Career Paths with an EU Medical Degree: Working Worldwide

The starting point: medicine is an international labour market

In its International Migration Outlook 2025, the OECD measured how many practising doctors obtained their degree abroad. The average is 19.6 per cent for the period 2021 to 2023. Between 2010 and 2023, the number of foreign-trained doctors in OECD states grew by 62 per cent – considerably faster than the number trained domestically.

Source: OECD, International Migration Outlook 2025 and Health at a Glance 2025, reference period 2021 to 2023. One methodological note that regularly gets lost in guides: depending on the source, „foreign doctors“ is measured as nationality, as migration background or as place of training. For the question of what a degree from abroad is worth, the place of training is what counts – a German citizen with a diploma from Hungary does not appear in the nationality statistics at all.

The WHO Regional Office for Europe followed up in September 2025: between 2014 and 2023 the number of foreign-trained doctors in Europe rose by 58 per cent, and a shortage of 950,000 health professionals is projected for the European Region by 2030. Anyone starting a medical degree today is therefore entering a market that needs new entrants.

Germany: the medical licence, specialist training and what is currently shifting

A degree from an EU state is recognised automatically under Directive 2005/36/EC. There is no aptitude or equivalence examination; the competent body is the licensing authority of the federal state where you want to work.

Specialist training then begins under the German Medical Association's model further-training regulations. What is binding is always the further-training regulation of your state medical association – the model version is only a model, and the 17 chambers implement it at different speeds.

Since 2018, further training has been competence-based rather than target-number based: what counts is what you can do, not how often you have done something. Documentation is in the eLogbook, supplemented by annual reviews. In 2026 the 130th German Medical Assembly restructured several specialties, among them neurology and psychiatry as well as geriatrics. There is no binding date from which everything applies – implementation is staggered across the state medical associations.

Two developments are worth knowing before planning a career. First, the outpatient sector is shifting: the number of employed doctors in practices has risen by 48 per cent since 2020, while the number in private practice has fallen by 8 per cent in five years. Running your own practice is no longer the default but one option among several. Second, almost half of the foreign doctors in Germany are under 35 – international graduates entering the profession is lived normality, not a special case.

Switzerland: the most attractive destination for German-speaking graduates

The figure that explains everything: 43 per cent of working doctors in Switzerland held a foreign diploma in 2025. Of those foreign diplomas, almost half come from Germany and a further six per cent from Austria. The FMH itself points out that this value lies far above the OECD average.

The route runs through the Medical Professions Commission MEBEKO at the Federal Office of Public Health, which recognises EU, EFTA and British diplomas directly. One point is almost always overlooked: after recognition and entry in the medical professions register, you additionally need a licence to practise – and that is issued by the canton, not the federal government. Further training itself runs through the Swiss Institute for Postgraduate and Continuing Medical Education and takes five to six years depending on the title.

An honest word on salary: a junior doctor starts at around CHF 80,000 a year and later sits at CHF 100,000 to 125,000. These figures come from salary surveys, not from a national collective agreement – there is none in Switzerland, and pay is set cantonally and at the level of the individual employer. And gross comparisons with Germany are misleading: health insurance premiums, rents and cantonal taxes considerably relativise the advantage. I live and work in Bern myself and say that deliberately plainly.

Austria: shorter basic training from August 2026

In July 2026 Austria adopted a reform that noticeably speeds up entry into the profession: basic training was shortened from nine to six months, effective from 1 August 2026. The justification was that the clinical practical year and basic training overlap by around 50 per cent in content.

Specialty training follows; in total it comes to around six years to specialist level. General medicine is currently being reshaped into a specialty of its own: 60 months instead of the previous 42, with a transition phase to 2030 and time in a teaching practice growing from 12 to 24 months.

The need is well documented: with 53,353 chamber members at the end of 2025, 18,346 doctors will reach the age of 65 over the coming ten years, which produces a replacement need of around 1,836 doctors a year. Among first registrations, about 18 per cent do not hold Austrian citizenship – the largest group being Germany.

Scandinavia: the diploma is not enough, entry is regulated

In Scandinavia the EU recognition of the diploma is granted automatically – but entry into the profession is nonetheless tied to a national entry year. This is the point at which many plans become imprecise.

On language, one clarification that matters: the frequently repeated claim that „C1 is required everywhere in Scandinavia“ cannot be substantiated in that form. Within the EU, a language examination may not form part of diploma recognition; it can, however, be a condition of employment or of the licence to practise, and each country sets the level itself. Anyone heading for Scandinavia should therefore plan for the language early – there it is the real hurdle, not the diploma.

United Kingdom: 42 per cent of doctors hold a foreign degree

The British labour market is as internationally open as almost any other. The GMC Workforce Report 2025 gives, for the 2024 data year: 328,149 licensed doctors, of whom 138,405 are internationally qualified – that is 42 per cent. Among new entrants, 20,060 came from abroad and 10,384 from the United Kingdom.

Since 2024, PLAB 1 has met the requirements of the new Medical Licensing Assessment and PLAB 2 those of the clinical examination. Important for EU graduates: anyone holding a relevant European qualification currently needs no PLAB. The GMC does, however, expressly point out that this legal position can change – anyone planning on the United Kingdom should check the status again shortly before graduating. Entry through the Foundation Programme is oversubscribed: in 2025, 10,121 places faced 10,788 first-preference applicants, and in London the ratio is consistently above 2.4.

