020” has initiated changes to the structure and content of the curricula, focusing, for example, on the physician-patient relationship, ambulatory care and general medicine.

“In the winter term of 2018/2019, 43,631 people applied for the 9232 places in medicine, 6190 applied for the 1518 places in dentistry, and 3980 for 1841 places in pharmacy (Stiftung für Hochschulzulassung, 2018). The duration of studies is four years for pharmacy, five years for dentistry and six years for medicine. The curricula are highly standardized by federal law and organized around three state examinations. After graduation, physicians, dentists and pharmacists receive their licence to practise (Approbation) from the state ministries responsible for health. The number of students and graduates has increased continuously since 2005 (Table 4.5).”

Source: Blümel M, Spranger A, Achstetter K, Maresso A, Busse R. Germany: Health system review. Health Systems in Transition, 2020; 22(6): pp.i–273.

“Primary training of most other health professionals requires vocational technical training after secondary school, leading to qualifications/diplomas, and increasingly university degrees (see below), and usually takes three years. After graduation, health care professionals are eligible for authorization by the state authorities responsible for health to use the professional title.

“The primary training of nurses currently takes place in publicly financed facilities, mostly affiliated to hospitals. Their practice-based training in inpatient facilities is combined with course-based instruction at the training facility (some days per week or in blocks throughout the week), and they receive a vocational training salary. Starting from 2020, according to the 2017 Nursing Care Professions Act (Gesetz zur Reform der Pflegeberufe), all nurses will receive joint, generalist training for two years. In their third year they can choose to specialize in the care of children (“paediatric nurse”) or the elderly (“geriatric nurse”) or to follow generalist training and acquire the qualification of professional nurse (Pflegefachfrau, Pflegefachmann). Fees for nursing training were abolished in 2020 (Deutscher Bundestag, 2018a).

“Medical assistants and dental assistants are trained separately in a threeyear vocational training based at training facilities and physicians’ practices, including obligatory rotation, and they receive a basic income. In contrast, schools for other health professions, such as physiotherapists, occupational therapists, dieticians and speech therapists, are often privately funded and charge fees (from about € 150 to € 700 per month). Some states have already abolished these fees, but the nationwide regulation to abolish all fees for health professionals’ training and to introduce a vocational training salary is still in progress (Bundesministerium für Gesundheit (BMG), 2020c, 2020o).

“According to EU directive 2013/55/EU, the training of midwives at universities is required for all Member States. The Midwifery Reform Act (Hebammenreformgesetz) entered into force in January 2020. Training takes place at universities, ending with a bachelor’s degree in midwifery. During a transitional period until 2022, midwifery vocational schools are still allowed to offer courses, which have to be completed by 2027 (Bundesministerium für Gesundheit (BMG), 2019f; Deutscher HebammenVerband e.V.).”

Source: Blümel M, Spranger A, Achstetter K, Maresso A, Busse R. Germany: Health system review. Health Systems in Transition, 2020; 22(6): pp.i–273.

Health Systems Facts is a project of the Real Reporting Foundation. We provide reliable statistics and other data from authoritative sources regarding health systems in the US and several other nations.

Page last updated Nov. 17, 2021 by Doug McVay, Editor.