Doctors Between Tension, Exodus and a New Future in the Middle East
Officially, Germany is at peace. Hospitals operate under “normal” conditions. Medical practices remain full, while emergency services continue to run. Still, one question hangs in the air. Almost no one dares to ask it out loud:
How long will doctors in Germany truly remain free to choose where they work? At what point does that freedom quietly turn into obligation?
A system that would falter without foreign doctors
The numbers speak clearly. Over recent years, the number of foreign doctors in Germany has risen sharply. According to data from the German Medical Association, more than 60,000 doctors without a German passport now work in the country. Within this group, the largest share comes from Syria, with well over 6,000 registered practitioners. Major media outlets have already raised a blunt question. How would the German health system function without Syrian doctors? The issue becomes especially visible in rural regions, where these physicians now secure a large share of basic care.
At the same time, long-term forecasts paint a troubling picture. Consulting firms and financial institutes warn of a massive gap ahead. By 2035, up to 1.8 million positions in health and care could remain unfilled. This would represent nearly one third of the entire sector. Against this backdrop, the idea of “replaceable” medical labor becomes difficult to defend.
What happens if those holding the system together move on?
Once the focus shifts beyond headcounts, the situation grows more complex. Movement patterns matter just as much as absolute numbers. For many Syrian doctors, the decision is deeply personal. Staying in Germany offers stability, while returning home means helping to rebuild a shattered health system. International reporting shows that thousands have become indispensable in German hospitals. At the same time, a growing number consider returning if conditions improve.
In parallel, Germany continues to recruit medical staff abroad. Programs increasingly target countries such as Egypt. With state support, doctors and nurses enter German hospitals and care homes through structured pathways. This development raises an uncomfortable but legitimate question. What long-term price will this strategy carry? Who ultimately pays it, both in the source countries and in Germany itself?
Adding further pressure, global competition for medical talent keeps intensifying. Gulf states such as Saudi Arabia invest billions into modern health systems under Vision 2030. New hospitals, digital platforms, and research hubs emerge at speed. Under these conditions, Germany can no longer assume it will remain attractive by default.
“State of tension”: legal theory or practical risk?
Another layer of this debate receives far less public attention. Until now, it has mainly occupied constitutional lawyers and security experts. At its core lies the concept of the “state of tension” (“Spannungsfall”).
Article 80a of the Basic Law dates back to 1968. It allows special legislation when the Bundestag declares a situation between peace and open defence. According to the Federal Agency for Civic Education, this stage precedes a formal defence case and applies when a serious external threat becomes likely. Legal analyses outline the possible consequences. The state may protect critical infrastructure. Civilian resources can be mobilised. Essential state functions may be secured through extraordinary measures.
Healthcare clearly qualifies as critical infrastructure. This classification is not disputed. From there, a further question follows logically. Would medical personnel receive a special role in such a scenario? If so, another issue cannot be ignored. Would doctors still be free to leave the country purely at their own discretion? This is not about panic. It is about foresight.
Linear thinking versus strategic planning
Public debate around staff shortages often remains superficial. The proposed solutions usually sound familiar: more recruitment, more agencies, more campaigns. The logic stays linear.
A shortage gets plugged with another person.
The next position follows shortly after.
Additional pressure lands on a system already stretched to its limit.
Meanwhile, other countries pursue a different strategy. International reporting shows how the UAE and Saudi Arabia build health systems from the ground up. Digital infrastructure receives heavy investment. Hospitals connect through networks. Telemedicine scales rapidly. Entire health clusters emerge instead of improvised fixes. These systems aim to multiply impact rather than simply increase headcount. This leads to a central question. In which system can the competence of a single doctor truly scale? And ultimately, who makes that system choice? The state, or the doctor?
Medical freedom: idea or real option?
Many doctors repeat the same sentence: “If it gets too much, I’ll leave.” That statement, however, deserves closer inspection. Is a recognized qualification prepared for another country?
Have licensing routes been clarified or even initiated?
Do concrete offers exist beyond vague ideas or online impressions?
For many, this exit remains theoretical. It functions as psychological relief rather than a real path. Once constitutional law, demographics, and global workforce shifts intersect, the core issue becomes unavoidable: Is medical freedom in Germany a stable condition, or merely a time-limited window?
Options before pressure replaces choice
No one suggests that doctors should leave Germany tomorrow. That was never the argument. Still, building at least one viable alternative while the framework allows it seems rational. Waiting until pressure forces action rarely leads to good outcomes.
Responsibility toward patients is obvious. Duty toward one’s family matters just as much. Care for one’s own long-term stability cannot be ignored either. Planning early does not signal disloyalty. It signals professionalism.
Programs such as “Dubai Docs Fast Track” position themselves precisely here. Rather than spreading fear, they translate vague thoughts into concrete, legal, and professional options. The final decision always remains with the doctor.
Without a real option, however, there is nothing to decide.
One question every doctor should ask
In the end, everything condenses into a single question: Do I want to say in ten years, “I work here because I chose this consciously” or,
“I am here because I never moved when I still could”?
As long as the window stays open, medical freedom exists.
The real challenge lies in noticing when that window narrows.
And in deciding whether to step through it before it closes.