United States: the route through ECFMG, USMLE and the Match

The American route is long but open. ECFMG certification requires USMLE Step 1 and Step 2 CK, an ECFMG Pathway with proof of language ability, at least four credited years of study – and the listing of your university in the World Directory of Medical Schools with an ECFMG Sponsor Note for your year of graduation. That last point is the critical one: it is university-specific and belongs on the checklist before you choose where to study, not afterwards.

More than one in two international graduates without a US passport therefore obtains a residency position – out of 44,344 positions offered in total. The choice of specialty is decisive: in 2026, 3,448 international graduates matched in internal medicine, 962 in family medicine, 684 in paediatrics, 222 in psychiatry and 170 in pathology. In highly competitive specialties such as dermatology or orthopaedics, by contrast, the chance is very small without an exceptional profile.

Since January 2022, USMLE Step 1 has been graded only as pass or fail. That shifts the weight onto the Step 2 CK score, onto clinical experience in the United States, publications and letters of recommendation from US physicians. A 2024 systematic review covering 25 studies and 375,549 participants confirms exactly these predictors. The practical consequence: anyone aiming for the United States builds contacts and clinical electives there from the third year of study – not after graduating.

Canada and Australia: smaller quotas, clear rules

In Canada, 4,103 positions were offered in the 2026 R-1 Match and 95.6 per cent were filled. In all, 931 internationally trained doctors obtained a position – after 851 in 2025 and 671 in 2024, a clear upward trend. A match rate for international graduates cannot be derived from this, because CaRMS does not publish the number of applicants in that group; circulating percentage figures should therefore be treated with caution. Worth knowing: in most provinces, positions for international and Canadian graduates are separate quotas, so the two groups do not compete directly. The Practice Ready Assessment programmes are expressly aimed at fully qualified specialists with a return-of-service obligation in underserved regions – for new graduates they are not a route.

In Australia, Ahpra regulates jointly with the Medical Board, and assessment runs through the Australian Medical Council. As at 30 June 2025 there were 69,880 first registrations across all health professions, more than 26,000 of them internationally trained. One detail that is decisive for German-speaking doctors: the expedited route to specialist registration introduced at the end of 2024 applies only to specialists from the United Kingdom, Ireland and New Zealand – not to German or Austrian ones. For them the standard or specialist pathway remains.

Gulf states: possible, but not as a first job

EU degrees are in principle recognised in Qatar, Saudi Arabia and the United Arab Emirates – but nowhere automatically and without examination. In Qatar, verification through DataFlow is mandatory, and a Prometric examination is required for all general practitioners, expressly without exception. Saudi Arabia requires at least one year of work experience from foreign doctors – direct entry after graduation is therefore closed off. In the Emirates the licence is emirate-specific: a Dubai licence is not valid in Abu Dhabi.

Impressive salary figures circulate for the region. They come practically exclusively from recruitment agencies and cannot be independently verified – which is why we deliberately name none here. Income is tax-free only with actual tax residence on the ground; anyone who keeps their residence in Germany or Austria remains taxable there. And work experience from the Gulf region is usually not credited, or only partly credited, towards European specialist recognition. Interesting as a later career step, not as a first one after graduation.

What the research says about internationally trained doctors

The most important work on this question comes from Tsugawa and colleagues and appeared in the British Medical Journal in 2017. It analysed 1,215,490 hospital admissions across 44,227 internists in the United States. The result: adjusted 30-day mortality was 11.2 per cent among patients of internationally trained doctors against 11.6 per cent among those of US-trained doctors – a statistically significant difference in favour of the international graduates. On readmissions there was no difference.

And now the scientifically clean qualification that has to go with it: the effect is small, 0.4 percentage points. The most plausible explanation is a selection effect – an international graduate who obtains an American residency position has USMLE, ECFMG and the Match behind them and is positively preselected. The study therefore does not prove that training abroad is better. But it very robustly refutes the assumption that it is worse. Anyone who reads somewhere that patients of international doctors have a „20 per cent lower mortality“ has fallen for a faulty summary – the original figures do not say that.

A word on ethics: intra-European mobility is not brain drain

In 2010 the WHO adopted a code of practice on the international recruitment of health personnel and has maintained, since 2023, a list of 55 countries from which active recruitment should not take place because of critical staff shortages. That list covers above all states in Africa, the Western Pacific and the Eastern Mediterranean.

An EU citizen who studies in Hungary, Poland or Latvia and then works in Germany or Switzerland does not fall within that problem – freedom of movement within the EU was created for precisely this. The WHO data incidentally shows that Germany is at the same time one of the most important source countries of doctors for Austria, Switzerland and Bulgaria. The exchange runs in every direction.

What this means for choosing where to study

Three things follow from this in very practical terms. First: before enrolling, check whether the degree of the university you have in mind is listed in Annex V of Directive 2005/36/EC and whether an ECFMG Sponsor Note exists in the World Directory, in case the United States might ever be a consideration. Second: countries with a high foreign-trained share – Switzerland, the United Kingdom, Norway, Ireland – have well-practised procedures for international graduates, which makes a great deal easier. Third: the language of the destination country is almost always the greater hurdle, not the diploma.

Which of these routes fits your professional goal, and which place of study keeps which doors open, is best looked at together – in a free consultation.