How can I get a job as a dentist in Germany?

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    How can I get a job as a dentist in Germany?


    Council of European Dentists
    Dr Anthony S Kravitz OBE
    Professor Alison Bullock
    EU Manual of Dental Practice 2015
    Edition 5.1
    ____________________________________________________ __ ___ ___ ___
    The revised EU Manual of Dental Practice (Edition 5) was commissioned by the Council of European Dentists 1 in April 2013. The work has
    been undertaken by Cardiff University, Wales, United Kingdom. Although the unit had editorial control over the content, most of the
    changes were suggested and validated by the member associations of the Council. This is an updated version of the 2014 edition which
    had two missing paragraphs related to the Ethical Code.
    About the authors2
    Dr Anthony Kravitz graduated in dentistry from the University of Manchester, England, in 1966. Following a short period working in a
    hospital he has worked in general dental practice ever since. From 1988 to 1994 he chaired the British Dental Association’s Dental
    Auxiliaries’ Committee and from 1997 until 2003, was the chief negotiator for the UK’s NHS general practitioners, when head of the
    relevant BDA committee. From 1996 until 2003 he was chairman of the Ethics and Quality Assurance Working Group of the then EU
    Dental Liaison Committee.
    He gained a Master’s degree from the University of Wales in 2005 and subsequently was awarded Fellowships at both the Faculty of
    General Dental Practice and the Faculty of Dental Surgery, at the Royal College of Surgeons of England.
    He is an Honorary Research Fellow at the Cardiff University, Wales and his research interests include healthcare systems and the use of
    dental auxiliaries. He is also co-chair of the General Dental Council’s disciplinary body, the Fitness to Practise Panel.
    Anthony was co-author (with Professor Elizabeth Treasure) of the third and fourth editions of the EU Manual of Dental Practice (2004 and
    President of the BDA from May 2004 until May 2005, he was awarded an honour (OBE) by Her Majesty The Queen in 2002.
    Professor Alison Bullock: After gaining a PhD in 1988, Alison taught for a year before taking up a research post at the School of
    Education, University of Birmingham in 1990. She was promoted to Reader in Medical and Dental Education in 2005 and served as coDirector
    of Research for three years from October 2005.
    She took up her current post as Professor and Director of the Cardiff Unit for Research and Evaluation in Medical and Dental Education
    (CUREMeDE) at Cardiff University in 2009. With a focus on the education and development of health professionals, her research interests
    include: knowledge transfer and exchange; continuing professional development and impact on practice; workplace based learning.
    She was President of the Education Research Group of the International Association of Dental Research (IADR) 2010-12.
    Professor Jonathan Cowpe graduated in dentistry from the University of Manchester in 1975. Following training in Oral Surgery he was
    appointed Senior Lecturer/Consultant in Oral Surgery at Dundee Dental School in 1985. He gained his PhD, on the application of
    quantitative cyto-pathological techniques to the early diagnosis of oral malignancy, in 1984. He was appointed Senior Lecturer at the
    University of Wales College of Medicine in 1992 and then to the Chair in Oral Surgery at Bristol Dental School in 1996. He was Head of
    Bristol Dental School from 2001 to 20004.
    He was Dean of the Faculty of Dental Surgery at the Royal College of Surgeons in Edinburgh from 2005 to 2008 and is Chair of the Joint
    Committee for Postgraduate Training in Dentistry (JCPTD). He has been Director of Dental Postgraduate Education in Wales since 2009.
    His particular interest now lies in the field of dental education. He was Co-ordinator for an EU six partner, 2-year project, DentCPD,
    providing a dental CPD inventory, including core topics, CPD delivery guidelines, an e-learning module and guidelines (2010-12).
    Ms Emma Barnes: After completing a degree in psychology and sociology, Emma taught psychology and research methods for health
    and social care vocational courses, and later, to first year undergraduates. Following her MSc in Qualitative Research Methods she started
    her research career as a Research Assistant in the Graduate School of Education at the University of Bristol, before moving to Cardiff
    University in 2006, working firstly in the Department of Child Health and then the Department of Psychological Medicine and Clinical
    In 2010 Emma joined Cardiff Unit for Research and Evaluation in Medical and Dental Education (CUREMeDE) as a Research Associate.
    Working in close collaboration with the Wales Deanery, (School of Postgraduate Medical and Dental Education), her work focuses on
    topics around continuing professional development for medical and dental health professionals, and knowledge transfer and exchange.
    1 CED Brussels Office, Avenue de la Renaissance 1, B – 1000 Brussels, Tel: +32 – 2 736 34 29, Fax: +32 – 2 732 54 07 2 The authors may be contacted at

    EU Manual of Dental Practice 2015
    Edition 5.1
    _______________________________________ __________ ______ __ __ __
    Date of last revision: 23rd January 2015
    Government and healthcare in Germany
    Germany is one of the founder members of the EU. Its federal
    system of government delegates most of the responsibility for
    expenditure and many policy decisions to the regional level
    which also has additional powers to raise local taxes.
    The capital is Berlin.
    There is a bicameral Parliament, which consists of the Federal
    Assembly or Bundestag, with approximately 600 seats, elected
    by popular vote under a system combining direct and
    proportional representation (a party must win 5% of the national
    vote or three direct mandates to gain representation; members
    serve four-year terms) and the Federal Council or Bundesrat
    (69 votes; state governments are directly represented by votes;
    each has 3 to 6 votes depending on population and the
    representatives of each state are required to vote as a block).
