Training Networks Set to Safeguard Specialty Training Between Hospital and Practice
17.09.2026
What is the German Medical Association demanding for medical specialty training?
On 28 July 2026, the Standing Conference ‘Medical Specialty Training’ of the German Medical Association published six demands. At their core is securing regional training networks legally and organisationally, refinancing the extra coordination work involved, and removing employment-law obstacles to rotations between hospitals, practices and outpatient care centres.
- The effects of service-group planning should be systematically factored into hospital planning.
- Inpatient and outpatient training should be strengthened equally.
- Regional training networks should be given a secure legal and organisational footing.
- The extra coordination effort involved should be refinanced.
- Employment-law obstacles to rotations between providers should be removed.
- Training requirements should be anchored in remuneration and funding systems.
Cross-cutting specialties such as anaesthesiology and radiology are specifically named, since many sites can now only partially cover their content. The German Medical Association regards training networks as an investment in the next generation of doctors, not as an administrative task.
How far the structure has already developed, and where it is stalling, is shown in the table below, which brings together figures from four sources that are usually cited separately.
| Metric | Value | Source and date |
|---|---|---|
| Active training networks | 388 | 2023 evaluation report on Section 75a SGB V |
| Participating practices | 3,999 | 2023 evaluation report |
| Participating hospitals | 763 | 2023 evaluation report |
| Practices per network | around 10 | own calculation from both figures |
| Competence centres for training in general practice | 15 | 2023–2027 funding period |
| Funded positions in general practice provided by law | at least 7,500 | Section 75a SGB V |
| State medical associations with regulated network authorisation | 3 of 17 | Marburger Bund, 10 May 2026 |
| Funding for an outpatient placement in general practice | €5,800 per month | Funding agreement of 23 September 2024 |
The last row is the real finding. 388 networks are already operating, but according to the Marburger Bund, only three of the 17 state medical associations have given network authorisation a legally secure footing in their training regulations: Mecklenburg-Western Pomerania, Thuringia and Hesse. The structure, in other words, no longer needs to be built – it needs to be made reliable.
What is a training network (Weiterbildungsverbund)?
A training network is a regional alliance of hospitals, medical practices and outpatient care centres that pool their authorisation to provide specialty training in a cooperation agreement. Doctors in specialty training rotate through the agreed stages according to a shared schedule, instead of applying separately for each placement.
This is especially relevant in general practice. Based on the model training regulations, the state medical associations' training rules provide for 60 months, including at least 24 months of outpatient primary care and at least 12 months of inpatient internal medicine. At least six further months go to another area of direct patient care, and up to 18 months can be completed in other approved specialties. Moving between sectors is therefore not the exception – it is built into the structure.
The funding agreement under Section 75a SGB V, as amended on 23 September 2024, expressly recognises planned and documented rotations, for example within networks. The minimum duration of a fundable placement is three months.
Network authorisation and training regulations
The legal footing is the bottleneck. At its 147th general assembly on 10 May 2026, the Marburger Bund called on the state medical associations to regulate training networks and the conditions for network authorisation in their training rules, and additionally argued for harmonising the states' healthcare-profession chamber laws. The German Medical Association picks up the point in its July position paper and also points to the state hospital laws.
Why does the hospital reform affect medical specialty training?
The Hospital Reform Adjustment Act of 6 March 2026 plans inpatient care in Germany around 61 service groups, down from the previous 65. Because service groups are tied to quality requirements, a hospital that no longer offers a given group can no longer provide the related training content itself.
The new capacity-based payment (Vorhaltevergütung) is introduced on a budget-neutral basis in 2026 and 2027, moves through a convergence phase in 2028 and 2029, and becomes fully effective from 2030. The federal government is increasing its contribution to the Hospital Transformation Fund by €4 billion to a total of €29 billion; €3.5 billion a year is earmarked for 2026 to 2029, and €2.5 billion a year for 2030 to 2035.
