Reform of Medical Education 2026 - State of the Licensing Regulations and the Cost Dispute

What actually applies in August 2026

The legal basis of medical education in Germany remains the Licensing Regulations for Doctors of 2002. On its topic page on these regulations, the Medical Faculty Association expressly states that the current version dates from 2002 and was last amended in 2023. A revised set of licensing regulations has still not come into force.

This clarification is necessary because the content of the reform has been described publicly in detail for around six years. Anyone reading only those descriptions can easily gain the impression that they are already law. They are not: this is draft stage. For students starting in the 2026/2027 winter semester, the existing structure therefore continues to apply, with the three sections of the state medical examination and the final practical year in its current form.

New licensing regulations take the form of a statutory instrument of the Federal Ministry of Health. It has to be agreed within the federal government and then requires the consent of the Bundesrat. It is at this second hurdle that the process is stuck, as the MFT describes on its topic page.

From the 2020 Master Plan to a postponed entry into force

The political starting point is the Medical Studies Master Plan 2020, agreed between the federal government and the states in 2017. It set out the aim of making the degree more practice-oriented, more competence-based and more strongly geared to outpatient care. Implementation was to happen through new licensing regulations.

What is notable about this chronology is that the direction of travel has been largely uncontested from the start. In January 2024 the Rheinisches Ärzteblatt summed up the position by saying that everyone involved agrees on the need for change – more practice, more general practice and outpatient care, digital teaching formats, alignment with actual clinical competencies. What remained open was the question of who pays.

What the revision provides for in substance

The Federal Ministry of Health's draft describes a reform that shifts fewer individual subjects than it changes the architecture of the degree. The most important elements:

• The national learning objectives catalogue as a binding basis. The National Competence-Based Learning Objectives Catalogue for Medicine (NKLM) is to be anchored in the licensing regulations and thereby become a binding basis for teaching and examinations.
• An end to the strict separation of preclinical and clinical study. Under the draft, theoretical and clinical content is to be taught in connection with one another from the first semester onwards.
• Longitudinal rather than block-based thinking. Content such as scientific working or communication skills is to be built up across the whole degree instead of in isolated courses.
• General practice substantially strengthened. The draft provides for compulsory block placements in primary care amounting to six weeks, as well as a stronger presence of general practice in the final practical year.
• Fewer lectures, more blended learning. To limit the burden, the revised draft provides for a reduction in lectures of around 30 percent in favour of digital formats (Deutsches Ärzteblatt).
• Public health services. Strengthening public health within the degree is also among the draft's aims.

The planned restructuring of the state examinations

The reform would be most visible in the examinations. The draft still provides for three examination sections but redistributes the formats: the first section consists of a written and an oral-practical part, the second section is written, and the third section combines an examination with a patient and a circuit examination.

The circuit examination is the real change of system. Instead of testing knowledge alone, practical and communication competencies are examined in a structured way at several stations – internationally established as the OSCE. This is precisely the format that MFT and AWMF recommended in February 2026 independently of the revision, because it can be fitted into the existing legal framework.

The draft also provides that general practice will not only receive more teaching time but will have a fixed role as a subject in its own right in the final examination. That is the point at which primary care would for the first time gain the same visibility in examination law as internal medicine and surgery.

The compulsory outpatient quarter in the final practical year

Under the draft, the final practical year would consist of four training sections of twelve weeks each: internal medicine, surgery, a section in primary care or a specialty, and one further specialty. The third quarter is to be completed in teaching practices or in outpatient care facilities under Social Code Book V. That would anchor a compulsory outpatient quarter for the first time.

This is also where a large part of the costs sits: outpatient teaching practices have to be recruited, qualified, coordinated and paid. In its February 2026 recommendations the MFT therefore identified better access to outpatient teaching and learning opportunities as a field of action in its own right. How the practical year works organisationally and financially is covered in detail in our linked article on it; here it is placed in the context of the revision as a whole.

