Fachsprachprüfung Ärzte: The FSP Format, Fees by State and a 12-Week Plan
The FSP (Fachsprachprüfung Ärzte, the medical language exam for doctors trained abroad) tests medical German at about C1 level in three parts of about 20 minutes each: a doctor-patient interview, written documentation and a doctor-doctor talk. It is usually run by the state medical chamber. Fees we checked range from 420 to 800 euros per attempt.
Checked in October 2026 against the FSP pages and fee rules of eleven state medical chambers and authorities (named in the fee table), the Bayerisches Ärzteblatt and the Bundesärztekammer orientation guide. Fees and formats change: confirm with your state’s chamber.
For the bigger picture (general level, how the licence works, which certificates exist) see our overview of German for doctors.
What is the FSP exam in Germany?
To get a licence to practise (Approbation) or a temporary permit (Berufserlaubnis), a doctor must prove the German needed for the job. The state health ministers agreed on a common frame in 2014: medical language “orientiert am Sprachniveau C1”, tested in a simulated patient talk, a written document and a talk between doctors. Most states hand the exam to the Ärztekammer.
In practice:
- Before the FSP you usually need a general German certificate at B2 (Thüringen, Brandenburg and Baden-Württemberg say so explicitly).
- You do not book it yourself in many states. In Bavaria and Baden-Württemberg, for example, the licensing authority refers you to the chamber, which then sends you a date.
- The result goes to the authority. Bavaria also tells you orally on the exam day.
- It expires. Baden-Württemberg states that a passed FSP is valid for usually 3 years.
The 3 parts and their timing
| Part | Usual time | What you do |
|---|---|---|
| 1. Arzt-Patienten-Gespräch | 20 min | Take a full history from a simulated patient (an actor or an examiner), in everyday German. In some states you also explain the next steps to the patient. |
| 2. Dokumentation | 20 min (25 in Rheinland-Pfalz, 30 in Brandenburg) | Write down what you learned: on a form in some states, as an Arztbrief in others. |
| 3. Arzt-Arzt-Gespräch | 20 min (10 to 15 in Brandenburg) | Present the case to a doctor examiner in medical language, then answer questions on diagnosis, differentials and plan. |
The core is the same everywhere; the details are not:
| State | Special features |
|---|---|
| Nordrhein | Three stations of 20 minutes. Three examiners score you; the maximum is 60 points, the pass mark 36 points (60 percent). |
| Hessen | Adds a 20-minute written vocabulary test. Plan about two hours in total. No phones, books or other aids in the vocabulary test. |
| Brandenburg | Patient talk 20 minutes, written document 30 minutes, colleague talk 10 to 15 minutes. All on one day; no grades, only pass or fail. |
| Rheinland-Pfalz | Five sections, including a comprehension test with terminology and a body diagram, and a phone task. Plan 3 to 3.5 hours including waiting time. |
Thüringen’s flyer and a 2021 Westfalen-Lippe leaflet both end the third part with a short list of medical terms you must translate into everyday German words, so a term list is worth practising wherever you sit the exam.
Two companion posts cover the first two parts: Anamnese questions in German for part 1 and writing an Arztbrief for the FSP for part 2.
A template for part 3 (case presentation)
Part 3 is where many candidates lose structure. Learn one frame and use it every time:
Ich möchte Ihnen Herrn Becker vorstellen, einen 28-jährigen Patienten, der sich heute mit seit gestern Abend bestehenden Schmerzen im rechten Unterbauch vorgestellt hat. Begleitend bestehen Übelkeit und einmaliges Erbrechen. An Vorerkrankungen sind keine bekannt. Er nimmt keine Medikamente ein und hat eine Penicillinallergie. Ich habe den Verdacht auf eine akute Appendizitis. Differenzialdiagnostisch kommen eine Gastroenteritis und ein Harnleiterstein rechts in Betracht. Ich würde eine Laboruntersuchung mit Blutbild und CRP, einen Urinstatus und eine Sonographie des Abdomens veranlassen und die Kollegen der Chirurgie hinzuziehen.
