Anyone studying medicine, pharmacy or psychotherapy in Germany knows the traineeship (Referendariat) mainly from law and teacher training. After graduation, these subjects have their own practical phases with their own rules: the clinical year (Praktisches Jahr, PJ) in medicine, the practical training in pharmacy and the psychotherapy training. A civil-servant status is generally not provided for in these phases, and that is the main reason why pay and insurance differ.
In short: The clinical year (PJ) in medicine lasts 48 weeks and is split into three blocks of 16 weeks (section 3 of the German Medical Licensing Regulations, last updated October 2026). Whether you are insured by statutory health insurance during the PJ depends on whether the placement is unpaid, and your health insurer decides this case by case. In pharmacy and psychotherapy, pay and insurance depend on the individual contract.
The key points
- In medicine the PJ lasts 48 weeks, split into internal medicine, surgery and an elective block.
- The expense allowance (Aufwandsentschädigung) during the PJ is not regulated uniformly. It varies by federal state and hospital.
- Whether you are in statutory health insurance during the PJ depends on whether the placement is unpaid. Your health insurer clarifies this.
- In pharmacy, the practical training follows the German Pharmacy Licensing Regulations (AAppO), usually under a training contract.
- In psychotherapy, the practical work is part of the training. Pay and insurance depend on the status and the contract.
Which training phase applies in which subject?
| Subject | Phase after graduation | Legal basis | Status and pay | Check insurance with |
|---|---|---|---|---|
| Medicine | Clinical year (PJ), 48 weeks | German Medical Licensing Regulations, section 3 | Compulsory placement, expense allowance varies by state and hospital | Health insurer: is the placement unpaid? |
| Pharmacy | Practical training after graduation | German Pharmacy Licensing Regulations | Training relationship, pay per contract | Health insurer: is there an employment relationship with pay? |
| Psychotherapy | Psychotherapy training with practical work | Psychotherapy Act (PsychThG) | Training contract, pay or cost reimbursement per contract | Health insurer and training institution |
How long is the clinical year in medicine?
Under section 3 of the German Medical Licensing Regulations (ÄApprO), the PJ comprises 48 weeks of full-time training. It is divided into three blocks of 16 weeks each: internal medicine, surgery and an elective block. The elective can be general practice or another clinical specialty. The training placement determines the order of the blocks, while the total length stays the same.
Part-time training at 50 or 75 percent extends the overall duration accordingly. If you plan a part-time PJ, include the longer duration from the start, for example in your housing, side job and financing plans.
What does the PJ mean for health insurance?
During the PJ you are usually still a student at university. Whether you are compulsorily insured under statutory health insurance is governed by section 5 (1) no. 10 of the Social Code Book V (SGB V). That provision covers compulsory unpaid vocational placements. The key question is therefore whether your PJ is unpaid.
Many German states pay an expense allowance, and its amount varies widely. Whether it counts as remuneration is not settled in general terms and depends on how it is structured. Ask your health insurer for a written statement covering exactly this period before you sign. Our overview of PJ allowances by federal state (in German) shows which amounts are common in each state.
How does the practical training in pharmacy work?
After a pharmacy degree, practical training follows, which is governed by the German Pharmacy Licensing Regulations (AAppO). Most placements take place in pharmacies, supplemented by other institutions that the regulation allows. Registration and recognition run through the competent state authority, and the details are set out in the leaflet of the respective state.
For insurance, what matters is whether the placement creates a paid employment relationship. Then the rules for employees apply, which means compulsory insurance up to the insurance threshold, which is 77,400 euros per year in 2026. Without pay, section 5 SGB V applies, as with the PJ.
How does psychotherapy training work?
Training to become a psychological psychotherapist is regulated in the Psychotherapy Act (PsychThG). It includes practical work in approved institutions, for example in clinics, alongside theoretical training at a training institute. The practical work is therefore not a post in a traineeship but part of a training with its own contract.
Unlike the traineeship, there is generally no civil-servant status here. The contract with the institution sets the pay, the cost reimbursement or both. For insurance, the decisive point is whether an employment relationship with pay exists. Put the contract on the table before you sign it, ideally together with a written statement from your health insurer.
What documents should you collect?
You will need these documents for your health insurer, for any funding applications and for your tax return. Sorting them from the start avoids follow-up questions and gaps.
- Training or employment contract with details of pay, duration and weekly working hours.
- A certificate from the university or the training placement confirming the start and end of the activity.
- A written statement from your health insurer about compulsory insurance for exactly this period.
- Proof of any expense allowance or cost reimbursement, so that tax and funding information is consistent.
Frequently asked questions
Is the PJ a traineeship?
Some people call the PJ a traineeship, but legally it is not a preparatory service under civil-service law. The term Referendariat is mainly used in law and in teacher training. For forms and applications, the name in the licensing regulations and on your certificate is what counts.
Can I receive BAföG during the PJ?
Whether and how BAföG applies during a PJ is decided case by case by the competent BAföG office (Amt für Ausbildungsförderung). Our guide on BAföG repayment (in German) explains how the repayment of a loan from your studies works.
Do I need to arrange my own insurance during psychotherapy training?
That depends on your status. With paid employment, the rules for employees apply. For training without pay, the rules for unpaid work under the SGB V apply. Whether you remain in statutory insurance or need private cover should be confirmed in writing before the training starts.
What to do next
- Read the contract or job advertisement and note whether it provides for pay, an expense allowance or cost reimbursement.
- Ask your health insurer for a written statement on compulsory insurance for exactly this period.
- For training contracts, clarify the status of the activity before you sign.
- Enter the start and end of the training in your insurance and funding documents, so that no gaps arise.
- Plan health insurance for the period after completion early, because requirements change when you start working.
Related guides
- PJ allowance by federal state (in German)
- Health insurance during the traineeship (in German)
- Health insurance between final exam and traineeship (in German)
- BAföG repayment: start, instalments, exemption and partial write-off (in German)
- Teacher as civil servant or employee
Sources: section 3 ÄApprO, duration and structure of the PJ (accessed October 2026); section 5 SGB V, compulsory insurance (accessed October 2026); German Pharmacy Licensing Regulations, AAppO (accessed October 2026); Psychotherapy Act, PsychThG (accessed October 2026).
Last updated: October 2026. This guide is general information, not individual advice.
