Practice financing for doctors in Germany: the four approvals that must come first
The financing is not the hard part. The order is. A single signature in the wrong week destroys a subsidised loan you can never recover — and no bank, no notary and no seller will warn you, because it is not their job. Practice financing in Germany follows its own logic — separate from a standard home mortgage.
Practice financing in Germany: why does the sequence matter more than the loan?
The sequence matters more than the loan because four approvals must come in a fixed order: the Approbation, recognition as a specialist by the state medical chamber, entry in the medical register of the regional association of statutory health insurance physicians, and admission through the admissions committee. Only then does the bank appointment make sense.
What has to be in place before practice financing in Germany starts?
Practice financing in Germany starts only after four approvals, obtained in a fixed order.
- What must be in place before a bank finances a practice in Germany? Four gates, in order: Approbation (full licence to practise), specialist recognition (Facharzt) by the state medical chamber, entry in the medical register (Arztregister) of the regional KV, and admission (Zulassung) by the admissions committee. Only after the fourth does the practice have a legal basis to earn — and something a bank can finance.
- When must the KfW application be filed? Before the project begins, that is before you sign the practice purchase agreement, the lease or the order for the treatment unit. There is no retroactive application. In the KfW StartGeld programme the KfW carries 80 % of the credit risk, which eases the house bank’s decision; customary collateral is still discussed, so the indemnity does not replace it.
- Practice financing: are the regional KV grants equity? No. Most schemes reimburse against invoices after you begin practising, funding is discretionary and capped, and five years of practice in the funded district is the usual commitment. The directives and forms are published in German.
What does treating statutory patients in Germany require beyond a medical degree?
In Germany, treating patients insured under the statutory system, about 88 % of the population (KBV, 2023), requires more than a medical degree. It requires a chain of approvals, and a lender will not finance a practice for someone who has not yet cleared them. In order:
- Approbation — the full licence to practise medicine, issued by the competent authority of the federal state. For a qualification from outside the EU the authority compares your training with the German one (Gleichwertigkeitsprüfung); if the differences are substantial and cannot be offset by experience, you sit a knowledge examination (Kenntnisprüfung). You also need general German at B2 level and a medical-language examination (Fachsprachprüfung, C1). EU diplomas are recognised automatically. A temporary professional permit (Berufserlaubnis) is limited to a specific activity and one federal state for at most two years and is not enough to run a practice. There is no English-language route through this.
- Specialist recognition (Facharzt) — awarded by the state medical chamber (Landesärztekammer). Only a recognised specialist can hold a practice licence in that discipline. Specialist recognition follows the Approbation, not the other way round, and recognition of specialist training completed abroad is decided case by case and can take considerable time. The authorities publish no fixed processing time.
- Entry in the medical register (Arztregister) — held by the regional Association of Statutory Health Insurance Physicians (Kassenärztliche Vereinigung, KV). Entry requires the Approbation and completed specialist training; it is the precondition for applying for admission. Admission (Zulassung) — granted by the admissions committee (Zulassungsausschuss).
In many planning districts you cannot simply open a practice: once the supply level of a specialty reaches 110 % the district is closed to new admissions, and you take over an existing one through a succession procedure. The admission is what you are really acquiring. Districts below 75 % (GPs) or 50 % (specialists) count as under-supplied, and that is where regional funding becomes possible (Federal Association of SHI Physicians, KBV).
How a succession runs: the departing doctor, or the heirs, apply to the admissions committee for a succession procedure. The committee may refuse if the practice is not needed for supply reasons, as a rule where the supply level is 140 % or more; the departing doctor then receives compensation at market value. Otherwise the seat is advertised, interested doctors apply, and civil-law negotiations over the purchase contract run in parallel. The committee selects among applicants by criteria such as professional suitability, years since Approbation, experience, five years in an under-supplied area, kinship with the seller, work as an employed doctor in the practice and time on the waiting list. It considers the seller’s financial interest only up to the practice’s market value (§ 103 SGB V; KVB). Total duration is not published, so plan with the committee dates of your KV.
Residence permit: non-EU physicians need a residence permit that allows work. The EU Blue Card (§ 18g AufenthG) is a common route, with a lower salary threshold for shortage occupations such as medicine; thresholds are reset every year. According to published information, a Blue Card holder can apply for a settlement permit after 21 months with German at B1 level or after 27 months with A1. Whether your permit also covers running your own practice is a question for the local immigration authority, which you should ask before you plan the setup. We do not give immigration advice.
