{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T15:52:09Z","timestamp":1791561129278,"version":"4.3.4"},"reference-count":37,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T00:00:00Z","timestamp":1791417600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T00:00:00Z","timestamp":1791504000000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Global Health"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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\u201360\u00a0min 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\u2019 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12992-026-01239-3","type":"journal-article","created":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T10:43:46Z","timestamp":1791456226000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Institutional barriers and professional integration of physicians with an Arab migration background in Germany: a qualitative study"],"prefix":"10.1186","volume":"22","author":[{"given":"Maria Noha","family":"El-Halabi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jutta","family":"H\u00fcbner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emadaldin","family":"Ahmadi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,8]]},"reference":[{"issue":"8","key":"1239_CR1","first-page":"A","volume":"121","author":"M Blum","year":"2024","unstructured":"Blum M. \u00c4rztestatistik 2023: Sorgenvoller Ausblick trotz leichter Erholung. Dtsch Arztebl Int. 2024;121(8):A\u2013502.","journal-title":"Dtsch Arztebl Int"},{"issue":"4","key":"1239_CR2","doi-asserted-by":"publisher","first-page":"380","DOI":"10.1016\/j.healthpol.2020.01.001","volume":"124","author":"V Winter","year":"2020","unstructured":"Winter V, Schrey\u00f6gg J, Thiel A. Hospital staff shortages: Environmental and organizational determinants and implications for patient satisfaction. Health Policy. 2020;124(4):380\u20138.","journal-title":"Health Policy"},{"issue":"5","key":"1239_CR3","first-page":"186","volume":"117","author":"H Korzilius","year":"2020","unstructured":"Korzilius H. MB-Monitor 2019: \u00c4rzte f\u00fchlen sich \u00fcberlastet. Dtsch Arztebl Int. 2020;117(5):186.","journal-title":"Dtsch Arztebl Int"},{"key":"1239_CR4","doi-asserted-by":"publisher","first-page":"342","DOI":"10.1186\/s12889-016-3016-y","volume":"16","author":"A Loerbroks","year":"2016","unstructured":"Loerbroks A, Weigl M, Li J, Angerer P. Effort-reward imbalance and perceived quality of patient care: a cross-sectional study among physicians in Germany. BMC Public Health. 2016;16:342.","journal-title":"BMC Public Health"},{"issue":"3","key":"1239_CR5","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1093\/occmed\/kqr004","volume":"61","author":"K Tomioka","year":"2011","unstructured":"Tomioka K, Morita N, Saeki K, Okamoto N, Kurumatani N. Working hours, occupational stress and depression among physicians. Occup Med (Lond). 2011;61(3):163\u201370.","journal-title":"Occup Med (Lond)"},{"issue":"3","key":"1239_CR6","doi-asserted-by":"publisher","first-page":"241","DOI":"10.1177\/1028315306287002","volume":"10","author":"DK Deardorff","year":"2006","unstructured":"Deardorff DK. Identification and Assessment of Intercultural Competence as a Student Outcome of Internationalization. J Stud Int Educ. 2006;10(3):241\u201366.","journal-title":"J Stud Int Educ"},{"issue":"2","key":"1239_CR7","doi-asserted-by":"publisher","first-page":"166","DOI":"10.1093\/jrs\/fen016","volume":"21","author":"A Ager","year":"2008","unstructured":"Ager A, Strang A. Understanding Integration: A Conceptual Framework. J Refugee Stud. 2008;21(2):166\u201391.","journal-title":"J Refugee Stud"},{"issue":"5","key":"1239_CR8","first-page":"303","volume":"76","author":"N Farhan","year":"2014","unstructured":"Farhan N, Wiesemann A, Wirsching M. [Equivalency examinations for foreign physicians in Baden-Wuerttemberg]. Gesundheitswesen. 2014;76(5):303\u20135.","journal-title":"Gesundheitswesen"},{"issue":"27\u201328","key":"1239_CR9","first-page":"A","volume":"111","author":"J Protschka","year":"2014","unstructured":"Protschka J, Hillienhof A, Fachsprachpr\u00fcfung. Einheitliche Sprachtests beschlossen. Dtsch Arztebl Int. 2014;111(27\u201328):A\u20131229.","journal-title":"Dtsch Arztebl Int"},{"issue":"09","key":"1239_CR10","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1055\/s-0036-1595410","volume":"23","author":"B Rosenthal","year":"2018","unstructured":"Rosenthal B. Fort- und Weiterbildung: Ausl\u00e4ndische \u00c4rzte: Wege in den Arbeitsmarkt. kma - Klinik Manage aktuell. 