Formally, the state medical association's training authorisation is unaffected. In practice, it shrinks wherever the range of services narrows. The network is the natural answer, because it combines the authorisations of several institutions into one continuous training pathway.
How much funding is available under Section 75a SGB V?
An outpatient training placement in general practice is funded in Germany at €5,800 a month, split evenly between the payers and the regional association of statutory health insurance physicians. Inpatient placements in internal medicine and general practice receive €1,650 a month, with a €1,170 supplement for placements in other specialties.
| Funding component | Amount per month | Funded by |
|---|---|---|
| Outpatient training in general practice | €5,800 (€2,900 + €2,900) | Health insurers and KVen, split evenly |
| Inpatient training in internal medicine and general practice | €1,650 | Payers |
| Supplement for placements in other specialties | €1,170 extra | Payers |
Across the 24 mandatory months of outpatient primary care, that comes to €139,200 in funding per trainee (own calculation). The law provides for at least 7,500 funded positions in general practice nationwide, plus up to 2,000 positions for primary-care specialties, including at least 250 in paediatrics. Up to five percent of the funds may be used for institutions that improve the quality and efficiency of training.
How large the programme has become is shown by the 2023 evaluation report on training funding. In outpatient general practice, 10,189 doctors in training were funded, equivalent to 5,847 full-time positions; they completed 13,178 placements across 9,030 practices. In the inpatient sector there were 1,201 trainees and 1,131 full-time equivalents across 448 sites, plus 3,718 people in outpatient placements in other specialties. Outpatient funding totalled around €495 million, of which €376.3 million went to general practice and €123.0 million to other specialties; the inpatient sector accounted for €22.7 million.
The two figures can be checked against each other. €376.3 million across 5,847 full-time equivalents works out to around €64,400 per full-time position per year (own calculation). The maximum funding available is €69,600. Funding is therefore being drawn down almost in full. One caveat: the report reflects 2023, the most recent complete figures available, and does not capture 2026.
What do the Competence Centres for Training in General Practice do?
The Competence Centres for Training in General Practice, known as KWAM, offer doctors training in general practice accompanying seminars, mentoring programmes with experienced GPs, and train-the-trainer courses for supervising physicians. They are funded from up to five percent of the resources allocated under Section 75a SGB V.
The overall framework is coordinated by a joint body that has been run by the DLR Project Management Agency since April 2019 and is backed by the National Association of Statutory Health Insurance Funds, the German Hospital Federation, the National Association of Statutory Health Insurance Physicians, private health insurers and the German Medical Association. The 2023 evaluation report lists 15 competence centres in the second funding period, 2023 to 2027, with a total volume of around €4.7 million.
According to the German Foundation for General Practice and Family Medicine, corresponding centres exist in almost every chamber district, from Baden-Württemberg through North Rhine and Westphalia-Lippe to Thuringia. Funding is split between the regional associations of statutory health insurance physicians and health insurers at a ratio of 45 to 55, supplemented by a performance-based component.
How many GPs are missing in Germany?
A forecast by the IGES Institute, commissioned by the Bosch Health Campus and published on 20 July 2026 under the title ‘Primary Care 2035+’, projects that around 12,000 GP positions in Germany could remain unfilled by 2040 – about a fifth of all positions. According to the same calculation, around 4,400 were unfilled in 2025.
The starting point is described in the National Association of Statutory Health Insurance Physicians' statistics of 12 March 2026. In 2025, a total of 191,875 physicians and psychotherapists took part in statutory outpatient care, including 55,778 GPs, up 0.6 percent on 2024. The average age was 53.9, and the share of women was 53.2 percent, up from 44.1 percent in 2015. More than 70,000 worked part-time and 98,447 full-time.
The German Medical Association's physician statistics as of 31 December 2025 record 446,120 practising doctors, of whom 45,915 work in general practice. In 2025, 16,195 doctors gained specialist recognition, up from 15,378 in 2024; of these, 2,283 were in internal medicine, 2,147 in general practice and 1,524 in anaesthesiology.