    Elections for the Federal Assembly are held every 4 years (or
    less). There are no elections for the Bundesrat; the composition
    is determined by the composition of the state- governments so
    the Bundesrat has the potential to change any time one of the
    16 states (Länder) holds an election.
    The President of Germany is elected for a five-year term by a
    Federal Convention including all members of the Federal
    Assembly; the Chancellor (equivalent to Prime Minister) is
    elected by an absolute majority of the Federal Assembly for a
    four-year term.
    There is a long-established statutory health insurance system
    where health care depends on membership of a “sick fund”.
    Sick funds are state-approved health insurance organisations.
    In 2013 there were 134 in the country. There are also private
    insurance organisations (43 in 2013).
    Approximately 90% of the population are members of a stateapproved
    sick fund, which provides a legally prescribed
    standard package of healthcare.
    The sick funds are “not for profit” organisations. Membership is
    mandatory for all employees with an income of less than €4.350
    gross/month. As of January 1st, 2009, premiums are the same
    across all statutory sick funds (15.5%) and are split fairly
    equally between employers (47%) and employees (53%).
    Individuals whose monthly gross income exceeds a certain
    amount (€4,462.50 in 2014) may opt out of the state-approved
    insurance system and join a private insurance scheme. For
    self-employed persons and certain groups of professionals (e.g.
    civil servants) membership of a private insurance scheme is
    Private insurance schemes are regulated by insurance law only
    and may thus offer more flexible packages of care. For
    example, the schemes carry all the financial risks of treatment
    or reimburse only a defined percentage of the costs and the
    premiums vary according to the level of cover required and the
    age or past health of the member. Membership of a private
    sick fund is also a personal contract, so in contrast to stateapproved
    sick funds dependants cannot be co-insured.
    The actual provision of health care in the statutory system is
    managed jointly by the sick funds, and the doctors’ and
    dentists’ organisations. As with many other aspects of German
    legislation, responsibilities are split between the federal level
    and the regional level of the Länder.
    Year Source
    % GDP spent on health 11.3% 2011 OECD
    % of this spent by government 76.5% 2011 OECD
    In the EU/EEA since 1957
    Population (2013) 80,523,746
    GDP PPP per capita (2012) €29,773
    Currency Euro
    Main language German
    There is a long established insurance based healthcare system of
    “sick funds”, which are not for profit organisations. Almost 90% of the
    population belong to one of the 134 funds. There is also wide use of
    private insurance. In 2013, were 43 private health insurance funds
    plus a rising number of insurance companies offering supplementary
    health insurance outside of their core business. Dental fees, both inside
    and outside sick funds and insurance based care, are regulated.
    Number of dentists: 88,882
    Population to (active) dentist ratio: 1,163
    Members of Dental Association: 100%
    The use of dental specialists and the development of dental auxiliaries
    are both well advanced. The national federation of Chambers is known
    as the Bundeszahnärztekammer (BZÄK) and all dentists must be a
    member of the local Chamber.
    Continuing education for dentists has been mandatory since 2004 for all
    dentists practising in the health fund system.
    EU Manual of Dental Practice 2015
    Edition 5.1
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    Oral healthcare
    Public health care
    The key organisations in oral healthcare delivery are:
    Sick funds In January 2013, there were 134 state-approved sick funds in Germany, organised broadly into five main groups. The number of
    state-approved sick funds has decreased considerably over the last years, due to changed regulation regarding minimum number
    of members etc., but also due to an increasing consolidation of the market (mergers or closures of sick funds). They are selfgoverning
    not-for-profit insurance bodies, jointly managed by employers’ and employees’ representatives. They generally insure
    employees whose incomes exceed a specified amount. Their dependants (non-working spouses and children) are usually coinsured
    under the same contract.
    Private Insurances These are ‘for-profit organisations’ which may insure those who are not compulsory members of a sick fund. The activities of the
    private insurance companies are only regulated by general insurance law.
    KZVs KZVs are the 17 self-governing regional authorities, which every dentist has to be a member of in order to give dental treatment to
    patients within the framework of the social security system. The KZVs are the key partners of the sick funds, holding budgets and
    paying dentists.
    KZBV This is the national legal entity of KZVs, which together with the sick funds defines the standard package of care benefits within the
    legal framework. It also provides support services to the regional KZVs.
    Dental Chambers The 17 Dental Chambers (Zahnärztekammern) at the Länder level are the traditional professional associations (legal entities). It
    is their responsibility to represent the interests of the profession, but also to protect the public’s health. Every dentist has to be a
    member of a Dental Chamber.
    BZÄK The Bundeszahnärztekammer is the voluntary union of the Dental Chambers at a national level. It represents the common
    interests of all dentists on a national and international level.
    The delivery of oral health care in the statutory system is organised by the federal dental authority (the Kassenzahnärztliche
    Bundesvereinigung or KZBV) nationally, and locally by the regional dental authorities (the Kassenzahnärztliche Vereinigungen, or KZV) in
    partnership with the sick funds. There are 17 KZVs within the 16 German Länder, (one for each state, with two for North Rhine-Westphalia,
    the largest state). They represent all dentists who are entitled to give treatment to patients within the framework of the statutory health
    insurance system.