Only after that fourth gate does a bank have something to finance — because only then does the practice have a legal basis to earn.
Why must the subsidised loan be applied for before you sign anything?
Because the KfW StartGeld programme, in which the KfW carries 80 % of the credit risk for your bank, cannot be applied for retrospectively once the project has begun.
Germany’s state development bank, the KfW, offers the cheapest capital available to a practice founder.
The application must be filed through your bank before the project begins. A signed practice purchase agreement, lease or equipment order can count as the start, and there is no retroactive application. According to the KfW product information for StartGeld, you may conclude first contracts such as renting premises or ordering equipment once the application has been filed. What counts as the start in your case, your house bank clarifies before you sign anything. This is a programme rule, not a bank policy.
A common funding failure is a sequencing failure, not a credit failure. The founder finds the practice, agrees terms, signs to secure it — and only then starts looking for financing. By that point the most favourable component of the capital structure may be lost, and nobody involved had any reason to mention it. Details on practice financing.
What does the capital demand consist of?
Surgery premises, medical technology, IT and telematics infrastructure, and the facilities; the premises are often the largest single item.
- Surgery premises: refurbishment, accessibility, fire safety, hygiene areas. Often the largest single item of expenditure in the construction of new medical centres.
- Medical technology: the item that makes your specialism expensive or affordable – see costs by specialism.
- IT, PVS, telematics infrastructure: practice management system, connector, card reader, data protection.
- Facilities: Reception, waiting area, treatment rooms.
- Start-up liquidity: staff costs, rent, lease payments, insurance – from day one, while the first fee payment has not yet been received.
- Personal income: You only start earning once the practice is making a profit. This gap should be included in the capital requirements.
The proportion of expenditure varies depending on the specialism. According to IDZ and apoBank, when setting up a new solo dental practice in 2024, 24 % of expenditure was on refurbishment, just under 41 % on equipment, 13 % on fittings, including IT, and just under 22 % on other items, including operating supplies. In 2023, the proportion spent on equipment stood at 46 %.
The payment schedule is crucial during the start-up phase. The Saxony Association of Statutory Health Insurance Physicians (KV Sachsen), for example, pays instalments by the 15th of the following month at the latest, with the balance due at the end of the fourth month following the end of the quarter. For new practices, it bases the interim payments on reported case numbers for the first six months and thereafter as a fixed monthly amount. An interim payment is only made if the monthly amount is €1,000 or more (as at 4 October 2026). Other KVen have different arrangements.
The ERP StartGeld start-up loan (KfW 067) provides for working capital of up to €80,000. The total funding limit is up to €200,000 in external financing per project, with a term of up to 5 years and a maximum of one repayment-free year, or up to 10 years with a maximum of two repayment-free years. The fixed interest rate applies for the entire term (information sheet as at 18 June 2026). We have deliberately not specified interest rates here, as they depend on creditworthiness, collateral and the date of the enquiry.
How does your specialty determine the scale of capital needed?
Through the equipment list: how much capital a start-up needs is decided by the medical technology your discipline requires.
For dentistry, the specialty with the highest equipment share and the best data, the figures are available in detail: Setting up a new dental practice (DE). All specialties at a glance: Financing by specialty (DE).
Specialties with little equipment manage with considerably less. For psychiatry and psychotherapy, apoBank reported a total investment of €62,000 for taking over a single practice in 2022/2023. Three quarters of founders in these specialties set up with a half admission. Whether a new start-up rather than a takeover makes sense also depends on this: around 93 percent of dental practice start-ups in 2024 took the form of a takeover or joining an existing practice, while new start-ups accounted for about 7 percent.
Status and sources. Information based on the pages of KV Brandenburg (Weg in die Niederlassung) and KV Bayerns (Zulassung), apoBank (Gründen mit Business Plan), all retrieved 04.10.2026, KfW leaflets no. 067 (as of 18.06.2026), no. 077 (as of 10.12.2025), no. 297/298 and no. 299 (as of 07/2026), the IDZ Online Journal 03/2025 (InvestMonitor Zahnarztpraxis 2024), the apoBank press releases of 28.10.2024 and 23.10.2025, § 103 SGB V, the page on fee and advance payments of KV Sachsen, Bürgschaftsbank NRW and an article in Arzt & Wirtschaft (as of 02.03.2026), checked on 04.10.2026. The guideline valid at the time of application is decisive.