I’d like to present Mr Becker, a 28-year-old patient who came in today with pain in the right lower abdomen since last night. He also has nausea and vomited once. No known previous illnesses. He takes no medication and is allergic to penicillin. I suspect acute appendicitis. Differential diagnoses are gastroenteritis and a right ureteric stone. I would order bloods with a full blood count and CRP, a urine test and an abdominal ultrasound, and involve the surgical team.
Then expect questions: Warum denken Sie an eine Appendizitis? Was machen Sie, wenn der Ultraschall unauffällig ist?
Fachsprachprüfung Ärzte: fees by state (as of 2026)
The Marburger Bund fee overview we found dates from 2019, and several fees have risen since, so this table uses only figures we saw on official pages in October 2026.
| State | Fee per attempt | Source and date |
|---|---|---|
| Baden-Württemberg | 420 euros | Regierungspräsidium Stuttgart page (exam run by the Landesärztekammer) |
| Bayern | 550 euros | Bayerische Landesärztekammer page (“derzeit”) |
| Berlin | 420 euros | LAGeSo information sheet (no date shown) |
| Brandenburg | 487 euros | LAVG information sheet, April 2026 |
| Hessen | 500 to 800 euros | Landesärztekammer Hessen fee rules, last amended November 2025 |
| Mecklenburg-Vorpommern | 700 euros | Ärztekammer fee schedule valid from 1 January 2025 |
| Niedersachsen | 595 euros | Information sheet, as of 1 January 2026 |
| Nordrhein (NRW) | 430 euros | Ärztekammer Nordrhein page |
| Rheinland-Pfalz | 470 euros | Ärztekammer Mainz page, from 1 January 2026 |
| Sachsen | 590 euros | Sächsische Landesärztekammer fee schedule, 2026 version |
| Thüringen | 600 euros | Landesärztekammer Thüringen flyer (no date shown) |
Not checked: Hamburg, Bremen, Saarland, Sachsen-Anhalt, Schleswig-Holstein and Westfalen-Lippe. Ask the chamber there.
Three cost rules:
- You pay again for every retake. Nordrhein, Thüringen and Hessen say so explicitly.
- You pay before the exam, usually by bank transfer, and in Brandenburg the fee is due even if you do not show up.
- Late cancellation costs money or time. The Mainz chamber keeps the full fee if you cancel within 14 days of the date and half if you cancel earlier. Westfalen-Lippe’s 2021 leaflet says a cancellation or no-show means no new date for three months.
Fees also rise: the Mainz sheet from 2024 said 425 euros, the page now says 470. Budget for one retake: roughly 840 to 1,600 euros for two attempts, plus travel and any course.
Practise your German out loud with SipLingo, free to try on iPhone and Android:
How many times can you take the FSP?
Niedersachsen, Berlin, Brandenburg and Thüringen state there is no limit, and Nordrhein allows several retakes. Two rules are common:
- You repeat the whole exam, not just the part you failed (Niedersachsen, Berlin and Brandenburg say this directly).
- A waiting time is recommended. Bavaria recommends at least three months before the next attempt; Westfalen-Lippe’s 2021 leaflet recommended three to six months. Rheinland-Pfalz expects you to wait the preparation time the examiners suggest, unless you have a documented urgent reason such as an expiring visa.
Do not confuse this with the Kenntnisprüfung, the medical knowledge exam some doctors from third countries must take. That one may be repeated only twice, according to the Bundesärztekammer guide.
How hard is the Fachsprachprüfung?
Hard: in Bavaria about half of candidates fail. The chamber reported in its journal that in 2024, 53 percent passed at their first attempt and 49 percent at their second. In Baden-Württemberg the chamber reported 65 percent passing in 2021. These are the only official pass figures we found; other states may differ.
The Bavarian chamber named the typical problems: medical terms, underestimating the exam, little knowledge of how German healthcare is organised, and pressure, because the FSP is often the last step before the licence. Four skills decide most results:
| Skill | Why it is hard |
|---|---|
| Switching registers | You ask the patient about Stuhlgang and Wasserlassen, then tell the examiner about Defäkation and Miktion minutes later. |
| Listening to vague speech | The simulated patient talks like a real one: half answers, Ich hab’s mit dem Kreislauf. |
| Writing under time | 20 minutes for a complete, correct document, often without a dictionary. |
| Structured presenting | The examiner interrupts. You need a frame that survives questions. |
A general C1 certificate does not make the FSP easy; it tests a job, not general fluency. If your general German is still the bottleneck, read how to get from B2 to C1 first.