    The main functions of the KZVs are:
    to ensure the provision of dental care to all members of sick funds and their dependants
    to supervise and control the duties of member dentists
    to negotiate contracts with regional associations of sick funds
    to protect the rights of member dentists
    to establish and manage committees for the examination and admission of dentists, and the resolution of disputes
    to collect the total fees from the sick funds and distribute them to member dentists
    to maintain the dental register
    to appoint dental representatives on admission, appeal and contract committees and for regional arbitration courts
    Benefits in the legal system
    In principle, membership of a statutory sick fund entitles all
    adults and children to receive care from the statutory health
    insurance system. The sick funds offer full compensation for all
    medically necessary conservative and surgical dental treatment
    as well as necessary orthodontist care for persons aged less
    than 18. Persons under 18 are also entitled to receive certain
    prophylactic treatments free of charge. Dental treatments
    exceeding the pre-defined scope of necessary care as well as
    dental protheses are subject to co-payments of the insured
    person. Those co-payments can be reduced if the patient takes
    measures to maintain healthy teeth. In a typical year
    approximately 75% of adults and children use the system.
    Before seeking general care from the statutory health system,
    the patient must have a voucher from the sick fund. This
    voucher is both a certificate to demonstrate entitlement to care,
    and also the dentist’s claim form for reimbursement of the care
    provided. The patient hands the voucher to the dentist at the
    first visit. The dentist then treats the patient and quarterly
    forwards the completed vouchers to the KZV, which checks the
    invoices, sends them to the ‘sick funds’, collects the money
    from the ‘funds’ and pays the total amount to the practitioner.
    For prosthetic treatment, all legally insured persons may
    choose between a private health insurance and the statutory
    scheme – but it is mandatory to be insured in one or the other.
    Usually, most adults have their oral health checked on an
    annual basis.
    Year Source
    % GDP spent on oral health 0.11% 2011 OECD
    % OH expenditure private No data 2007
    EU Manual of Dental Practice 2015
    Edition 5.1
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    Private insurance for dental care
    Persons not required or not entitled to participate in the
    statutory scheme can apply for insurance cover from a private
    health insurance company – for example, this applies to
    freelance workers and members of the liberal professions, civil
    servants and employees with incomes above the limit for
    compulsory insurance. The scope of coverage is subject to
    individual agreements between the insurance company and the
    patient. This implies that coverage can be flexibly adjusted to
    each individual’s needs.
    By the end of 2012, about 9.8 million people were covered by
    comprehensive private health insurance policies. As of June
    2013, there were 43 private insurers exclusively offering health
    care coverage, with the legal form either of public limited liability
    companies or of mutual insurance funds, organised on a
    cooperative basis. In addition, there is a growing number of
    insurers offering health care coverage outside of their core
    business. The private health insurance companies differ
    appreciably in economic significance and size – the four largest
    companies, with some 4.5 million comprehensively insured
    persons, account for more than 50% of the total.
    Less than 2% of all dentists in active practice treat only patients
    with private insurance schemes, that is to say they have no
    contract with the statutory sick funds.
    The Quality of Care
    The standards of dental care are monitored by a federal
    committee on guidelines for dental care (the Gemeinsame
    Bundesausschuss). Both the sick funds and the federal
    authority for dental care (the Kassenzahnärztliche
    Bundesvereinigung) are represented on this committee. Its
    main role is to determine the range of medically necessary
    treatments which are to be covered by the statutory sick fund
    system. This includes the approval of new treatments or the
    use of new materials. Another responsibility of the committee is
    to determine the value of any treatment relative to other items
    of care.
    Routine monitoring is carried out by the KZV and consists of
    checking invoices and the amount of work provided by each
    dentist. Dentists providing substantially more or less than the
    average of particular treatments are required to explain the
    anomaly. Other measures of quality assurance are patient
    complaints and expert opinion procedures.
    For dentists in free practice the controls for monitoring the
    standard of care are those described above. The same
    monitoring framework also applies to patients who pay the
    whole cost of care themselves; their bills do not need to be
    submitted to any external body for approval, but influence is
    exercised by the insurance companies who reimburse the
    payment. The threat of patient complaints has a direct effect on
    the quality of care for most dentists.
    Domiciliary (home) care is provided both by self-employed
    dentists for their respective patients, or by those contracted with
    a residential home for the elderly or another institution.
    Health data
    “DMFT zero at age 12” refers to the number of 12 years old children
    with a zero DMFT. “Edentulous at age 65” refers to the numbers of over
    64s with no natural teeth
    DMS IV refers to Micheelis, W., Schiffner, M.: Vierte Deutsche
    Mundgesundheitsstudie (DMS IV). Institut der Deutschen
    Zahnärzte, Deutscher Zahnärzteverlag,
    Cologne 2006
    There is no water or milk fluoridation, but extensive salt
    fluoridation. In 2010, 68.3% of all consumed table salt
    contained fluoride as an additive.
    Year Source
    DMFT at age 12 0.70 2009 WHO
    DMFT zero at age 12 70.1% 2007 CECDO
    Edentulous at age 65 23.0% 2007 CECDO
    EU Manual of Dental Practice 2015
    Edition 5.1
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    Education, Training and Registration
    Undergraduate Training
    To enter dental school a student has to have passed the
    general qualification for university entrance (Abitur/ Allgemeine
    Hochschulreife) and achieved a successful result in a Medical
    Courses Qualifying Test.
    All but one of the dental schools are publicly funded and are
    part of the Colleges of Medicine of Universities. There is only
    one private dental school offering undergraduate training, in
    Witten-Herdecke. The undergraduate course lasts 5 years and
    6 months.
    In 2012, there were about 2,100 places at the publicly funded
    dental schools, for entry (thus, excluding any figures for the
    private university at Witten-Herdecke). However, more students
    actually enter dental schools, because there are more
    applicants and dental schools are forced to accept the excess
    students who pass the entrance examinations (Numerus
    Clausus). So, the real number of undergraduate students
    entering dental schools was over 2,200, and the estimated
    number of all dental under-graduates was over 13,000.
