With the uncertainty of Brexit increasingly looming over every job sector it has never been more timely for those seeking new challenges to explore work opportunities in other countries. Approaching the end of a year and a half long application, it seems fitting to explain the process, recently undertaken, to become a Hygieniker (Senior Hygienist) in Germany.
Background The Dental Hygienist’s role in Germany is increasingly emerging in importance. The scope of practice is however tiered by level of qualification, with less advanced tiers only able to perform supragingival scaling and with more advanced tiers being able to perform root surface debridement.
National vs regional accreditation Currently those from the UK seeking employment as a Hygienist, at whatever level, are under no obligation to be recognised by the Bundeszahnaerztekammer at a national level (equivalent of the GDC). British Dental Hygienists are free to approach a German practice and can be accepted to work (provided they can get insurance). This might however involve being recognised to work by the Landeszahnaerztekammer (regional dental council)
Job description The job description of a Hygieniker (Senior Hygienist), which corresponds most fittingly to that of a UK qualified Hygienist, varies from region to region. The role therefore can only be recognised at a regional level. A Hygieniker moving to a different area of Germany, from the one they work in, needs to gain new certification from the regional Landeszahnaerztekammer.
Income Rate of pay varies greatly for those working at different tiers, with salary increases based on years of service (or further training to become more senior).
Employment status It is worthy of note that German Hygienists are employed, mainly full time, but sometimes part time. Not only is self-employment within the German dental industry unheard of, German taxation makes the process of self-employment highly complicated. Each Hygieniker therefore is affiliated to just one practice.
Therapy Lastly, there is no German equivalent for the role of Therapist. Indeed some years ago the nearest equivalent role was abandoned.
Application process in practise Whilst there is no formal German language test, a very high level of German fluency, both written and spoken, is required given the rigours of the application process. Given the fact that currently there is no obligation to gain formal accreditation to work in Germany as a Hygienist, the process of extrapolating what was required and to whom enquiries should be addressed took up no small amount of time.
It became apparent early on in the process that Hessen region Landeszahnaerztekammer (where the author is considering working) would only consider applications to become a Hygieniker from those who had been recognised at a national level. This entailed a more complicated application process than had first been envisaged.
Accreditation at a national level can only take applicants as far as being recognised as ‘Zahnmedizinischen Fachangestellter’ (Dental Nurse with supragingival scaling duties). This role is weighted heavily in favour of nursing and its associated clerical duties.
In effect, this national application is based on a tick box system ensuring that the applicant can prove they have performed the exact same equivalent training as someone who trained in Germany. This process is easier for those Hygienists who were previously Dental Nurses as, unlike the UK, in Germany it is not possible to become a Hygienist without having first been a Dental Nurse.
The author came across three key issues during the application process:
1. Understanding best practice in the dental environment from a German perspective: This requires attending a course in Germany. There are no approved courses as such, meaning applicants must find a suitable course themselves and submit their suggested course for approval to the Bundeszahnaerztekammer.
2. Understanding how German patients pay for their dental treatment: Again, this can only be attained by attending a course in Germany.
All patients are entitled to a basic level of dental care to get them out of pain. Beyond this, all treatment is private: either paid for directly by the patient or through their healthcare provider. Naturally there are also different levels of insurance available. Careful invoicing is required by means of a coding system. Treatments performed and even materials used have unique codes that must be correctly inputted during the patient’s appointment to provide an invoice that receives prompt payment.
3. Time and cost: All certificates and documents e.g. parts of the course handbook were needed to be countersigned by an English lawyer, then translated and countersigned by a recognised specialist German translator. The accreditation process itself also costs 300 euros.
Having received accreditation at a national level, the author approached the Landeszahnaerztekammer in Hessen. Unlike at the national level, where there is a formal document that must be filled in as part of the application process, the regional application involved writing a letter stating the author’s wish to work in the Hessen region. All documents that had been sent to the Bundeszahnaerztekammer had to be provided as original copy. The application was then passed to their lawyers. As has already been mentioned, each region has a different application process and the author’s experience in Hessen might differ for an applicant to another region.
At the time of writing the author is awaiting written accreditation from the Hessen region and has been informed that, unlike other regions in Germany, he is the only UK qualified Dental Hygienist who has ever applied for accreditation to work as a Hygieniker in the Hessen region.
If you would like further information about applying to work in Germany or details of the exact people to contact at the Bundeszahnaerztekammer please feel free to contact Nick.
About the author: Nick qualified with an MA (Oxon) from St Catherine’s College Oxford, in French and German. He worked for 10 years in Marketing, Communication and Business Strategy before changing careers into Dentistry. He was awarded the Tutor’s Award from Kings College Hospital where he studied a Diploma in Dental Hygiene and Therapy. Nick currently works across a variety of specialist private and mixed practices in Central and South West London. He also runs his own facial aesthetics business.
Publication: Dental Health | July 2019 P.12-13