Foreign national health personnel wishing to practise medicine in Türkiye encounter a two-stage process that goes beyond an ordinary work permit application. The work permit for a foreign doctor is a category of permit made subject to more onerous conditions than those applying to other occupational groups: it requires both the registration of the physician’s professional qualifications by the administration and the satisfaction of certain thresholds by the health institution that is to employ them.
In practice a significant proportion of applications founder because the employer assumes the process to be a single step. In fact, a work permit request submitted through the e-permit system without pre-approval having been obtained from the Ministry of Health is doomed from the outset. In the same way, an application by an institution that does not meet the capital threshold or the ratio of Turkish personnel will be refused even if the physician’s diploma has been recognised as equivalent.
In this briefing note we examine, in turn, the criteria sought in the foreign physician and in the employing health institution, the operation of the pre-approval stage, the documents to be submitted with the work permit application, the matters to be observed in the employment contract, the salary and fee items, the legal remedies available against a refusal decision, and the extension regime.
Criteria Sought in the Foreign Physician and in the Health Institution
The legislation conducts the assessment of admissibility along two separate axes: on the one hand the personal qualifications of the physician on whose behalf the application is made, and on the other the institutional capacity of the employer who is to engage them.
The conditions sought in respect of the physician may be summarised as follows. First, the equivalence of the diploma or specialist certificate must have been recognised by the Council of Higher Education (YÖK) and thereafter registered with the Ministry of Health. The second condition is the absence of any legal impediment preventing the physician from practising the profession. Third, the physician must have sat the Turkish language examination and documented proficiency at level B or above. In addition, the physician must have obtained both a work permit and a residence permit in Türkiye. Finally, compulsory professional and financial liability insurance must have been taken out in Türkiye.
On the employer’s side, the criteria are institutional in nature:
- For every foreign physician to be employed, at least 5 Turkish citizens must be employed at the health institution, because foreign personnel may not be employed in a manner exceeding one sixth of the total number of employees.
- The paid-in capital of the private health institution that is to employ the physician must not be below TRY 100,000.
- Where the shareholder of the applicant company is likewise a foreign national, that shareholder’s share in the capital may not fall below 20%; nor may the monetary equivalent of that ratio be less than TRY 40,000.
- The monthly salary agreed in the employment contract between the parties must be equal to or higher than the minimum wage determined for foreign nationals. That amount is redetermined by the Directorate General of International Labour Force every 6 months.
The criteria listed are cumulative. A deficiency identified in any one of them results in the application being refused in its entirety.
How Is a Work Permit Obtained?
The permit comes into being upon the completion of three links in the chain: obtaining pre-approval from the Ministry of Health, actually satisfying the conditions sought, and submitting the set of documents in due form. The mere recording of the application in the system does not of itself create a right; the request must be received favourably by the Ministry.
How Does Ministry of Health Pre-Approval Work?
The pre-approval process is opened by the physician applying to the private health institution at which they intend to work. At this stage the physician submits the documents required for pre-approval to the responsible manager of the institution.
The responsible manager forwards the documents submitted to them to the provincial health directorate. If the directorate finds no deficiency in the file, it transmits the documents to the Ministry of Health.
The Ministry examines the file as to whether the criteria have been satisfied. If no deficiency is identified as a result of that examination, the physician’s diploma is registered and a pre-approval certificate is issued establishing that they have been found suitable to practise the profession.
Documents to Be Submitted at the Pre-Approval Stage
The documents that must be placed in the file at this stage consist of four items.
The first is the document establishing that the equivalence of the physician’s diploma, graduation certificate or the document taking their place has been recognised by the competent authority.
The second is the document showing that success at level B or above has been achieved in the Turkish language examination conducted by the universities. This document must be added to the file within 1 year of the application made to the provincial health directorate. No such document is required from physicians who have graduated from higher education institutions whose language of instruction is Turkish.
The third is the document issued by the competent authority of the country from which the physician has come, establishing that there is no legal impediment to their practising the profession. Three groups are exempt from this document: those who completed a higher education institution in Türkiye one year before the application, those who document that they resided in Türkiye without interruption for 5 years prior to the application, and those who have taken refuge in Türkiye by reason of a state of emergency in their own country.
