Medicine Without a Top Abitur: Admission Routes Explained

Studying medicine without a top school leaving grade is possible, but the route runs through selection procedures other than the grade alone. Applicants with a weaker average should know which quotas exist, which tests count and which criteria universities weight themselves. This overview shows the structure using the example of the University of Hamburg and places it in context.

The key points at a glance

• The school leaving grade is only one route. The grade quota uses the points of the qualification, while the university procedure uses its own criteria.
• At the University of Hamburg, the medical faculty allocates 30 percent via the grade quota, 10 percent via the aptitude quota and 60 percent via the university procedure.
• According to the same page, waiting time has not played a role in allocation since the summer semester 2022.
• Aptitude tests such as the medical aptitude test can play a role in the procedures. Universities set the exact weights.
• Additional routes exist through the rural doctor quota, hardship cases and quotas for people nominated by the Bundeswehr. Their shares differ by place of study.

Which quotas apply to medicine?

Before the main allocation quotas apply, many places first deduct places for special quotas. The University of Hamburg names, among others, places for foreign applicants not equal to German applicants, for second-degree applicants, for hardship cases and for people nominated by the Bundeswehr. Only the remaining places are then distributed. This structure is an example, because the shares vary from place to place.

The grade quota is the classic route through the grade. It follows the points of the higher education entrance qualification. The university procedure assesses more than the grade. This is where applicants with a weaker average can have a chance, provided they can document other strengths.

How does the university selection procedure count?

For medicine in Hamburg the university website gives concrete points for the selection procedure. The school leaving grade can give at most 40 points, the medical aptitude test HAM-Nat also at most 40, and the SJT at most 20. The sum gives the result. This split is a Hamburg rule and does not apply automatically at other universities.

Anyone with a weaker school leaving grade can therefore make up points in the test and in the aptitude quota. The aptitude quota in Hamburg works differently: for medicine there, the HAM-Nat counts with 80 points and the SJT with 20 points. School grades do not enter there. Applicants should therefore read the selection rules of the specific university before fixing their strategy.

What role does waiting time play?

Waiting time used to be a central route into medical study. According to the University of Hamburg page it has not played a role in allocation since the summer semester 2022. For applicants without a top grade this means that time since school alone secures no place. Anyone still hoping for waiting time should check whether the university they want has different rules.

Our guide on university waiting time and NC applications (in English) explains the general rules, while this guide only looks at access to medicine.

Which other routes exist?

Besides the central quotas there are routes that only apply to certain groups or states. These include the rural doctor quota, which binds applicants to later work in general practice. Hardship cases and the quota for people nominated by the Bundeswehr are separate categories too. Their shares are small in Hamburg but differ by location. Anyone who wants to use one of these routes must check the requirements carefully.

The rural doctor quota is a special case, because it is tied to a long commitment. Our guide on the rural doctor quota (in German) explains deadlines and obligations in detail.

Frequently asked questions

Can I study medicine without a top school leaving grade at all?

Yes. The grade quota is only one route. Alongside it there is the university selection procedure and the aptitude quota, in which other criteria count. Which route fits depends on your profile, not on the grade alone.

How much weight does the medical aptitude test carry?

That depends on the procedure. In Hamburg the test counts with a maximum of 40 points in the university procedure and with 80 points in the aptitude quota. Other universities weight it differently, so the rules of the office concerned are decisive.

Is a selection interview part of the procedure?

Some universities use selection interviews or other suitability assessments. Whether and how they do so is up to the university. The Hamburg page lists the components named there, not every possible interview. Ask the university directly.

Is it still worth applying?

Yes, if you know the selection rules and present your strengths in a targeted way. An application is not a failure just because the school leaving grade is below average. What matters is that you keep the quotas and deadlines in view.

How to plan step by step

1. Check the quotas: Find out which routes the medical faculty offers and how many places each one receives.
2. Plan the test: Clarify which aptitude test applies to your cohort and which deadlines apply to it.
3. Use suitability routes: Check whether you can document training, voluntary service or volunteer work with patient contact.
4. Note the deadlines: Enter the application deadlines of all universities in your calendar.
5. Clarify financing: Settle early how you will fund the long course before you accept any offer.

A look at the place of study is also worthwhile. According to the Hamburg university page, special quotas are deducted per place of study, so the shares can differ between locations. If you are considering several cities, check separately for each university which quotas apply there and how many places they award.

Related guides

• Study places: free places and waiting list procedures explained (in German), the hub of this topic group.
• Rural doctor quota: how to apply and which deadlines apply.
• TMSnat 2027: What changes in the medical aptitude test.
• University waiting time and NC applications
• Studying without Abitur: routes, rules and funding

Sources: University of Hamburg, page “Das Auswahlverfahren von hochschulstart.de” (page status October 2026, German original).

Last updated: November 2026. This guide is general information, not individual advice.