freedom of establishment

What does Article 49 TFEU protect?

Freedom of establishment covers the stable and continuous exercise of a self-employed activity in another member state, including the establishment of practices, branch offices, and companies. The host state may not impose conditions that it does not impose on its own nationals. It is to be distinguished from the freedom to provide services: under that, the provider remains established in the country of origin and works abroad only temporarily. For employed physicians, the free movement of workers under Article 45 TFEU also applies.

How does professional recognition interact?

Without recognition of the qualification, the freedom is ineffective for regulated professions. This is why Title III of Directive 2005/36/EC regulates establishment in detail: the general system of recognition in Articles 10 to 14 and automatic recognition in Articles 21 to 23. Article 51 sets the procedural deadlines: acknowledgement of receipt within one month, decision no later than three months after complete documents, extendable by one month under the general system.

What does this mean for graduates from EU countries?

Those who completed their studies in Bulgaria, Romania, Hungary, Croatia, Malta, or the Baltic states may establish themselves in any EU state once the medical licence or corresponding professional authorisation has been granted. In Austria this requires registration in the physicians' register with the Austrian Medical Chamber, which charges between €290.03 and €1,883.71 for recognition under the 2025 tariff in non-automatic procedures. Switzerland is not an EU member but grants comparable rights through the Agreement on the Free Movement of Persons; the MEBEKO is responsible for diploma recognition.

Where the freedom ends

Admission to the statutory health insurance system is not harmonised. Those who wish to practise in Germany as a panel doctor billing the statutory health insurance funds need admission in the planning area, and in areas with a moratorium on new admissions freedom of establishment is of no further help. Language requirements, chamber membership, and specialist training evidence also remain national matters. In short: market access is open, panel practice admission is not. Waiting times of several years for a panel practice position becoming available are not unusual in urban centres. The competent approval committee decides on the specific admission.