The fourth is the employment contract concluded between the physician and the private health institution, in which the monthly salary to be paid is clearly stated; the full name and signature of the parties must appear on every page of the contract.
These documents relate solely to the pre-approval stage. The pre-approval procedure begins with the delivery of the documents to the provincial health institution; once the procedure has been completed favourably, the process moves to the work permit application stage.
Submitting the Application Through the E-Permit System
Once pre-approval has been concluded favourably, the work permit request is transmitted by the employer by means of the e-permit application. The method of entry into the system varies according to whether the physician on whose behalf the application is made is abroad or in Türkiye.
If the physician is abroad, they obtain an application code by applying to the Turkish mission in the country where they are located; the employer enters the system by means of that code. If the physician is already in Türkiye, the foreigner identification number beginning with the digits 99, or passport details, are used on entry.
Once access to the system has been secured, the personal details of the physician are recorded and the necessary documents are scanned and uploaded.
When the upload has been completed and the application has been assessed favourably, a notification containing the fee amounts and the bank account details is sent to the electronic mail address registered in the system. The application is deemed complete upon payment of the fees.
Documents Required for the Work Permit Application
The following must be present in the application file:
- The employment contract concluded between the health institution and the physician
- The physician’s passport or the document serving in place of a passport
- 2 biometric photographs of the physician
- The physician’s diploma or the document taking the place of a diploma
- The pre-approval certificate issued by the provincial health directorate
- The Trade Registry Gazette reflecting the current capital and shareholding structure of the institution
- The institution’s profit and loss statement and balance sheet for the most recent year, approved by an MMM or obtained from the tax office
- The certificate of activity obtained from the provincial health directorate
It is sufficient for the documents listed to be uploaded to the e-permit system in pdf format at the time of the application; physical delivery is not additionally required. Where a deficiency is found in the file, the administration grants additional time for completion. If the deficiency is not remedied within the additional time granted, the request is refused.
Documents obtained from abroad must bear consular approval or an apostille. Documents drawn up in a foreign language must be uploaded to the system together with a sworn Turkish translation.
Points to Be Observed When Drafting the Employment Contract
The content of the contract directly determines the fate of the application. Texts drafted without compliance with the matters set out below may give rise to a problem of invalidity, and a work permit request founded upon them may be refused.
The contract must be drawn up in writing, and the full name and signature of the physician and of the employer must appear on every page. Where the employer party is a legal person, the company title is written on the pages and the signature is affixed by the person authorised to represent it. The text must expressly state that the physician has been informed in writing of their rights. In addition, the numbers of the 157 Helpline for Victims of Human Trafficking and of the 170 helpline must be shown in the contract. The tax number of the workplace, the date on which the physician will commence work and the job description must be written with a clarity that leaves no room for doubt. The salary agreed must not fall below the minimum wage announced by the competent authorities.
A permit cannot be obtained on the basis of a contract that does not bear these elements. Alongside those listed, the general conditions of validity of the employment contract also arise separately. Since the application will remain without result if the contract fails to meet the qualities it must bear, it is appropriate that the utmost care be taken when the text is drafted and that legal support be obtained in the field of the law on foreign nationals.
The Minimum Salary That May Be Agreed for a Physician
According to the amount announced by the Ministry of Labour and Social Security, the lowest salary that may be determined for a foreign physician is TRY 30,024. Since the Ministry updates that amount every 6 months, the figure in force must be checked when the contract is concluded. Applications founded on contracts providing for a sum below the minimum salary are refused.
Fees and the Payment Period
As at 2023, the items payable are the valuable paper charge in the amount of TRY 356 and the annual work permit fee of TRY 3,090. Since the fee is levied on an annual basis, TRY 3,090 is paid separately for each year requested.
After the application has been accepted, the Ministry of Labour and Social Security sends the bank account details to the electronic mail address recorded by the employer in the e-permit system. Payments are made to those accounts by the employer and must be completed within 30 days of the date on which the notification was sent.