    Quality assurance for the dental schools is provided by control
    mechanisms and regulations of the universities, and the
    Ministry of Science and Education in each state.
    Qualification and Vocational Training
    Primary dental qualification
    The main degree to be included in the register is Zeugnis über
    die zahnärztliche Staatsprüfung (the state examination
    certificate in dentistry).
    Vocational Training (VT)
    In order to register as a dentist and provide care within the
    statutory sick fund system, a German dentist with a German
    state exam pass must have two years of approved supervised
    experience, in addition to the five and a half years of dental
    training at university. A dentist can then apply to the admission
    committee of the Kassenzahnärztliche Vereinigungen (KZV).
    The conduct of an independent dental practice providing
    treatment under the statutory health insurance scheme
    demands extensive professional and management knowledge
    and skills: knowledge of law applicable to health insurance
    practitioners and to the profession, of manage-ment, of
    educational skills for the training of dental auxiliaries,
    organisational talent in the conduct of a practice and familiarity
    with the institutions involved in dental self-government and their
    functions. Hence work as an assistant is intended principally to
    prepare young dentists to cope with the ma
    EU Manual of Dental Practice 2015
    Edition 5.1
    _______________________________________ __________ ______ __ __ __
    For dentists exclusively providing care outside of the statutory
    system, there are no formal regulations as to the extent of
    continuing education.
    Postgraduate Master’s programmes
    In recent years, postgraduate Master’s studies have been
    established by the universities, mostly part-time alongside work,
    for example in implantology, functional therapy, periodontics,
    endodontics, orthodontics, surgery, aesthetics, lasers in
    The courses cover about 60 – 120 ECTS (European Credit
    Transfer System in which 1 ECT equals 25 to 30 hours
    workload) and the final examination is for a Master’s degree
    Specialist Training
    Three dental specialties are recognised throughout Germany
    Oral Surgery
    Dental Public Health
    The speciality “Periodontology” is only recognised by the dental
    chamber in the region Westfalen-Lippe.
    Training for all specialties lasts four years and takes place in
    university clinics or recognised training practices, except Dental
    Public Health, which is trained in its own environment.
    An orthodontist would receive the Fachzahnärztliche
    Anerkennung für Kieferorthopädie (certificate of
    orthodontist), issued by the Landeszahnärztekammern
    (Chamber of Dental Practitioners of the Länder), as the
    outcome to training.
    An oral surgeon would receive the Fachzahnärztliche
    Anerkennung für Oralchirurgie/Mundchirurgie (certificate
    of oral surgery), issued by the Landeszahnärztekammern.
    For periodontists the equivalent to the certificate for
    orthodontists and oral surgeons (certificate of
    periodontology issued by the Zahnärztekammer
    Westfalen-Lippe) is awarded.
    For Dental Public Health the dentist will receive the title
    Zahnarzt für Öffentliches Gesundheitswesen (Public
    Health Dentist), if he has passed an examination at an
    academy for public health (Akademie für Öffentliches
    In principle, there is no limitation in the number of trainees,
    because there are sufficient dentists in free practice with the
    permission to train a dentist in orthodontics or oral surgery.
    However, the fact that all dentists who want to specialise have
    to attend university for one year limits access to specialist
    training. The trainee has the status of an employee and gets a
    salary from his or her employer (ie a dentist in free practice
    with the special permission to train specialising dentists, a
    university or a hospital).
    After completion of the specialised training the trainee has to
    pass an examination organized under the responsibility of the
    dental chamber. He or she is then approved as a specialist and
    registered with the dental chamber as such.
    EU Manual of Dental Practice 2015
    Edition 5.1
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    During recent years, between 1,500 and 2,100 dentists a year
    received their dental approbation. Consequently, the number of
    active dentists is increasing. A change of legislation, effective
    from 2007, has led to an increase in the number of dentists
    employed in a practice rather than running their own practice.
    There is some small reported dentist unemployment.
    Movement of dentists across borders
    In 2012, there were 2,164 dentists who qualified abroad active
    in Germany. There are no figures on how many German
    qualified dentists are practising outside Germany.
    Specialists work mainly in private practice, hospitals and
    universities while those specialists in Dental Public Health are
    largely located in the public dental service or are employed
    directly by the sick funds. There are many regional
    associations and societies for specialists.
    There are no limitations on the ratio of specialists to other
    dentists in Germany and there is no compulsory referral system
    for access to them. In general, patients are referred from the
    general dentist to a specialist, however, the patient may also
    visit the specialist without referral.
    Auxiliary personnel can only work under the supervision of a
    dentist, who is always responsible for the treatment of the
    patient. They cannot practice independently.
    The range of auxiliaries is fairly complex, leading progressively
    (with training) from Dental Chairside Assistant
    (Zahnmedizinische Fachangestellte) to Dental Hygienist
    (Dentalhygieniker). Registered Zahnmedizinische
    Fachangestellte may qualify as Zahnmedizinische
    Fachassistentin (Specialised Chairside Assistant, ZMF),
    Zahnmedizinische Verwaltungsassistentin (Dental
    Administration Assistant, ZMV), Zahnmedizinische
    Prophylaxeassistentin (Dental Prophylaxis Assistant, ZMP) or
    Dentalhygieniker (Dental Hygienist). These registerable
    qualifications do exist in almost all Länder and are coordinated
    by the Bundeszahnärztekammer (BZÄK).