Read closely, the IGES forecast tempers its own headline figure. GP density would fall by around five percent by 2040, but the effects vary sharply by region: in major urban areas, the estimate suggests nearly all positions would remain filled. The shortage, in other words, is not a nationwide one, but a geographic one.
How is GP specialty training organised across Europe?
Germany, the United Kingdom, the Netherlands and Switzerland solve the same problem differently, but all work with a clearly defined practice-based phase. Germany and Switzerland steer through funding and regional cooperation; the United Kingdom and the Netherlands through centrally set numbers of places.
| Country | Duration | Mandatory practice component | How places are allocated |
|---|---|---|---|
| Germany | 60 months in general practice | at least 24 months outpatient primary care | at least 7,500 funded positions under Section 75a SGB V, networks organised regionally |
| United Kingdom | 3 years, GP Specialty Training | around 2 years in general practice, extended by 6 months since August 2021 | allocated centrally, 4,276 places in the first 2025 round |
| Netherlands | 3 years, huisartsopleiding at 7 institutes | two periods in general practice, with clinical placements in between | intake set by the Ministry: 1,035 places for 2026 |
| Switzerland | 5 years, general internal medicine (SIWF) | at least 6 months outpatient, preferably as a practice assistantship | cantonal programmes; canton of Bern has funded around 35 positions a year since 2019 |
United Kingdom
GP Specialty Training in England and Wales lasts three years and combines a clinical hospital component with two years in general practice; since August 2021, the practice component has been extended by six months without changing the overall length. Demand is high: in the first 2025 recruitment round, according to analysis by the trade publication Pulse, 20,995 applications competed for 4,276 places, a ratio of 4.91 to 1. In 2024 there were 15,036 applications for 4,096 places. NHS England set a target of 6,000 GP training places by 2031 in its 2023 Workforce Plan, and has since announced 1,000 additional places over three years under the 10 Year Health Plan.
Netherlands
The huisartsopleiding lasts three years and is run by seven training institutes. Two training periods take place in general practice, with a clinical placement focused on emergency care, a placement in mental health care and a placement in chronic and complex conditions in between, supplemented by a weekly return day at the institute. The Ministry sets the number of places based on need estimates from the Capaciteitsorgaan: 954 for 2024, 984 for 2025 and 1,035 for 2026, up from 870.
There is a figure here that is rarely cited alongside the rest. According to Huisartsopleiding Nederland's data of 16 January 2026, only around 725 trainees actually start each year in practice – about 70 percent of the places made available for 2026 (own calculation). Even central planning, in other words, does not guarantee that places get filled.
Switzerland
Under the SIWF training programme, the specialist title in general internal medicine requires five years: three years of basic training and two years of advanced training. Requirements include at least two years of inpatient and at least six months of outpatient general internal medicine, at least three months at a recognised emergency department, at least one year at a second training site, and at least 18 months within Switzerland. The programme has been in force since 1 January 2022 and was last revised on 26 August 2023.
Practice assistantships are organised by the cantons. According to the Swiss Society of General Internal Medicine, all cantons fund selected practice assistantships; six months full-time or twelve months half-time is typical. The canton of Bern launched its programme in 2007, funded 21 positions a year from 2013, and increased that number to 35 for the period from 2019. In addition, the FMH-backed Foundation for the Promotion of Training in Family Medicine co-funds around fifty practice assistantships a year.
I am a dentist, not a GP, so I see practice assistantships from the outside. What still stands out is that moving from a hospital into a practice is treated here as a normal part of training, not as stepping away from it. That is precisely the mindset Germany is now trying to build through training networks and Section 75a SGB V – just by a different route.
What does this mean for students with a degree from elsewhere in the EU?