Which documents does the bank want to see?
A business plan with realistic projections, a robust investment list, evidence of the location with a demand forecast, your licence and specialist accreditation, the prospects for admission and a private statement of assets and liabilities. Banks are happy to provide funding for healthcare professions, but they do not finance letters of intent.
The point at which most start-ups hit a snag is not their creditworthiness, but the completeness of their documentation. A bank that has to ask for further information three times takes a long time to make a decision, and that delay proves costly when there is a deadline for filling a vacancy.
Regarding admission prospects: In a planning area subject to admission restrictions, the Admissions Committee (Zulassungsausschuss) decides, in accordance with Section 103 of Book V of the Social Code (SGB V), whether a vacancy-filling procedure will take place. The Association of Statutory Health Insurance Physicians (KV) advertises the vacancy and maintains the list of applicants. Please contact your KV to find out how your planning area is classified. Submitting the documents for funding does not replace authorisation.
A specialist article (Arzt & Wirtschaft, as at 2 March 2026) lists, amongst other things, the assignment of claims under the Statutory Health Insurance Scheme, the transfer of ownership of practice equipment as security, mortgages, guarantees and term life insurance (Risikolebensversicherung) as forms of security. For the StartGeld scheme, KfW requires standard banking collateral and relieves the financing partner of liability by providing an 80 % indemnity.
This page explains financing structures in terms that are easy to understand. It does not constitute tax or legal advice (Section 1 of the German Tax Advisers Act (StBerG) and the German Legal Services Act (RDG)). The tax assessment of your project is a matter for your tax adviser. We structure the financing accordingly.
Which KV grants exist for setting up in under-supplied districts?
Investment grants from the structural funds of the regional KVs, with published ceilings of up to €39,000 in Rhineland-Palatinate, up to €70,000 at KV Nordrhein and up to €120,000 in Bavaria.
Every regional KV is required by law to operate a structural fund (§ 105 (1a) SGB V), and many use it to pay investment grants to physicians who set up in under-supplied districts. KV Westfalen-Lippe pays no flat grant and offers an interest-free practice loan of €60,000 or €80,000 instead, and Berlin has announced the end of its scheme from 2027.
Three things international doctors should know before building any of this into a plan:
It is not equity. Most schemes reimburse against invoices after you begin practising. You will have paid for the equipment already — with the bank’s money. The grant reduces the debt later; it does not reduce the capital you need on day one.
It is not a right. Funding is discretionary and capped by the fund; in some regions applications are ranked by date of receipt, in others by selection criteria, and in some the money is simply exhausted.
It is conditional. Three to five years of practice in the funded district is the usual commitment. Leave early and a proportion is reclaimed.
The directives, the district lists and the application forms are German-language instruments of German public law. We are not aware of English versions, and the KV will correspond with you in German.
That is precisely the work we take off your desk — we read the current directive for your planning district and tell you what it is actually worth in your financing plan, rather than what a comparison article claims.
The full analysis, region by region, is in the German-language KV funding cluster.
Status and sources. Checked on 4 October 2026: Bundesärztekammer guidance for foreign physicians, Bremen service portal on recognition for third-country doctors, Saxon Chamber of Physicians, BIBB recognition portal, KBV on needs planning, KVB on succession, § 103 and § 105 SGB V, KfW fact sheets and product information, published KV guidelines as summarised in our German KV pages. The guideline valid at your application date is decisive.
Why does the bank argue about goodwill?
Because in a closed planning district most of the purchase price is goodwill, the patient base, location and admission, and goodwill cannot be realised like equipment.
This is why practice financing for an incoming physician turns on two questions and not on the purchase price: can the practice’s own earnings service the debt (including your private living costs), and what security remains if it cannot?
Where the answer to the second is thin — and with a high goodwill component it always is — the first becomes decisive, and the instruments that bridge the gap are the KfW indemnity and a guarantee-bank surety, not a regional grant.
What a foreign qualification does not do is worsen those numbers. Once you hold the admission, you are a German practice owner like any other. The obstacles are in front of the admission, not behind it.
Frequently asked questions
Advice on setting up a practice: How much does advice on financing cost?