How Long Does the Application Take to Conclude?
A work permit request is decided within an average of 30 days, and a pre-approval application within 15 days. The placing of missing or erroneous documents in the file causes these periods to be extended.
Refusal of the Application and Legal Remedies in the Event of Refusal
The request is refused where the conditions sought are not satisfied, where the documents are uploaded to the system incompletely, where the documents submitted are found to be forged, or where pre-approval from the Ministry of Health has not been obtained at all.
The physician is obliged to leave the country within 10 days of the notification of the refusal decision to them or to their representative. Failure to comply with this obligation results in deportation.
Objection to the Refusal Decision and Action for Annulment
Not only the physician but also the employer who made the application may object to the refusal decision. The notice of objection is submitted through the e-permit application within 30 days of the notification of the decision to the persons concerned. Where the objection is likewise refused, it is possible to bring an action for annulment before the Ankara administrative courts.
This route of objection and action is subject to the same procedure and principles as the mechanism operated against the refusal of other categories of work permit. For the detail of the matter, reference may be made to the note entitled “refusal of a work permit application”.
Reapplication After Refusal
The fact that the request has been refused is no obstacle to a fresh application being made. However, for a favourable result to be obtained from the second application, the ground of refusal on which the first decision was based must have been removed.
Extension of the Work Permit
The extension request is transmitted by the employer through the e-permit application. That request may be made from the point at which 60 days remain until the expiry of the existing permit. Extension applications transmitted after the permit period has expired are not taken into assessment.
Two conditions are sought together for the request to be accepted: that the application has been made within the period, and that the conditions of the permit continue to be present. Otherwise the extension is refused. Detailed explanations concerning extension applications are contained in the note entitled “work permit extension”.
Remedies Against the Refusal of an Extension Request
Where an extension request is refused, the possibility of objecting and of bringing an action for annulment likewise exists. That route is subject to the same procedure and principles as the regime of objection and action operated against the refusal of a work permit application.
May Work Continue While the Extension Is Being Assessed?
It is possible for the physician to continue working while the extension application is under examination. That possibility is not unlimited, however: it may not exceed 90 days from the moment at which the period of validity of the work permit expires.
Where the extension request is refused, it is not legally possible for the physician to continue working even if the 90-day period has not yet elapsed.
Exemption in Respect of Physicians of Syrian Nationality
As a rule, physicians who are Syrian citizens are subject to the same regime as other foreign physicians. Nevertheless, where those physicians wish to take up duties at migrant health centres coordinated or approved by AFAD, they are exempted from two conditions: the obligation to submit a diploma certificate and the obligation to establish that there is no legal impediment to their practising medicine.
Independent Legal Assessment
The employment of foreign physicians is one of the most heavily staged and least forgiving areas within the work permit regime. The two-layered structure of the process requires the employer to manage not only its own institutional thresholds but also, simultaneously, the timetable for the physician’s equivalence and language proficiency. In practice, the greater part of the time lost arises from a single missing document in the pre-approval file, or from the minimum salary being written on the basis of the previous period’s figure rather than the current amount.
When a concrete employment plan is being devised, clarifying the following headings in advance markedly accelerates the process:
- That diploma equivalence and registration with the Ministry of Health have been completed before the pre-approval file is opened
- Scheduling the one-year period allowed for the submission of the Turkish proficiency certificate, and establishing from the outset whether an exemption applies
- Verifying by documentary evidence, before the application, the paid-in capital of the institution, the ratio of Turkish personnel and the percentage shareholding of the foreign shareholder
- Comparing the salary in the employment contract with the minimum amount in force on the date of signature
- Fully satisfying the requirement of an apostille or consular approval and of sworn translation for documents originating abroad
- Acting with the 30-day objection period and the 10-day period for leaving the country in contemplation, against the possibility of refusal
Independent Legal provides advisory services and the conduct of litigation at every stage of the employment of foreign health personnel, from the preparation of pre-approval files to the objection and annulment proceedings to be pursued against refusal decisions.