    Dental Chairside Assistants (Zahnmedizinische Fachangestellte)
    The main type of dental auxiliary is Zahnmedizinische Fachangestellte. After 3
    years training in a dental practice, attendance of a vocational school and a
    successful examination conducted by the Dental Chamber, they are awarded a
    registerable qualification.
    Specialisations of Dental Chairside Assistants
    There are 3 types of specialisations of Dental Chairside Assistants (Zahnmedizinische Fachangestellte): ZMF, ZMP and ZMV.
    Zahnmedizinische Fachassistentin (Specialised Dental Assistant, ZMF): requires 700 hours training at a Dental Chamber, and their
    duties include support in prevention and therapy, organisation and administration, and training of Zahnmedizinische Fachangestellte.
    Zahnmedizinische Prophylaxeassistentin (Dental Prophylaxis Assistant, ZMP): requires a minimum 400 hours training at a Dental
    Chamber, and their duties include support in prevention/prophylaxis, motivation of patients and oral health information.
    Zahnmedizinische Verwaltungsassistentin (Dental Administative Assistant, ZMV): requires a minimum 350 hours training at a Dental
    Chamber, and their duties include support in organisation, filing and training of Zahnmedizinische Fachangestellte.
    There is no available data about numbers of each group.
    Year of data: 2012
    Total Registered 88,882
    In active practice 69,236
    Dentist to population ratio* 1,163
    Percentage female 42%
    Qualified outside Germany** 2,164
    * active dentists only
    ** excl. State of Schleswig-Jolstein
    Year of data: 2011
    Hygienists 550
    Technicians 58,000
    Denturists 0
    Assistants 182,000
    Therapists 0
    Other 0
    All figures estimated
    Year of data: 2012
    Orthodontics 3,443
    Oral Surgery 2,552
    Dental Public Health (estimated) 460
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    Dental Hygienists (Dentalhygieniker)
    To become a hygienist a student needs to undergo 3 years
    training, pass an examination as a dental chairside assistant,
    300 – 700 hours training and an examination as ZMP or ZMF
    first, followed by a further 800 hours training and an
    examination conducted by the dental chamber. Their duties
    include advice and motivation of patients in prevention,
    therapeutic measures for prophylaxis and scaling of teeth. They
    are normally salaried.
    Dental Technicians (Zahntechniker)
    Dental technicians are also not permitted to treat patients. They
    are trained for 3 years, 40% in a vocational school and 60% in
    the dental laboratory. After a successful examination conducted
    by the Chamber of Handicraft they are awarded a registerable
    qualification. However, only those who run a technical
    laboratory register (with the dental technicians’ guild).
    A dentist may employ a Zahntechniker directly in his practice,
    but most use independent laboratories. They produce
    prosthodontic appliances according to a written prescription
    from a dentist. They do not deal directly with the public.
    EU Manual of Dental Practice 2015
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    Practice in Germany
    Numbers of dentists
    Working in Free (Liberal or General) Practice
    The figures above for dentists in general practice comprise both
    self-employed dentists (53,767) and dentists employed in
    general practices (12,390).
    In Germany, dentists who practice on their own or as small
    groups, outside hospitals or schools, and who provide a broad
    range of general and specialist treatments are said to be in
    Free Practice. More than 60,000 dentists work this way, which
    represents about 96% of all dentists registered and practising.
    Most of those in free practice are self-employed and earn their
    living through charging fees for treatments. Very few dentists
    (less than 2%) accept only private fee-paying patients.
    Once registered with a KZV, a dentist in free practice may treat
    legally insured persons and claim payments from the sick fund
    via the regional KZV.
    Fee scales
    Fees are not nationally standardised. Negotiations between the
    national association for dental care (the KZBV) and the major
    sick funds establish the standard care package for people
    insured with legal sick funds. Using a points system, relative
    values are allotted to each type of treatment. It is then up to the
    regional associations and sick funds to decide the monetary
    value of each point for payments in each region.
    For private patients, the levels of private fees payable are
    regulated by federal law and set out in the Gebührenordnung
    für Zahnärzte – GOZ. In this fee scale, the different types of
    treatment are described and a number of reference points are
    allotted to each of those. In order to calculate the price for any
    dental service, the respective reference points have to be
    multiplied by the so-called “point value”, a fixed factor set at
    5.62421 Euro cents (in 2013). Depending on the difficulty of the
    treatment required, the dentist may multiply the result with a
    factor of up to 3.5. A factor of 2.3 should indicate a treatment of
    average difficulty. If a factor higher than 2.3 is applied, the
    invoice must include evidence to justify the increase. An invoice
    with a factor higher than 3.5 requuires a written agreement by
    the patient. Although there is no direct link between the GOZ
    and the private insurances, the private insurances co-ordinate
    their fees with the GOZ system and reimburse for treatment
    accordingly, if they accept the justification of the factor
    As of January 1st, 2012, the GOZ was reviewed for the first time
    since 1988. Certain newer forms of treatment were included in
    the fee scale while the prices for a few others were adjusted.
    Much to the regret of the dentists and their professional
    organisations, however, the point value was not changed.
    Hence, the vast majority of prices remain at the level of 1988.
    Joining or establishing a practice
    There are no rules which limit the size of a dental practice in
    terms of the number of associate dentists or other staff.
    Premises may be rented or owned, but any obligations to the
    owner of the practice must not influence the clinical autonomy
    of the dentist. There is no state assistance for establishing a
    new practice and dentists must take out commercial loans or
    other contracts with a bank.
