Arab migrant physicians in Germany face lengthy licensure and workplace barriers

Physicians who migrated to Germany from Arab countries describe a professional integration process shaped less by their own clinical skills than by the institutions they must navigate, according to a qualitative study published in Globalization and Health. The research, based on in-depth interviews with 20 physicians from Syria, Lebanon, Egypt and Yemen, found that lengthy and opaque licensure procedures, insufficient onboarding, high administrative workloads and experiences of discrimination were recurring obstacles, while shared language and cultural background with Arab patients emerged as valuable professional resources.

The study comes against the backdrop of a persistent physician shortage in Germany, particularly in hospitals and rural regions. Projections cited by the authors indicate a shortfall of approximately 30,000 to 50,000 physicians between 2024 and 2040. Migrant doctors form a critical component of the German healthcare workforce, and Arab migrant physicians constitute a significant subgroup of the medical workforce. Yet while previous research has examined structural and regulatory barriers, the authors note that limited empirical evidence has captured integration processes from the perspective of the Arab physicians themselves.

To address that gap, the researchers conducted semi-structured interviews with 20 physicians, 16 men and 4 women, aged 29 to 64 years, with a mean age of 38.6 years. Twelve participants originated from Syria, three from Egypt, three from Lebanon and two from Yemen. Participants were recruited through purposive and snowball sampling, including recruitment via Facebook groups and referrals from previously interviewed physicians, and data were collected between April and December 2023. Interviews lasted 45 to 60 minutes, were conducted in Arabic or German according to participant preference, were audio-recorded with consent and transcribed verbatim. Arabic-language interviews were translated into German by a bilingual member of the research team, and the analysis was performed using the German transcripts.

The researchers analyzed the data using reflexive thematic analysis, an approach in which themes are treated as interpretive constructions developed through engagement with the data rather than neutral categorizations of responses. Two researchers participated independently in coding and theme development, holding regular analytical discussions to reflect on coding decisions and consider alternative interpretations. Deviant or contradictory cases were deliberately examined to refine the developing themes. Theoretical saturation was assessed after approximately 18 interviews, when no new core topics emerged, and two additional interviews were conducted to confirm that saturation held across different medical specialties and regional contexts.

The analysis identified five interconnected themes that together trace an experiential trajectory from entry into the profession to an eventual mediating role. The first theme, seeking recognition and professional legitimacy, captured how entry into the German healthcare system was experienced as a prolonged process of institutional uncertainty. One participant reported having to submit the same original documents, including a police clearance certificate, multiple times, needing three months to find a chief physician willing to hire without full licensure, and spending almost two years on the recognition process. Another described a constant back-and-forth of document requests, with recognition alone taking one and a half years.

The second theme concerned learning to navigate institutional complexity. All participants described difficulties with administrative processes, including applications, documentation, rehabilitation referrals and legal forms, with these challenges most pronounced during early employment and attributed to insufficient institutional onboarding rather than individual deficits. Language difficulties were concentrated in early integration phases and related primarily to dialects and colloquial patient communication rather than medical terminology, which participants said was not the main problem. Linguistic insecurity was often misinterpreted as professional insecurity, though this perception diminished with increasing routine, and collegial support proved crucial in overcoming language-related challenges. Approximately half of the participants reported experiences of discrimination, mainly from patients, ranging from subtle mistrust to open rejection of treatment. Marked regional variation was observed, and participants developed pragmatic coping strategies such as ignoring minor incidents, redirecting conversations or involving supervisors.

The third theme portrayed a healthcare system experienced as structurally reliable but under pressure. Participants consistently described the German system as well resourced and highly standardized, emphasizing stable emergency services, widespread availability of diagnostics and therapies, digital documentation, preventive services and compulsory health insurance. These features contrasted sharply with experiences of resource scarcity, political instability and interrupted care in participants’ countries of origin, although they were viewed as baseline conditions enabling practice rather than sources of daily job satisfaction. Disadvantages were located primarily in working conditions rather than clinical standards: excessive documentation, billing and reporting obligations, staff shortages that intensified workloads through overtime and additional shifts, and time pressure that limited direct patient contact. Participants emphasized that these challenges affected both migrant and German-trained physicians, though unfamiliarity with administrative procedures made the early integration phase particularly demanding for migrant doctors.

The fourth theme examined intercultural competence as simultaneously a resource and a marker of difference. Shared language and cultural knowledge with Arab patients were widely described as professional assets that facilitated trust, nuanced interpretation of symptoms and communication in emotionally charged situations. At the same time, participants occasionally encountered implicit cultural insensitivities, particularly regarding religious practices such as fasting during Ramadan, with one participant noting that colleagues did not understand that Muslim doctors can work just as efficiently while fasting. Most participants nonetheless described supportive professional relationships and reciprocal cultural consideration, such as working on Christian holidays. While cultural preferences such as physician gender or family presence were often accommodated in practice, participants noted informal devaluation of such expectations within teams and highlighted the absence of institutional guidelines for managing cultural expectations.

The fifth theme revealed an often-unrecognized mediating role. Participants frequently acted as cultural and institutional intermediaries between healthcare institutions and patients with migration backgrounds, translating not only language but also institutional expectations, administrative procedures and healthcare practices. Language barriers were identified as a primary obstacle for patients, affecting history-taking, informed consent and understanding of treatment, and professional interpreters were described as optimal but inconsistently available. In their absence, participants relied on multilingual colleagues, digital translation tools or relatives, despite the risk that family members may not be fully proficient in German and may communicate misinformation. Understanding referral pathways and the general-practitioner-managed admission system posed major challenges for newly arrived patients, and participants reported spending approximately 10 to 15 minutes per consultation explaining system structures, depending on workload. This additional mediating role created demands on consultation time and workload, functioning both as a resource for patient care and an unrecognized professional responsibility.

Across all five themes, the authors conclude that professional integration is best understood as a multidimensional, institutionally mediated and relational process rather than solely an individual adaptation task. They argue that structural reforms, including more transparent and streamlined licensure procedures, structured onboarding and mentoring programs, improved administrative support, wider availability of professional interpreting services, systematic intercultural training and organizational strategies to prevent discrimination, are essential to support migrant physicians and strengthen the resilience and equity of the German healthcare system. The authors also acknowledge limitations: the sample was non-probabilistic and potentially affected by self-selection bias, the overrepresentation of male physicians should be considered when interpreting findings, some interviews were conducted by telephone, which may have limited access to non-verbal cues, and the interpretive nature of reflexive thematic analysis means the five themes represent one situated account rather than an objective or exhaustive representation of participants’ experiences. Future research, they suggest, should include comparative perspectives from German-trained physicians and institutional stakeholders to triangulate the findings.

Subject of Research: Professional integration experiences of physicians with an Arab migration background in the German healthcare system

Article Title: Institutional barriers and professional integration of physicians with an Arab migration background in Germany: a qualitative study

Article References: El-Halabi, M. N., Hübner, J., & Ahmadi, E. (2026). Institutional barriers and professional integration of physicians with an Arab migration background in Germany: a qualitative study. Globalization and Health, 22(1), Article 70. https://doi.org/10.1186/s12992-026-01239-3

Image Credits: AI Generated

DOI: 10.1186/s12992-026-01239-3

Keywords: migrant physicians, Germany, professional integration, licensure, qualitative study, discrimination, intercultural competence, physician shortage, healthcare workforce, thematic analysis, Arab countries, onboarding