For doctors with a medical degree from another EU member state, nothing changes about access to specialty training in Germany. If the degree meets the requirements of Directive 2005/36/EC, automatic recognition applies, and once the licence to practise is granted, the training regulations of the relevant state medical association and the funding under Section 75a SGB V apply exactly as they would otherwise.
Article 24 of the directive requires basic medical training of at least five years, with at least 5,500 hours of theoretical and practical instruction at or under the supervision of a university. Article 28 sets a Europe-wide minimum of three years full-time for specific training in general practice, including at least six months in hospital and at least six months in an approved general practice. Germany, at 60 months, is well above that. Anyone who earns the German specialist qualification therefore clearly exceeds the European minimum requirements.
In consultations about studying abroad, one question comes up almost every time, usually quieter than the ones before it: will this let me enter specialty training in Germany afterwards? I studied in Sofia from 2015 to 2021 and then went through the recognition process for my own degree in Switzerland – a comparable path in a different country. My experience: the degree itself is rarely the problem. How predictable your first professional years turn out to be depends on structures like these training networks, not on where you studied.
My assessment: network authorisation will become established in more state medical associations over the coming years, because pressure from hospital planning is rising and the networks are already operating in practice. That does not mean a uniform national framework is coming – chamber law remains a matter for the individual states. This assessment follows from the trend since 2023, not from any announced change in the law.
If you would like to know which location abroad in the EU fits your own path, and how that translates into entering specialty training in Germany, our team at Medschool Experts is happy to offer you a free consultation.
This article reflects the situation as of August 2026 and is intended for general information only. It does not replace individual legal advice; the applicable laws, the training regulations of the state medical associations, and the decisions of the responsible authorities take precedence.
Author's opinion
I studied dentistry in Sofia and now work in Bern. Two things from that experience shape how I read this news. First: automatic recognition under EU law isn't a footnote – it's the door you walk through. Second: what comes after that determines your first professional years, and that's a question of structure, not of where you studied.
That's exactly why I find the debate around training networks so interesting. It's discussed as a health-policy topic, but it affects young doctors planning their specialty training very directly. If 388 networks exist, with almost 4,000 practices and more than 760 hospitals, but only three state medical associations have expressly regulated network authorisation in their training rules, then the task isn't building the structure – it's making it reliable. And reliability is exactly what you need when you're writing a five-year plan in your late twenties.
Switzerland showed me how powerful a well-organised practice phase can be. Here, the practice assistantship isn't an add-on – it's often the moment people first realise primary care suits them. The canton of Bern raised its number of positions from 21 to 35 because the model works. In Germany, Section 75a SGB V makes something very similar possible with €5,800 a month in outpatient funding – just through a funding mechanism rather than a cantonal programme.
What I want prospective students to take from this: the path through a degree abroad in the EU is nowhere near a detour any more. In 2025, 2,147 doctors gained specialist recognition in general practice, and the funding structures behind that have grown over years, not been improvised. Anyone studying today in Sofia, Pécs, Kraków or Osijek enters the same training networks later as someone from Heidelberg or Greifswald. That connection is something we make a point of explaining to every student we work with at Medschool Experts, because it's told far too rarely.
My personal takeaway: the German Medical Association's demand is phrased in an unspectacular way, and yet it's one of the most practically significant shifts of the coming years. Thinking of specialty training as a continuous pathway rather than a sequence of separate positions makes the medical profession more predictable – and that ultimately benefits exactly the generation that is only just starting to think about where to study.
Summary
Training networks are becoming a central part of how specialty medical training is organised in Germany, and they matter directly for anyone who studies medicine abroad and later returns to complete their specialisation. A degree recognised under EU law leads into exactly the same training structures as a degree earned in Germany.
At Medschool Experts we have the largest network of official partner universities in Europe, and we assess every applicant individually to determine the highest possible year of entry – in many cases, entry is possible directly into the final two years of the programme. That means less time spent abroad before your degree is recognised and you can start planning your specialty training in Germany.