    There are no special contractual requirements for practitioners
    working in the same practice but a dentist’s employees are
    protected by national and European laws for equal employment
    opportunities, maternity benefits, occupational health, minimum
    vacations and health and safety.
    Dentists can set up completely new practices, they can buy
    existing practices or they can buy into existing joint practices. In
    2012, 12% of all new establishments were new solo practices,
    61% were acquisitions of an existing solo practice and 27%
    were practice partnerships, either establishing a new practice
    partnership or joining an existing one. When existing practices
    are acquired, the predecessor’s patient list is usually part of the
    Establishing a new practice means to acquire totally new
    patients. In 2007, limitations on establishing a practice in a
    special location were abolished for dentists practising under the
    statutory health insurance scheme. That means that a dentist
    may establish his or her practice wherever he or she chooses,
    with only financial considerations being a limiting factor. There
    are still planning provisions necessary but no limitations of
    provision. Earlier regulations regarding the maximum retirement
    age for dentists active under the statutory insurance system (68
    years) have been abolished in the meantime.
    Practices are usually located in offices or private houses or
    apartments, rather than in shops or malls.
    The number of patients on a “list” of an average full-time dentist
    has been estimated at about 1,000. However, there are no
    reliable data available on this matter,
    Working in the Public Dental Service
    There is a public dental service to oversee and monitor the
    healthcare of the total population. The care provided is
    restricted to examination, diagnosis and prevention. The
    service employs dentists as Zahnarzt für öffentliches
    Year of data: 2012
    General (private) practice 66,157
    General Practice as a proportion is 96%
    Number of general practices 44,600
    Year of data: 2008
    Public dental service 450
    University 2000
    Hospital 200
    Armed Forces 450
    All figures estimated
    EU Manual of Dental Practice 2015
    Edition 5.1
    _______________________________________ __________ ______ __ __ __
    Working in the public dental service requires postgraduate
    training and examination by an academy of public health.
    Currently the specialty of Dental Public Health is represented in
    most of the 16 Länder.
    The quality of dentistry in the public dental service is assured
    through dentists working in teams which are led by experienced
    senior dentists, and the complaints procedures are the same as
    those for dentists working in other services.
    In general, there is more part-time work available in the public
    dental service than in other types of dental practice. Working
    hours are more flexible, or are shortened to reflect the length of
    the school day and the percentage of female dentists working in
    the public dental service is much higher. Dentists with this
    speciality are permitted to work in liberal practice as well as in
    public health.
    Working in Hospitals
    A relatively small number of dentists work in hospitals, mostly
    as Oral Maxillo-Facial Surgeons. Because Oral Maxillo-Facial
    Surgeons may register with either a dental or a medical
    chamber – and probably most register with a medical
    chamber- there is no accurate data relating to actual numbers.
    Surgeons who need in-patient care for their patients with
    severe diseases may use beds in public or private
    clinics/hospitals, but they are working in free practice and are
    not employed by the hospitals. Very few dental ambulatories
    with employed dentists exist, for example some owned by the
    sick funds. So, there are normally no restrictions on seeing
    other patients in private practice.
    Working in Universities and Dental Faculties
    Over 2,000 dentists work in universities and dental faculties as
    employees of a university. With the permission of the
    university, they may carry out some private practice outside
    the faculty.
    The main academic title in a German dental faculty is that of
    university professor. Other titles include university assistants,
    Oberarzt (senior physician), and academic dentists.
    As all dental schools are combined with dental clinics for
    outpatient and inpatient care, almost all employees at
    universities and dental faculties treat patients in the associated
    polyclinics and clinics.
    There are no formal requirements for postgraduate training but
    professors usually qualify for the title through a process called
    habilitation. This involves a further degree and a record of
    original research. Dentists teaching at universities have to earn
    the “right to teach” by giving a special lecture at the faculty.
    Professorships are mostly filled by external candidates through
    competition. Apart from these, there are no other regulations
    or restrictions on the promotion of dentists. The complaints
    procedures are the same as those for dentists working in other
    areas, as described earlier.
    Salaries differ considerably from assistant to professor. Since
    professors have the right to treat patients privately, their
    private incomes will exceed the normal salary paid by the
    Working in the Armed Forces
    There are few dentists working full time for the Armed Forces,
    an unreported (but increasing) number female.
    EU Manual of Dental Practice 2015
    Edition 5.1
    ___________________________________________________________ __ _____
    Professional Matters
    Professional associations
    Zahnärztekammern (Dental Chambers)
    Zahnärztekammern (or Dental Chambers) are the traditional
    bodies which represent the interests of dentists whether active
    under the statutory insurance system or not. Every dentist has
    to be a member of a Dental Chamber. The Chambers are also
    responsible for other defined legal tasks.
    There are 17 Dental Chambers in the 16 Länder and also, in
    some parts of the country, some subdivisions of the chamber,
    which work at a more local level. They are democratically
    elected organisations with strong traditions of self-regulation.
    Their main duties are:
    to create and maintain uniform professional ethics
    to advise and support members
    to organise and promote dental undergraduate and
    continuing education, including the training of
    to represent professional interests to authorities,
    legislative bodies, associations and in public
    to monitor the professional duties of its members
    to assure a dental emergency service
    to support quality assurance and continuing education
    to arbitrate disputes between dentists, and between
    dentists and patients
    The Bundeszahnärztekammer (BZÄK)
    The Bundeszahnärztekammer – BZÄK, Arbeitsgemeinschaft der
    deutschen Zahnärztekammern e.V. (German Dental
    Association), is the professional representative organisation for
    all German dentists, at federal level. Members of BZÄK are the
    dental chambers of the federal states (Länder), which send
    delegates to the Federal Assembly, the supreme decision
    making body of the Bundeszahnärztekammer. The Presidents
    of the dental chambers of the federal German states form the
    BZÄK-Board, together with the Federal President and the Vicepresidents.

