What Is the FSP? Where and How Do You Take It?
The Fachsprachprüfung (FSP) is the medical German language exam that foreign physicians must pass to work in Germany. Here is how it differs from general language tests (such as telc B2/C1): the FSP measures whether you can use your German at the bedside, with a colleague, and in a written report. The question is not "Do you know German?" but "Can you work as a physician in German?"
In this guide I lay out the structure of the FSP, the differences between states, and how you should prepare — in plain terms.
Why does it matter this much? At the end of 2024, 68,102 foreign-national physicians were working in Germany — more than 15% of all doctors, and the number has doubled over the past decade. But the threshold at the door is serious: in some states, one in every two foreign physicians fails the FSP on the first attempt. Without passing the FSP there is no independent medical practice (Approbation) in Germany.
The 3 parts of the FSP
Although there are small differences from state to state, almost everywhere the exam consists of the same three parts and lasts roughly 60 minutes in total:
| Part | Duration | What it measures |
|---|---|---|
| 1. Anamnesis (Arzt–Patient) | ~20 min | The patient interview: taking the history, asking questions, empathy, switching to everyday language. |
| 2. Documentation (Arztbrief) | ~20 min | Turning the interview into a written medical report (discharge letter / Arztbrief). |
| 3. Doctor-to-doctor presentation (Arzt–Arzt) | ~20 min | Presenting the case to a colleague, speaking in medical terminology, answering questions. |
The key point: in Part 1 you speak to the patient in everyday language ("Bauchschmerzen"), while in Part 3 you speak to a colleague in medical terms ("Abdominalschmerz"). Being able to express the same thing in two different registers is the heart of the FSP.
How is it in each state? (The Ärztekammer difference)
In Germany the FSP is not run by a single central body — each state's Medical Chamber (Ärztekammer) organizes it. That is why the fee, the waiting time, the passing criteria and the exam format vary from state to state. The important differences:
- Fee: Ranges from roughly 350–600 € depending on the state.
- Waiting time: In some states an appointment takes weeks, in others months.
- Format detail: Some chambers, such as the Münster region, have their own case style and assessment approach.
- Retake rights and intervals: The conditions for retaking after a fail differ by state.
Practical tip: Decide where to sit the exam not just because "that's my home town," but based on waiting time + format. Some candidates take the exam in another state to get a faster appointment.
How hard is it to pass? (A chasm between states)
There is no single official pass rate in Germany; each Medical Chamber reports its own. Looking at what has been published, we can see that success varies dramatically by state:
| State | First-attempt failure rate |
|---|---|
| Bayern | ~52% — "one in every two" (made headlines) |
| Niedersachsen | ~56% (2023) |
| Westfalen-Lippe (Münster) | ~52% (2023) |
| Nordrhein | ~36% |
| Baden-Württemberg | ~27% |
| Thüringen | ~26% (the lowest band) |
Sources: Deutsches Ärzteblatt (Bayern, Baden-Württemberg), state Kammer announcements. Rates vary by year.
Takeaway: These numbers are not about your medical knowledge — they are about your preparation. The experts' shared verdict: candidates fail not on grammar, but on structure + time management + documentation mismatch. The good news: with the right rehearsal, those odds swing in your favor.
Run an FSP simulation for your state
A real exam rehearsal with an AI patient, in the format of 16 states + telc-FSP.
How should you prepare? (4 steps)
1. Medical German vocabulary
Move the everyday-language ↔ medical-term matching from memory to reflex (e.g. "Herzinfarkt" ↔ "Myokardinfarkt"). This is the foundation of both Part 1 and Part 3.
2. Anamnesis practice
Practice the patient interview out loud and against the clock. Make your question patterns ("Seit wann haben Sie...?", "Strahlen die Schmerzen aus?") automatic.
3. Writing the Arztbrief
Turn the standard discharge-letter structure (Anamnese, Diagnose, Therapie, Procedere) into a template. In the exam you fill in the structure instead of thinking from scratch.
4. Rehearsal under real conditions
This is the most-skipped step. Knowing the material ≠ being able to use it fluently for 60 minutes under pressure. Before the exam, always do full-format, timed rehearsals.
Frequently asked
What language level do you need for the FSP? Generally general German at B2, often aiming for C1; but the FSP is a separate professional-language exam — a level certificate alone is not enough.
Is the FSP the same as the Approbation? No. The FSP is the language approval; it is one part of the Approbation (license to practice) process. In some cases the Kenntnisprüfung (professional-knowledge exam) is also required.