The initial consultation is free of charge and without obligation. We obtain quotes from specialist banks for healthcare professions, high-street banks offering services for healthcare professionals and regional banks, and check your eligibility for funding before you sign anything.
Can I buy a practice before my admission is granted?
Contracts are typically structured with the admission as a condition precedent — but be careful: signing such a contract can already count as the start of the project for funding purposes, which forfeits the KfW application. The sequence of signature, funding application and loan agreement has to be planned together. The legal drafting belongs to a lawyer; the sequence is our part.
Setting up and financing a practice: What is the correct order?
First, you work out your capital requirements; then you check your eligibility for funding; next come selecting a bank and submitting your application. Only then do you proceed with the tenancy agreement, ordering equipment and carrying out the refurbishment. You must submit your application for the subsidised loan to a financing partner of your choice before the project begins.
What should a business plan for setting up a medical practice include?
Not boilerplate, but a plan with a traceable calculation of patient numbers, revenue and costs. apoBank lists, among other things, target group and location, range of services, patient communication, networks and resources, supplemented by a financial plan (retrieved 04.10.2026). On this basis the bank assesses your debt service capacity. Without a plan, any commitment remains verbal.
Can I run a practice on a temporary professional permit?
No. A Berufserlaubnis is temporary, limited to a specific activity and one federal state, and lasts at most two years. Entry in the medical register and admission as a statutory-insurance doctor require the Approbation and completed specialist training.
Setting up a medical practice: What steps need to be taken before securing funding?
First, you must be entered in the medical register (Arztregister) of your regional association of statutory health insurance physicians (KV), followed by an application for authorisation to practise submitted to the admissions committee (Zulassungsausschuss), accompanied by a site inspection and advice on setting up a practice from the KV. The bank expects you to have a prospect of authorisation; submitting the funding application documents does not replace this. You can find out about the deadlines within your KV directly from them. The procedure itself is not a service we provide; we plan the financing accordingly.
Liquidity financing when setting up a practice: how much start-up liquidity does the practice need?
Enough for the practice and your private living costs to last until the first noticeable fee payment. Start-up liquidity covers staff, rent, leasing instalments and insurance from day one. The gap between opening the practice and the first significant money coming in is the most common planning mistake. One example: KV Sachsen pays the balance for a quarter at the end of the fourth month after the end of the quarter (as of 04.10.2026); your KV may handle this differently. Details on the page Working capital & start-up phase (DE).
As an employee, can I set up a business at the same time?
The KfW information sheet on StartGeld (KfW 067, as at 18 June 2026) explicitly states that part-time self-employment is also eligible for funding. The information sheet does not specify a deadline by which this must become full-time self-employment. The KfW 077 programme, on the other hand, only supports start-ups where this is the main source of income. From a professional regulations perspective, combining salaried employment with running your own practice is a separate matter, which is dealt with by your medical association and professional body.
How does the committee choose between several applicants for a seat?
It decides at its discretion, using criteria set out in § 103 SGB V, among them professional suitability, years since Approbation, length of medical practice, five years in an under-supplied area, kinship with the seller, work in the practice as an employed doctor and time on the waiting list. The seller’s interest counts only up to the practice’s market value, so a price above it belongs in the negotiation before the financing is fixed.
Do I need German for the practice itself?
Yes. Patient care, billing with the KV, documentation, the admissions committee and the loan agreement are all conducted in German — and the licence procedure itself requires a specialist language examination. Where we can help is the financing: we work with you in English and handle the German-language process with the lenders.
Loans for setting up a practice: Which KfW loan is right for you?
For start-ups, there is the ERP Start-up Loan ‘StartGeld’ (KfW 067) and the ERP Subsidised Loan for Start-ups and Succession (KfW 077). Under the StartGeld scheme, up to €200,000 is available per project, of which up to €80,000 is for working capital, with an 80 % liability exemption for the financing partner. The KfW 077 scheme provides funding of up to €500,000 per applicant and a maximum of 35 % of eligible costs, and requires a 100 % guarantee from a guarantee bank (Information sheets dated 18 June 2026 and 10 December 2025).
Is it cheaper to open a new practice than to take one over?
Usually you have no choice: in a closed planning district only a succession is possible. Where a new practice is permitted, you save the goodwill but you buy a start with no patients — which means a longer run-up and a heavier need for working capital. The cheaper option on paper is often the more expensive one in the first two years.