    The Bundeszahnärztekammer represents the health-political
    and professional interests of the dentists. Its supreme mission
    is to strive for a liberal future-orientated health care system,
    with the patient at the centre, and with the objective of
    establishing and developing a relationship between dentist and
    patient without any outside influence.
    Since 1993, the Bundeszahnärztekammer has also had its own
    representation in Brussels, with a full-time office based near the
    European Commission. This office also handles the
    administrative functions of the Council of European Dentists.
    Related bodies
    The magazine Zahnärztliche Mitteilungen (zm) is published
    twice a month. It is a communication means of both the
    German Dental Association and Federal Dental Authority. It
    informs about the topics of national and international
    professional politics, health and social politics, of topical
    scientific findings and innovations as well as of dental events
    and meetings. It offers services covering the whole range of
    dental subjects: dental exercise, dental management, and
    dental economy.
    Institut der Deutschen Zahnärzte (IDZ) the Institute of German
    Dentists is an institution of both the German Dental Association
    and Federal Dental Authority. The task of the IDZ is to initiate
    and implement research and practice-oriented work in the
    interest of the professional politics, and to act as a scientific
    advisory body for BZÄK and KZBV in their fields of activities.
    Zahnärztliche Zentralstelle Qualitätssicherung (ZZO) The
    Agency for Quality in Dentistry gives advice and support to
    BZÄK and KZBV in all matters of dental quality.
    Freier Verband Deutscher Zahnärzte e.V. (FVDZ)
    The FVDZ (Liberal Association of German Dentists) is the
    largest liberal professional association of dentists in Germany.
    Since it was established in the 1950s, the FVDZ has advocated
    a liberal health policy in Germany, vis-à-vis politicians and the
    German Parliament – a health policy which is centred around
    the patient. In addition to its activities at national level, FVDZ
    plays an active role in European and international professional
    dental policy. The FVDZ is active in the Council of European
    Dentists, as well as an associate Member of the European
    Regional Organisation of the Fédération Dentaire Internationale
    The objective of the FVDZ is to promote and represent the
    professional interests of German dentists in accordance
    with the principles set out in the following preamble: The
    purpose of the Liberal Association of German Dentists is to
    safeguard the free exercise of the dental profession in the
    best interest of the patients.
    Dentists can only fulfill their professional and ethical duties
    to their full extent if they can practise freely, without
    patronisation and with financial security.
    It is the objective of the Liberal Association of German
    Dentists to further the confidential relationship between
    patients and dentists that is necessary for dentists to fulfill
    their professional duties.
    The Liberal Association of German Dentists wishes to
    enforce these basic demands in the statutory dental
    corporations too.
    The entire profession is called upon to help in realising
    these basic demands.
    Number Year Source
    Bundeszahnärztekammer 69,236 2012 BZÄK
    EU Manual of Dental Practice 2015
    Edition 5.1
    _______________________________________ __________ ______ __ __ __
    Ethical Code
    Dentists in Germany must work according to an ethical code
    which covers the relationships and behaviour between dentists,
    contracts with patients, consent and confidentiality, continuing
    education and advertising, although the latter is very strongly
    regulated. This code is administered by the regional dental
    chambers and varies slightly from region to region. The BZÄK
    provides a sample ethical code on which variations may be
    The contract with the patient is usually verbal, but for complex
    treatments or those requiring prior approval from the sick funds,
    for example crowns and prosthodontic appliances, written
    consent and payment terms must be recorded. All treatment
    carried out must be recorded by the dentist and must
    demonstrate informed consent.
    Fitness to Practise/Disciplinary Matters
    If a patient complains about treatment, both the Dental
    Chamber and the KZV have grievance committees. Following
    a complaint, a second opinion is sought from an experienced,
    impartial dentist, appointed by the local dental chamber. If this
    dentist judges that the original care was unsatisfactory then the
    work must be repeated at no extra charge to the patient. Under
    both grievance procedures, the dentist has a right of appeal to
    the grievance committee.
    For serious complaints about malpractice the dental chambers
    have installed boards of arbitration and courts of professional
    law. The sanctions from the court of professional law may be:
    an oral or written rebuke or admonition, administrative fine (up
    to €50,000), or temporary or permanent withdrawal of licence.
    Heavier sanctions are very rare.
    A dentist may inform the public about his professional
    qualifications and priorities, key aspects of his activity and of
    the equipment in his practice. The information must be factual,
    adequate, verifiable and not misleading. The regulations on
    advertising in dentistry were very much softened and liberalised
    in 2001/02 through judgements of the Federal Constitutional
    Court, (Bundesverfassungs-gericht).
    The Electronic Commerce Directive has not been implemented,
    because existing regulations in Germany are even stronger.
    Data Protection
    A dentist is obliged to maintain professional secrecy. The duty
    of preserving medical confidentiality is an element both of the
    dentists’ professional codes and of the criminal law. The duty of
    secrecy applies to all facts that have been entrusted or become
    known to the dentist in his or her capacity as a medical or
    dental practitioner. Professional secrecy must be observed not
    only by the dentist himself or herself, but also by his or her
    employees and agents and by persons working in the practice.
    Patient data protection in accordance with the Federal Data
    Protection Law is very important due to these implications for
    medical professional secrecy.