The cost dispute between the federal government and the states

The figures are the heart of the matter. The original draft was estimated to cost the states around 300 million euros a year in additional expenditure. After the 2023 revision the Federal Ministry of Health put the annual additional costs at 177 million euros and the one-off additional costs at 94 million euros; the latter had previously been estimated at 88 million euros (Deutsches Ärzteblatt, BDC).

In January 2024 the Rheinisches Ärzteblatt reported that the Medical Faculty Association continues to see the actual cost at over 300 million euros a year, while the federal government assumes 177 million euros. The states, for their part, have made clear that there is currently no room for a reform with significant financial consequences without the federal government covering the costs. In early February 2024 the states' science ministries wrote to the Federal Health Minister asking for a federal financial contribution to the implementation costs (Bavarian State Medical Chamber).

Behind this lies an understandable question of competence: the licensing regulations are federal law, while universities and their funding are a matter for the states. The federal government can set the requirements; the bill falls to the states. MFT Secretary General Dr Frank Wissing pointed out as early as 2023 that, even after the proposed reductions, the burden on everyone involved remains very high.

Why the faculties are no longer waiting

The MFT and AWMF recommendations of 18 February 2026 are the logical consequence of this situation. They name six priority fields of action that the faculties can implement themselves within the existing legal framework:

• a longitudinal curriculum for scientific thinking with a formal assessment,
• better access to outpatient teaching and learning opportunities,
• examination of practical competencies, for instance through circuit examinations,
• improved conditions in the final practical year,
• further development of the state examinations with digital support,
• integration of new topics such as disaster medicine and digitalisation into the learning objectives catalogue.

AWMF President Prof. Dr Rolf-Detlef Treede justifies the emphasis on scientific rigour by saying that scientific thinking and practice must be "more explicitly than before a subject of the degree". The practical effect: students at individual faculties already benefit from reform content even though the revision is not in force. The price is inconsistency – binding licensing regulations would have greater binding force, as MFT and AWMF themselves stress.

Model degree programmes show that this route works. The Rheinisches Ärzteblatt pointed out that RWTH Aachen, for example, has been continuously developing its curriculum since 2003 under the model clause and is therefore less dependent on the revision.

An international comparison with the Netherlands, the United Kingdom and Switzerland

All three countries have already answered questions that the German revision is still negotiating: how binding is a catalogue of learning objectives? How do you examine practical competence centrally? And how do you structure the degree towards practice?

Three observations are relevant to the German debate. First: in Switzerland the competence catalogue is not merely a recommendation but directly determines the content of the federal examination – exactly the role the German catalogue would only acquire through the revision. Second: with the MLA, the United Kingdom has created a central examination that expressly combines a knowledge part with a clinical and practical part; according to the GMC, the PLAB test for internationally trained doctors was aligned with the MLA requirements in 2024. Third: the Netherlands achieves practical relevance through structure – the three-year master's phase consists largely of coschappen, and at Utrecht University the first coschap begins, according to the university, as early as the third bachelor year.

This does not diminish the German discussion; it puts it in order. The revision would not take Germany into new territory but to a standard that comparable systems have already reached.

What this means in practice for prospective students

For everyone starting a medical degree in 2026 or 2027, four sober conclusions follow. First, the existing licensing regulations apply, and planning should build on them. Second, thanks to the model clause and the MFT and AWMF recommendations, individual faculties can already teach in a far more practice-oriented way – looking at a faculty's actual curriculum is worth more than looking at the draft text. Third, entry into force on 1 October 2027 is not assured given the current state of the process. And fourth, the revision does not change access to the degree: it governs training and examinations, not the allocation of study places.

Anyone also considering a degree elsewhere in Europe will in some places find exactly the elements the German revision is aiming at – early patient contact, longitudinal clinical placements and structured practical examinations. Which option suits your own circumstances is best discussed case by case: you can book a free consultation with us at any time.

This article reflects the state of research as at 14 August 2026 and does not constitute legal advice. What is authoritative is solely the version of the licensing regulations in force at the time and the rules of the responsible state examination offices.