Why Do Exams Differ Between States?
When you read doctors’ experiences in Telegram groups or specialized forums, you notice a striking variation: a doctor succeeded in Schleswig-Holstein after weeks of preparation, while a female doctor failed three times in Munich despite her good language level. This variation is not a coincidence, but a direct result of the German federal system.
In Germany, there is no single central medical authority managing this exam. Instead, 16 medical chambers (Ärztekammer) in 16 states organize their exams independently. Each chamber sets its own standards, selects its committees, and determines its costs. The result: 16 systems, 16 levels of expectation, and 16 different experiences.
This reality makes choosing the state a strategic decision, not merely a logistical one.
Ranking States by Difficulty
Based on documented doctors’ experiences during the period 2024-2026:
Level One — Least Strict: States such as Schleswig-Holstein and Sachsen have committees that doctors generally evaluate as clearer in their standards and less strict on details. Exam appointments are reasonably available.
Level Two — Moderate: NRW (Düsseldorf) and Hessen represent the middle ground. Standards are clear and results consistent, but the volume of applicants is large. In Nordrhein alone, 2,040 exams were conducted in 2023. Hessen currently accepts the FaMed test as a temporary alternative until June 2026.
Level Three — Most Rigorous: NRW (Münster), Bayern, and Rheinland-Pfalz (Mainz) are characterized by higher requirements. Münster is known for mixing cases and strict committees. Bayern focuses on linguistic precision. Rheinland-Pfalz is unique with 4 sections instead of 3 — it adds a separate medical vocabulary test.
Detailed Comparison Table
| State | Cost | Main Focus | Level | Notes |
|---|---|---|---|---|
| NRW — Nordrhein (Düsseldorf) | €350 | Balanced | Moderate | Cheapest, 64% pass rate (2023) |
| NRW — Westfalen-Lippe (Münster) | €400 | Linguistic precision | Difficult | Committees mix cases |
| Bayern (München) | €550 | Latin terminology | Difficult | Highest precision requirements |
| Hessen | €650 | Documentation + dialogue | Moderate | Accepts FaMed until 30.06.2026 |
| Berlin | €420 | Medical dialogue | Moderate | Long wait (up to 6 months) |
| Rheinland-Pfalz | €425 | 4 sections | Difficult | Only one with additional vocabulary section |
| Sachsen | €590 | Patient language | Least strict | Calm assessment environment |
| Hamburg | €550 | Patient dialogue | Moderate | Relatively fewer applicants compared to NRW |
| Niedersachsen | €490 | Balanced | Moderate | 54.5% pass rate (2017) |
| Baden-Württemberg | €420 | Balanced | Moderate | Multiple exam centers |
| Brandenburg | €487 | Balanced | Moderate | Linked to LÄKB |
| Bremen | €530 | Balanced | Moderate | Low number of applicants |
| Thüringen | €600 | Balanced | Moderate | Small medical chamber |
| Mecklenburg-Vorpommern | €700 | Balanced | Moderate | Most expensive |
| Sachsen-Anhalt | €340 | Everyday language | Least strict | Appointments easily available |
| Schleswig-Holstein | €350 | Balanced | Least strict | Relatively fast appointments |
Source: Marburger Bund — September 2025
Can You Choose the State?
Yes, theoretically. But there are practical constraints:
First Constraint — Workplace: If you have an employment contract at a hospital in a specific region, it is natural to apply to the medical chamber of that state. Applying in a distant state without a connection to it may complicate procedures.
Second Constraint — Documents: Some states require residency, an employment contract, or at least an acceptance letter from a hospital.
Third Constraint — Waiting Time: The “easier” states are known to everyone, so demand increases and waiting times lengthen. In Berlin, you may wait 6 months for an appointment.
Optimal Strategy: If you are flexible in choosing your workplace, contact hospitals in states with flexible procedures and reasonable waiting times.
Kennti’s Advice
Do not fall into the trap of choosing the “easiest state” when you have not prepared well. The real difference is not made by the system, but by your level of preparation. A doctor who has conducted 15 complete simulations can succeed in Bayern. One who has not practiced may fail even in the least strict states.
Use the FSP Simulator — 87 free medical cases — to practice regardless of the state. For language building, remember that 2,460 flashcards are available to build the vocabulary you need.
The state chooses your location. Preparation determines your outcome.
Read Also
- The Comprehensive Guide to the FSP Exam 2026
- 90-Day Plan to Succeed on the First Attempt
- From B2 to Approbation: The Complete Roadmap
Last updated: April 2026 Sources: Marburger Bund (2025), Medical Chamber of Nordrhein (2024), Bundesärztekammer (2024)
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