    Insurance and professional indemnity
    Liability insurance is compulsory for dentists. Insurance is
    provided by private insurance companies and covers costs up
    to a predetermined maximum, usually €2 million. An average
    practitioner pays approximately €250 annually for the
    insurance. This insurance does not cover a dentist’s practise in
    another EEU country, except in individual cases, or for shortterm
    treatments – but not for permanent activity.
    Corporate Dentistry
    Companies or non-dentists are not allowed to be the sole
    owner of a dental practice – the majority of owners have to be
    dentists. For several years there have been moves to ease and
    liberalise the types of professional practice, in order to allow for
    more competition.
    Since 2007, the employment of dentists has been facilitated
    and for the first time the establishment of branch dental
    practices and practices where members with a variety of
    qualifications of the medical or dental profession work together
    in different locations have been allowed. This means, that the
    establishment of mega-dental surgeries and practice chains
    with international investors was facilitated.
    Tooth whitening
    The EU Directive 2011/84/EU of September 2011, amending
    Directive 76/768/EEC, concerning cosmetic products, regulates
    the use of hydrogen peroxide and other compounds or mixtures
    that release hydrogen peroxide in tooth whitening or bleaching
    products. It establishes a new legal framework for products
    containing between 0.1% and 6% of hydrogen peroxide and
    EU Manual of Dental Practice 2015
    Edition 5.1
    ___________________________________________________________ __ _____
    Regulations for Health and Safety
    For Administered by
    Ionising radiation Dental Chambers
    Factory Inspectorate
    Infection control The responsible health authorities
    Medical devices Bundesinstitut für Arzneimittel und Medizinprodukte (BfARM) – the
    Federal Institute for drugs and medical devices
    Waste disposal Dental Chambers and local authority
    Financial Matters
    Retirement pensions and Healthcare
    The normal retirement age is 62 to 68, depending upon
    individual circumstances and preferences.
    Retirement pensions in Germany average 60% of the salary on
    retirement. Any additional (insurance) pension depends on the
    individual contract and the amount insured. Dentists in free
    practice are members of a so called Altersversorgungswerk, a
    special pension fund/pool for the liberal professions, especially
    physicians and dentists, which is organised and supported by
    the chambers. Some of these old age pension funds are
    organised in cooperation with the physicians’ chambers, some
    are for dentists only.
    National income tax:
    In 2013, there was a basic tax-free allowance
    (Steuerfreibetrag) of €8,131 for singles and twice as much for
    a married couple.
    In addition to a basic allowance for low-income earners, there
    are numerous deductibles for taxes, such as deductions for
    raising children, commuting to work, paying for work uniforms,
    being a single parent, joining a trade union, contributing to
    private pension funds, selected insurance premiums, donating
    to charity, etc.
    The starting rate for the lowest taxable income is 14%. The tax
    rate then rises progressively: so that for annual gross incomes
    between €8,131 and €13,469, the rise is steep, followed by a
    more gradual rise for incomes of up to €52,881. Incomes
    higher than this are subject to a tax rate of 42%. For top
    incomes of over €250,730 (€500,000 for married persons) the
    highest tax rate of 45% applies.
    In addition, there is a so-called solidarity surcharge (5.5% of
    the income tax).
    VAT/sales tax
    The value added tax rate of 19% on purchases has applied
    since 2007. There is a reduced rate of 7% on certain items and
    services (including foodstuffs, books, medical, passenger
    transport, newspapers, admission to cultural and
    entertainment events, hotels and the costs of production of a
    dental prosthesis).
    Various Financial Comparators
    Zurich = 100
    2003 2012
    Prices (including rent) 71.9 62.5
    Wage levels (net) 54.5 52.9
    Domestic Purchasing Power 65.0 74.2
    Source: UBS August 2003 and November 2012
    EU Manual of Dental Practice 2015
    Edition 5.1
    _______________________________________ __________ ______ __ __ __
    Other Useful Information
    Main national associations and Information Centre: BZÄK Brussels office
    Bundeszahnärztekammer (BZÄK)
    Chausseestr. 13
    10115 Berlin
    Tel: +49 30 40005 0
    Fax: +49 30 40005 200
    Kassenzahnärztliche Bundesvereinigung (KZBV)
    Universitätsstr. 73
    50931 Köln
    Telefon: +49 221 4001 0
    Telefax: +49 221 40 40 35
    Freier Verband Deutscher Zahnärzte e.V.
    Mallwitzstraße 16, 53177 Bonn
    Tel: +49 228 8557 0
    Fax: +49 228 3406 71
    Bundeszahnärztekammer (BZÄK)
    Büro Brüssel
    1, Avenue de la Renaissance
    B-1000 Brussels
    Phone: +32 2 7 32 84 15
    Fax: +32 2 7 35 56 79
    Competent Authority:
    (For articles 2 & 3)
    Bundesministerium für Gesundheit
    Rochusstr. 1
    53123 Bonn
    Tel: +49 228 308 3515
    Fax: +49 228 930 2221
    (For specialist diplomas contact the dental chambers of
    the relevant “Länder”)
    Lists available from the Bundeszahnärztekammer
    Publications: Employment bureaux, and other bodies or
    publications with information on vacancies for
    Zahnärzliche Mitteilungen,
    and regional dental journals (each Zahnärztekammer and
    Kassenzahnärztliche Vereinigung publishes its own dental
    Employment bureaux:
    Bundesagentur für Arbeit
    Regensburger Str. 104
    90478 Nürnberg

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