Are KfW 297 or KfW 298 actually used in practice?
The KfW 297 and KfW 298 schemes relate to the climate-friendly construction of new residential buildings. For the construction or first-time purchase of a non-residential building, such as a medical practice, KfW refers to scheme 299. Those eligible to apply include, amongst others, self-employed professionals acting as clients commissioning the new build or as first-time purchasers (information sheet dated 07/2026). Those who merely rent premises are not eligible to apply.
Can I finance a practice and a home at the same time?
Frequently — but not by treating them as two separate applications. Both draw on the same debt capacity, and two lenders each unaware of the other will produce a structure that fails. They belong in one calculation, prepared once.
Talk to us before you sign, not after
A free consultation in English: what your sequence must look like, what funding your district actually offers, and what the practice has to earn for the numbers to work. Independent of any single bank — from a panel of more than 650.
Perini Finance & Property — licensed under §34i and §34c GewO, 650+ banks compared, we know the banks whose lending rules cover practice founders with a foreign qualification — the sequence, the funding your district actually offers and what the practice has to earn. Free consultation in English. Financing advice, not legal or tax advice (§ 1 StBerG, RDG), without guarantee. There is no binding commitment. Financing information, not legal, tax or immigration advice (§ 1 StBerG, RDG), without guarantee.
Related pages
Practice financing for doctors: What documents does the bank want to see?
Practice financing for doctors: what documents banks check — business analysis, investment plan, profitability forecast, cash flow plan, personal financial statements.
Taking over a practice in Berlin: How much does the practice seat cost, and what funding does the KV provide?
KV Berlin does not subsidise the purchase price of the premises. According to a press release dated 26 June 2026, its business start-up grant scheme will end from 2027.
Taking over a practice in Leipzig: What financial support is available in Saxony?
Taking over a practice in Leipzig: registration options with the Saxony Association of Statutory Health Insurance Physicians (KV Sachsen), the minimum turnover requirement for funding, and the sequence of the KfW application and the purchase agreement.
Taking over a naturopath’s practice: What are you buying without a contract with the health insurance fund?
Taking over a naturopath’s practice: what you’re buying without a contract with a health insurance fund, why the licence isn’t included, and how to finance the purchase with a subsidised loan or a bank loan.
Taking over a practice: staff – who comes with you, and how much does it cost?
Taking over a practice, including staff: which contracts are transferred under Section 613a of the German Civil Code (BGB), what this means for the purchase price and liability, and how to finance staff costs (Personalkosten).
Special right of termination (Sonderkündigungsrecht) when taking over a practice: Does such a thing even exist?
Special right of termination in the event of a practice takeover: what applies to the tenancy agreement and staff, what is governed by Sections 540 and 613a of the German Civil Code (BGB), and why the bank reviews the tenancy agreement.
KfW Loan: Applying for a start-up loan – when is the Startgeld 067 sufficient?
KfW Start-up Loan StartGeld 067: up to €200,000 per project, of which up to €80,000 is for working capital, with an 80 % exemption from liability (information sheet dated 18 June 2026).
KfW Loan for Practice Takeovers: When does Programme 077 apply?
KfW 077 provides funding for up to 35 % of eligible costs, up to a maximum of €500,000, with a 100 % guarantee from the Bürgschaftsbank. Self-employed individuals are eligible to apply.
Buying a medical practice: How much does it cost to take over a practice, depending on the specialism?
Buying a medical practice: purchase price and total investment by specialism, how to determine the value of a practice, and why equipment drives up capital requirements.
Financing a practice takeover: Which three items must the loan cover?
Financing a practice takeover: statutory health insurance licence, practice value and goodwill; KfW 067 and 077; ensuring a clear structure for bank loans and working capital facilities.
apoBank practice financing: Or would another bank be a better fit?
apoBank practice financing or alternatives: a comparison of four banking groups for doctors — strengths, limitations and why only a comparison reveals the full picture.
Editorially responsible: Olga Nikushkina — owner, §34i GewO (German mortgage brokerage), adviser register D-W-132-ZUCB-95. Specialised in German property financing with an international dimension: non-residents, foreign-currency income, cross-border workers, expats. Siegfried Perini is entered in the German intermediary register under this licence as a person directly involved in brokerage and advice (§ 11a GewO), active in real estate since 1992. Not legal or tax advice.
