Doctors' pay secured even without Approbation
Hospital must pay doctors' tariff rate even for provisionally licensed physicians
On 19 May 2026, Germany’s Federal Labour Court (Bundesarbeitsgericht, BAG) ruled (case no. 4 AZR 98/25): the doctors' collective agreement TV-Ärzte/VKA – which sets pay and working conditions for hospital doctors employed by public-sector hospitals – applies equally to doctors who hold a provisional practice licence (Berufserlaubnis) instead of full German medical authorisation (Approbation). The hospital had argued the opposite in two lower courts and lost both times. With this ruling, the judgment of the Hessian Regional Labour Court dated 28 October 2024 (case no. 7 Sa 491/23) is now final and binding.
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Cardiology resident, provisionally licensed, denied tariff pay
The Federal Labor Court has not yet issued its reasoning. The lower court had established the following facts:
A 43-year-old resident doctor started working at a hospital in December 2021, training to become a cardiologist. At that point he did not yet hold an Approbation – the permanent, full authorisation to practise medicine in Germany, roughly equivalent to a state medical licence in the US. Instead, he had a Berufserlaubnis under § 10 of the Bundesärzteordnung (Federal Medical Practitioners Act). This is a time-limited, supervised practice permit issued to foreign-trained doctors or doctors whose German recognition is still pending; it allows them to work as physicians under the constant supervision of a fully licensed colleague.
From February 2022 he was a member of Marburger Bund, the main trade union for hospital doctors in Germany – making the TV-Ärzte/VKA collective agreement binding on him. The hospital was also bound by that agreement. It refused to pay him the tariff rate all the same, on the grounds that the agreement only covered doctors with full Approbation. The court disagreed: a provisional licence under the Bundesärzteordnung carries the same rights and duties as full authorisation, and the collective agreement draws no distinction between the two.