Legal Framework for Physicians and Dentists in Germany

I. Legal Foundations of Medical and Dental Professions in Germany

1. Public Law Regulation

Physicians and dentists in Germany are governed primarily by public law, which ensures the protection of patients and the quality of healthcare services. Key statutes include:

• Federal Medical Code (Bundesärzteordnung – BÄO)

• Dental Practice Act (Zahnheilkundegesetz – ZHG)

• Professional Codes (Berufsordnungen) issued by the Medical and Dental Chambers of the German federal states

• Social Code Book V (Sozialgesetzbuch V – SGB V) for statutory health insurance matters

These laws regulate:

• Licensing (Approbation)

• Professional obligations and standards

• Continuing education

• Advertising restrictions

• Sanctions for breaches of duty

2. Private Law Application

Private law plays a crucial role in:

• Contracts between doctors and patients

• Cooperation between medical professionals

• Practice purchases and sales

• Employment and commercial law matters

The German Civil Code (Bürgerliches Gesetzbuch – BGB) governs general contractual relations.

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II. Common Types of Medical and Dental Cooperation Agreements

1. Among Physicians/Dentists

a) Partnership Agreements

Typically formed as:

• Partnership under the German Partnership Act (Partnerschaftsgesellschaft, PartG)

• Professional Practice Group (Berufsausübungsgemeinschaft, BAG)
  → Joint treatment of patients, shared liability, collective billing

b) Practice Sharing Agreement (Praxisgemeinschaft)

• Separate treatment and billing

• Shared infrastructure (premises, staff)

c) Medical Care Center (MVZ)

• Legal entity (e.g. GmbH) that employs doctors

• Enables inter-disciplinary structures

• Subject to approval by regional associations of statutory physicians

d) Locum Tenens Contracts (Vertretungsverträge)

• Temporary substitution in case of illness, leave, or absence

• Requires careful delineation of duties and liability

e) Freelance Service Agreements (Honorararztverträge)

• Especially in hospitals or private clinics

• Must avoid disguised employment (Scheinselbstständigkeit)

f) Employment Contracts

• For salaried physicians in practices or hospitals

• Includes working hours, remuneration, non-compete clauses

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2. Between Physicians/Dentists and Patients

a) Treatment Contract (Behandlungsvertrag, §§ 630a–630h BGB)

• Legal basis of doctor–patient relationship

• Duties:

  • Medical treatment to recognized standards

  • Patient information and informed consent

  • Documentation

  • Confidentiality

b) Private Treatment and Billing Agreements

• For patients under private insurance or for services not covered by statutory insurance

• Governed by:

  • GOÄ (Fee Schedule for Physicians)

  • GOZ (Fee Schedule for Dentists)

c) Individual Health Services (IGeL)

• Non-insurance-covered services

• Require separate, prior written agreements

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III. German Health Insurance System

1. Statutory Health Insurance (Gesetzliche Krankenversicherung – GKV)

• Covers approximately 88–90% of the population

• Based on the principle of solidarity and self-administration

• Financed by income-based contributions (split between employee and employer)

• Services reimbursed according to the EBM (Uniform Value Scale)

Contract Physicians (Vertragsärzte):

• Must be registered with the Association of Statutory Health Insurance Physicians (Kassenärztliche Vereinigung – KV)

• May only bill approved services

• Subject to strict regulation regarding scope and quality of care

2. Private Health Insurance (Private Krankenversicherung – PKV)

• Available to:

  • High-income employees

  • Civil servants

  • Self-employed

• Premiums are risk-based (age, pre-existing conditions)

• Doctors bill according to GOÄ/GOZ (with higher rates possible)

• Patients often pay up front and are reimbursed

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IV. Legal Services Provided by Lawyers to Physicians and Dentists

Lawyers provide highly specialized advice to medical professionals. Services include:

1. Regulatory and Licensing Law

• Assistance with Approbation or specialist licensing

• Guidance on foreign degree recognition

• Representation in administrative and disciplinary proceedings

2. Professional Law Compliance

• Compliance with the professional codes (Berufsordnungen)

• Defense in disciplinary cases before chambers

• Advice on advertising, secondary employment, or telemedicine

3. Practice Structuring and Transactions

• Drafting of:

  • Partnership agreements

  • Employment contracts

  • MVZ structures

• Advising on practice acquisition, sale, or succession

• Support in valuation, due diligence, and financing

4. Contracts with Patients

• Drafting patient information, consent, and IGeL agreements

• Advising on treatment documentation and liability avoidance

5. Medical Liability Law

• Defense in malpractice claims (civil and criminal)

• Risk management and professional liability insurance analysis

• Pre-court settlements and litigation representation

6. Social and Health Insurance Law

• Representation before:

  • Statutory health insurance authorities

  • Medical review boards (MDK)

  • Social courts (Sozialgerichte)

• Audits by KV and billing disputes with PKV

7. Employment and Labor Law

• Employment agreements for medical staff

• Non-compete and confidentiality clauses

• Terminations and employment litigation

8. Data Protection and Digital Health

• Implementation of GDPR in medical practices

• Structuring of electronic patient records, cloud services, and patient apps

• Risk assessments for medical devices and software under MDR