2018;23(09):57\u201360.","journal-title":"kma - Klinik Manage aktuell"},{"issue":"7","key":"1239_CR11","first-page":"A","volume":"114","author":"P Spielberg","year":"2017","unstructured":"Spielberg P. Ausl\u00e4ndische \u00c4rzte aus Drittstaaten: Integration mit Hindernissen. Dtsch Arztebl Int. 2017;114(7):A\u2013312. -4.","journal-title":"Dtsch Arztebl Int"},{"issue":"1","key":"1239_CR12","doi-asserted-by":"publisher","first-page":"342","DOI":"10.1186\/s12913-020-05209-2","volume":"20","author":"J Loss","year":"2020","unstructured":"Loss J, Aldoughle Y, Sauter A, von Sommoggy J. Wait and wait, that is the only thing they can say\u2019: a qualitative study exploring experiences of immigrated Syrian doctors applying for medical license in Germany. BMC Health Serv Res. 2020;20(1):342.","journal-title":"BMC Health Serv Res"},{"issue":"7","key":"1239_CR13","doi-asserted-by":"publisher","first-page":"539","DOI":"10.1007\/s00104-024-02113-x","volume":"95","author":"F Schlottmann","year":"2024","unstructured":"Schlottmann F, Drossard S, Dey Hazra M, Blank B, Herbolzheimer M, Mulorz J, et al. [Challenges and options for advanced training in surgery: An interdisciplinary position paper against the background of the hospital structural reform in Germany]. Chirurgie (Heidelb). 2024;95(7):539\u201345.","journal-title":"Chirurgie (Heidelb)"},{"issue":"12","key":"1239_CR14","doi-asserted-by":"publisher","first-page":"506","DOI":"10.1055\/s-0043-121635","volume":"68","author":"I Hohmann","year":"2018","unstructured":"Hohmann I, Glaesmer H, Nesterko Y. Zugewanderte \u00c4rzte: Chancen und Herausforderungen im deutschen Klinikalltag. Psychother Psychosom Med Psychol. 2018;68(12):506\u201315.","journal-title":"Psychother Psychosom Med Psychol"},{"issue":"1","key":"1239_CR15","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1186\/s12960-016-0153-4","volume":"14","author":"C Klingler","year":"2016","unstructured":"Klingler C, Marckmann G. Difficulties experienced by migrant physicians working in German hospitals: a qualitative interview study. Hum Resour Health. 2016;14(1):57.","journal-title":"Hum Resour Health"},{"key":"1239_CR16","first-page":"209","volume":"1","author":"J Van Maanen","year":"1979","unstructured":"Van Maanen J, Schein EH. Toward of Theory of Organizational Socialization. Res Organizational Behav. 1979;1:209\u201364.","journal-title":"Res Organizational Behav"},{"issue":"1","key":"1239_CR17","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1186\/s12992-022-00871-z","volume":"18","author":"M Schumann","year":"2022","unstructured":"Schumann M, Sepke M, Peters H. Doctors on the move 2: a qualitative study on the social integration of middle eastern physicians following their migration to Germany. Globalization Health. 2022;18(1):78.","journal-title":"Globalization Health"},{"key":"1239_CR18","unstructured":"Gie\u00dfelmann K. Kulturelle kompetenz: verst\u00e4ndigen hei\u00dft nicht verstehen. Dtsch Arztebl Int. 2016;113(48):7802."},{"issue":"10","key":"1239_CR19","doi-asserted-by":"publisher","first-page":"1099","DOI":"10.1007\/s00103-023-03764-7","volume":"66","author":"K Kajikhina","year":"2023","unstructured":"Kajikhina K, Koschollek C, Bozorgmehr K, Sarma N, H\u00f6vener C. Rassismus und Diskriminierung im Kontext gesundheitlicher Ungleichheit \u2013 ein narratives Review. Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz. 2023;66(10):1099\u2013108.","journal-title":"Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz"},{"issue":"3","key":"1239_CR20","doi-asserted-by":"publisher","first-page":"1278","DOI":"10.3390\/ijerph19031278","volume":"19","author":"AC Nowak","year":"2022","unstructured":"Nowak AC, Namer Y, Hornberg C. Health Care for Refugees in Europe: A Scoping Review. Int J Environ Res Public Health. 2022;19(3):1278.","journal-title":"Int J Environ Res Public Health"},{"key":"1239_CR21","volume-title":"Qualitative inquiry and research design: Choosing among five approaches","author":"JW Creswell","year":"2018","unstructured":"Creswell JW, Poth CN. Qualitative inquiry and research design: Choosing among five approaches. 4 ed. Thousand Oaks, CA: SAGE; 2018.","edition":"4"},{"key":"1239_CR22","volume-title":"Qualitative research & evaluation methods","author":"MQ Patton","year":"2015","unstructured":"Patton MQ. Qualitative research & evaluation methods. 4 ed. Thousand Oaks, CA: SAGE; 2015.","edition":"4"},{"key":"1239_CR23","volume-title":"The professional integration of international physicians in German rehabilitation facilities \u2013 Opportunities, challenges, and measures","author":"EM Jansen","year":"2026","unstructured":"Jansen EM. The professional integration of international physicians in German rehabilitation facilities \u2013 Opportunities, challenges, and measures. Berlin, Germany: Freie Universit\u00e4t Berlin; 2026."},{"issue":"4","key":"1239_CR24","doi-asserted-by":"publisher","first-page":"327","DOI":"10.1080\/13645570701401305","volume":"11","author":"C Noy","year":"2008","unstructured":"Noy C. Sampling Knowledge: The Hermeneutics of Snowball Sampling in Qualitative Research. Int J Soc Res Methodol. 2008;11(4):327\u201344.","journal-title":"Int J Soc Res Methodol"},{"key":"1239_CR25","volume-title":"Learning the Craft of Qualitative Research Interviewing","author":"S Kvale","year":"2009","unstructured":"Kvale S, Brinkmann S, InterViews. Learning the Craft of Qualitative Research Interviewing. 