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

Abstract

Background: Germany faces a persistent physicians shortage f, particularly in hospitals and rural regions. Migrant physicians, especially from Arab countries, represent a crucial component. However, their professional integration is shaped by complex licensure procedures, demanding working conditions, administrative burdens and sociocultural dynamics. While previous research has examined structural and regulatory barriers, limited empirical evidence exists on integration processes from the perspective of Arab physicians themselves.

Purpose: This study aimed to explore the challenges and experiences of professional integration among physicians with an Arab migration background in the German healthcare system. Particular attention was paid to credential recognition, workplace conditions, language-related challenges, discrimination, cultural dynamics and patient-related barriers in order to identify institutional factors shaping integration processes.

Methods: A qualitative research design was employed. Twenty physicians (16 men, 4 women) originating from Syria, Lebanon, Egypt and Yemen participated in semi-structured interviews conducted in Arabic or German. Participants were recruited through purposive and snowball sampling. Interviews lasted 45-60 min and were audio-recorded, transcribed verbatim and translated where necessary. Data were analyzed using reflexive thematic analysis to identify patterns and overarching themes across narratives. The analysis involved iterative coding and theme development, reflexive consideration of researchers' interpretive roles and examination of divergent and contradictory cases. Theoretical saturation was assessed after approximately 18 interviews, with two additional interviews conducted to confirm that no new core topics emerged.

Results: Five interconnected themes were identified. Participants described the German healthcare system as structurally reliable and well-resourced but characterized by high administrative workload, staff shortages and time pressure. Licensure procedures were experienced as lengthy, opaque and psychologically stressful. Administrative complexity and insufficient onboarding hindered early integration. Language barriers were primarily situational, relating to dialects and colloquial communication rather than medical terminology. Approximately half of participants reported experiences of discrimination, mainly from patients. Shared language and cultural background with Arab patients were perceived as professional resources that enhanced trust and communication. Participants also highlighted systemic barriers affecting patients with migration backgrounds, particularly language barriers and limited knowledge of the healthcare system. Participants additionally described an intermediary role in which their linguistic and cultural resources helped bridge communication and institutional gaps between patients with migration backgrounds and healthcare services. Across themes, professional integration emerged as a multidimensional and relational process shaped by institutional structures, workplace conditions, cultural dynamics and experiences of belonging and difference rather than solely as an individual adaptation process.

Conclusion: Professional integration of Arab migrant physicians in Germany is strongly influenced by institutional structures, administrative processes and workplace conditions. While Germany offers robust structural prerequisites for medical practice, deficits in recognition procedures, onboarding, intercultural institutionalization and administrative support pose significant challenges. The findings suggest that integration should be approached as a reciprocal institutional process rather than solely as an adaptation task for migrant physicians. Structural reforms including streamlined licensure processes, structured induction programs, expanded interpreting services and systematic intercultural training are essential to support migrant physicians and strengthen the resilience and equity of the German healthcare system.