Can you work as a doctor in Germany without German?
Not in patient care. The licence under the federal medical law (Bundesärzteordnung, §3 paragraph 1 number 5) requires the German needed for the job, and the FSP is how most states check it. For the temporary permit, the Bundesärztekammer guide says most states apply the same language requirements, and the permit is granted for a maximum of two years. Berlin, for example, asks for B2 plus the C1 FSP for the Berufserlaubnis too.
You may be exempt from the language tests if you completed your degree at a German-language university, or completed at least ten years of school or three years of vocational training in German (Baden-Württemberg lists these cases). Jobs without patient care, such as some research roles, follow different rules.
What many candidates do before the exam is an observership (Hospitation). The Mainz chamber lists proof of one as an optional document for the FSP application. As an observer you watch and learn the routines; you do not treat patients.
A 12-week preparation plan
This plan assumes you already have a B2 certificate and can study 12 to 15 hours a week.
| Weeks | Focus | Weekly output |
|---|---|---|
| 1–2 | The Anamnese order; 150 term pairs (medical term to everyday word) | 5 recorded histories of 20 minutes, self-checked against a list |
| 3–4 | Six key complaints: chest pain, shortness of breath, abdominal pain, headache, fever, back pain | 2 cases per complaint: history plus timed documentation |
| 5–6 | Documentation in Nominalstil; the case presentation frame | 4 timed documents (20 minutes), 4 spoken presentations |
| 7–8 | Explaining tests and treatments in plain German (ultrasound, gastroscopy, CT, blood test) | 2 full mock exams with a partner or teacher |
| 9–10 | Weak points from the mocks; German healthcare roles (Hausarzt, Notaufnahme, Station, Oberarzt, Konsil); term lists | 2 mock exams, 1 vocabulary test |
| 11–12 | Exam conditions: three parts back to back, no aids | 3 full mocks; reduce new material in the last week |
SipLingo (our app) is not an FSP trainer: it goes up to B2, its scenarios are everyday situations such as a visit to the doctor, and it has no C1 medical content. Where it can help is the base under the exam: daily spoken practice with instant corrections of grammar and word order, explained in your own language, and Fluency and Intonation scores that show where you still hesitate. Try SipLingo for your speaking base.
Realistic timing (our estimate, not an official figure): with B2 and focused work, 3 months is a fair target; if speaking is your weak skill, plan 4 to 6. Waiting lists add to that: Bavaria mentions about six weeks of lead time, and the Mainz chamber publishes dates quarter by quarter.
Official sources
For the official details and the latest updates, see:
- Landesärztekammer Hessen: Fachsprachprüfung for foreign doctors: exam notes (PDF, German) – Four FSP parts: vocabulary, patient talk, documentation, senior-doctor talk
- Make it in Germany (Federal Government): Physicians: Approbation and language requirements – Approbation, B2 general German plus a C1 medical language test
Frequently asked questions
How much does the FSP exam cost in Germany (Was kostet die Fachsprachprüfung)?
In the states we checked in October 2026, between 420 and 800 euros per attempt, for example 430 euros in Nordrhein, 550 in Bavaria and 595 in Niedersachsen. You pay again for each retake.
How hard is the Fachsprachprüfung?
Demanding: in Bavaria, 53 percent passed at their first attempt in 2024, according to the state medical chamber, which names medical terms, underestimating the exam and exam pressure as typical problems.
What is the FSP exam in Germany (Fachsprachprüfung Ärzte)?
The Fachsprachprüfung is the medical German exam for doctors who trained in another language. It has a simulated patient interview, a written document and a doctor-doctor talk at about C1 level, and is usually run by the state medical chamber.
Can I work as a doctor in Germany without speaking German?
Not with patients. Both the Approbation and, in most states, the Berufserlaubnis require proof of German, usually B2 general plus the FSP.
How many times can you take the FSP?
Niedersachsen, Berlin, Brandenburg and Thüringen set no limit, and Nordrhein allows several retakes. You usually repeat the whole exam, pay the fee again, and are advised to wait about three months between attempts.
Build the speaking base the FSP needs with 15 minutes of real conversation practice a day.