If you would like to talk through your options, book a free consultation with our team.
Frequently asked questions about training networks in general practice
What is a training network (Weiterbildungsverbund)?
A training network is a regional alliance of hospitals, medical practices and outpatient care centres that pool their authorisation to provide specialty training. Trainees rotate through the agreed stages according to a shared schedule, instead of applying separately for each placement.
What did the German Medical Association demand in July 2026?
On 28 July 2026, the Standing Conference ‘Medical Specialty Training’ set out six points: factoring service-group planning into hospital planning, strengthening both inpatient and outpatient training equally, giving regional training networks a secure legal and organisational footing, refinancing the extra coordination effort involved, removing employment-law obstacles to rotations, and anchoring training requirements in remuneration and funding systems.
How many training networks exist in Germany?
The 2023 evaluation report on funding under Section 75a SGB V records 388 active networks, involving 3,999 practices and 763 hospitals.
How much funding is available under Section 75a SGB V?
Under the funding agreement as amended on 23 September 2024, outpatient training placements in general practice are funded at €5,800 a month – €2,900 from payers and €2,900 from the regional association of statutory health insurance physicians. Inpatient placements in internal medicine and general practice are funded at €1,650 a month, with a €1,170 supplement for placements in other specialties.
How many funded training positions does the law provide for?
Section 75a SGB V provides for at least 7,500 funded positions in general practice nationwide. Up to 2,000 further positions are available for primary-care specialties, including at least 250 in paediatrics.
What are the Competence Centres for Training in General Practice (KWAM)?
KWAM are regional bodies that offer accompanying seminars, mentoring programmes and train-the-trainer courses for supervising physicians. They are funded from up to five percent of the resources allocated under Section 75a SGB V. The 2023 evaluation report lists 15 centres in the 2023–2027 funding period, with a total volume of around €4.7 million.
How long does specialty training in general practice take in Germany?
Based on the model training regulations, the state medical associations' training rules provide for 60 months. This includes at least 24 months of outpatient primary care and at least 12 months of inpatient internal medicine, with further stages in other areas of direct patient care.
Can I enter specialty training directly after a medical degree from another EU country?
Yes. If your degree meets the requirements of Directive 2005/36/EC – at least five years and at least 5,500 hours under Article 24 – automatic recognition applies. Once you hold your licence to practise, the same rules apply to your specialty training as to everyone else, including access to training networks and funding.
How is specialty training in general practice organised in the United Kingdom?
GP Specialty Training lasts three years, of which around two years are spent in general practice. Places are allocated centrally: in the first 2025 recruitment round, 20,995 applications competed for 4,276 places.
How many training places for general practitioners are there in the Netherlands?
The Ministry has gradually increased intake into the huisartsopleiding: 954 places for 2024, 984 for 2025 and 1,035 for 2026, up from 870. The Capaciteitsorgaan had calculated a need for 1,190 places in 2022 and has since revised that down to 1,026.
What role does practice-based training play in Switzerland?
The SIWF training programme in general internal medicine requires at least six months of outpatient training, preferably as a practice assistantship. Programmes are run at the cantonal level; the canton of Bern, for example, has funded around 35 positions a year since 2019.
Why does the hospital reform affect medical specialty training?
Under the Hospital Reform Adjustment Act of 6 March 2026, inpatient care in Germany will be planned around 61 service groups. Where services are consolidated, a single hospital can no longer cover every part of specialty training on its own, which is why rotations between institutions are becoming more important.
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About the author
Marcel Kloos
Swiss-licensed dentist and founder of Medschool Experts
Marcel Kloos founded Medschool Experts while studying abroad; since then, over 500 study places have been secured. The Stuttgart-born dentist studied dentistry from 2015 to 2021 in Sofia and holds a Swiss dental licence.
Today he lives in Bern and runs Medschool Experts full-time as its owner.
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