2 ed. Thousand Oaks: SAGE; 2009.","edition":"2"},{"issue":"12","key":"1239_CR26","doi-asserted-by":"publisher","first-page":"2954","DOI":"10.1111\/jan.13031","volume":"72","author":"H Kallio","year":"2016","unstructured":"Kallio H, Pietil\u00e4 AM, Johnson M, Kangasniemi M. Systematic methodological review: developing a framework for a qualitative semi-structured interview guide. J Adv Nurs. 2016;72(12):2954\u201365.","journal-title":"J Adv Nurs"},{"key":"1239_CR27","volume-title":"Constructing grounded theory","author":"K Charmaz","year":"2014","unstructured":"Charmaz K. Constructing grounded theory. 2 ed. London: SAGE; 2014.","edition":"2"},{"issue":"2","key":"1239_CR28","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1191\/1478088706qp063oa","volume":"3","author":"V Braun","year":"2006","unstructured":"Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Res Psychol. 2006;3(2):77\u2013101.","journal-title":"Qualitative Res Psychol"},{"key":"1239_CR29","doi-asserted-by":"publisher","DOI":"10.4135\/9781036232078.n9","volume-title":"Thematic analysis: A practical guide","author":"V Braun","year":"2021","unstructured":"Braun V, Clarke V. Thematic analysis: A practical guide. London: SAGE; 2021."},{"issue":"1","key":"1239_CR30","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1177\/1525822X05279903","volume":"18","author":"G Guest","year":"2006","unstructured":"Guest G, Bunce A, Johnson L. How Many Interviews Are Enough?An Experiment with Data Saturation and Variability. Field Methods. 2006;18(1):59\u201382.","journal-title":"Field Methods"},{"key":"1239_CR31","doi-asserted-by":"publisher","DOI":"10.1016\/0147-1767(85)90062-8","volume-title":"Naturalistic inquiry","author":"YS Lincoln","year":"1985","unstructured":"Lincoln YS, Guba EG. Naturalistic inquiry. Beverly Hills, CA: SAGE; 1985."},{"issue":"3","key":"1239_CR32","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1080\/00313220600769331","volume":"40","author":"N Yuval-Davis","year":"2006","unstructured":"Yuval-Davis N. Belonging and the politics of belonging. Patterns Prejudice. 2006;40(3):197\u2013214.","journal-title":"Patterns Prejudice"},{"key":"1239_CR33","doi-asserted-by":"publisher","first-page":"101286","DOI":"10.1016\/j.ssmph.2022.101286","volume":"20","author":"N Akbulut","year":"2022","unstructured":"Akbulut N, Razum O. Why Othering should be considered in research on health inequalities: Theoretical perspectives and research needs. SSM Popul Health. 2022;20:101286.","journal-title":"SSM Popul Health"},{"key":"1239_CR34","doi-asserted-by":"publisher","first-page":"1485933","DOI":"10.3389\/fpubh.2024.1485933","volume":"12","author":"T Gangarova","year":"2024","unstructured":"Gangarova T, Yildiz M, Kabangu L. Racism in German healthcare: uncovering the construction and silencing of the other. Front Public Health. 2024;12:1485933.","journal-title":"Front Public Health"},{"key":"1239_CR35","volume-title":"Providing Culturally Competent Rehabilitation Services to Foreign-Born Persons","author":"MA Jezewski","year":"2001","unstructured":"Jezewski MA, Sotnik P, Culture Brokering. Providing Culturally Competent Rehabilitation Services to Foreign-Born Persons. Buffalo, NY: Center for International Rehabilitation Research Information and Exchange; 2001."},{"issue":"4","key":"1239_CR36","doi-asserted-by":"publisher","first-page":"391","DOI":"10.1002\/nur.20259","volume":"31","author":"G Novick","year":"2008","unstructured":"Novick G. Is there a bias against telephone interviews in qualitative research? Res Nurs Health. 2008;31(4):391\u20138.","journal-title":"Res Nurs Health"},{"issue":"1","key":"1239_CR37","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1177\/0081175012465967","volume":"43","author":"S Vogl","year":"2013","unstructured":"Vogl S. Telephone versus face-to-face interviews: Mode effect on semistructured interviews with children. Sociol Methodol. 2013;43(1):133\u201377.","journal-title":"Sociol Methodol"}],"container-title":["Globalization and Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12992-026-01239-3","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12992-026-01239-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12992-026-01239-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T15:15:38Z","timestamp":1791558938000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12992-026-01239-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,8]]},"references-count":37,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["1239"],"URL":"https:\/\/doi.org\/10.1186\/s12992-026-01239-3","relation":{},"ISSN":["1744-8603"],"issn-type":[{"value":"1744-8603","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,8]]},"assertion":[{"value":"6 April 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 September 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"8 October 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"70"}}