Liechtenstein, Monaco, Andorra and San Marino: how four microstates license doctors without an exam

Borrowed licensing

A state with tens of thousands of residents cannot sustain its own item bank, its own examiners or, in most cases, its own medical school. These four states solve the problem by borrowing. A doctor arrives with a degree, residency or specialty from a neighbour. The small state checks identity, good standing, language and insurance, then enters the person on a list. That is why this page is about gates and not about exams.

It also means the exam you should prepare for sits elsewhere. If you want to work in Vaduz, Monaco-Ville, Andorra la Vella or Serravalle, ask where your training took place and which national exam that country sets.

The four states

Liechtenstein

Liechtenstein is the best documented, because the Amt für Gesundheit publishes a leaflet on practising as a doctor or other health professional (2026 edition). A practice licence (Berufsausübungsbewilligung) is personal and cannot be transferred. It covers either self-employed practice or practice on one's own professional responsibility within employment. You apply before work starts.

1. Prepare the documents: proof of citizenship or a passport copy, a recent criminal record extract, a recent medical certificate and German at CEFR B2.
2. The Amt checks the file and forwards it to the Ärztekammer or the relevant professional association, which reviews training and qualifications.
3. Receive the Zusicherung (assurance), valid up to six months. It does not allow self-employed practice.
4. Show premises and liability insurance: a minimum cover of CHF 5 million for surgeons and CHF 3 million for non-surgical doctors and several other professions.
5. Receive the licence and be entered in the doctors' list.

The leaflet gives fees of CHF 1,000 for self-employed practice and CHF 800 for employment, plus CHF 200 to be listed. It says processing takes about two to three months. It does not describe diploma recognition, the difference between EEA, Swiss and third-country applicants, or any knowledge exam, so ask the Amt for those. As an EEA state, Liechtenstein applies the EU professional qualifications directive (2005/36/EC) to EEA qualifications. A licence does not by itself give a contract with the basic health insurance, which the insurers' association handles separately.

Monaco

Doctors who practise in the Principality fall under the Conseil de l'Ordre des médecins. Its rules say the tableau lists doctors authorised to practise in Monaco, and that it is updated each year. After admission, and before the oath, the doctor receives the Council's rules and the Code de déontologie. The rules we read do not set out the conditions for authorisation, so ask the Direction de l'Action Sanitaire or the Ordre. French is the working language. A footnote to the rules mentions holders of the French State diploma of doctor of medicine in connection with patients of a social insurance fund. The route for a non-French degree is not documented in what we read.

Andorra

Andorra's General Health Law, as amended by Law 1/2009, says a government authorisation to practise has no effect until the professional is registered with the relevant college, where one exists. The Government sets requirements and maintains a register of health professions. Authorised professionals need professional liability insurance, take part in the paid emergency duty service and, if they work for the public health service, sign a specific contract. The law does not list degrees or a recognition procedure, so those sit in regulations.

For specialist doctors who want an agreement with the national social security fund, the CASS regulation we read asks for registration with the Col·legi Oficial de Metges d'Andorra, age under 65 at first application, at least two of the last five years in clinical work in the specialty, and a sworn statement of no serious sanctions in the last four years.

San Marino

The Istituto per la Sicurezza Sociale (ISS) employs most of the republic's doctors. A recruitment notice we read, dated 2015, asked for a degree in medicine and surgery, the abilitazione to practise, a specialisation, and enrolment in the register of the medical order. A degree obtained abroad needed certified equivalence, and a foreign specialisation was accepted if obtained under its own state's rules. There was no entrance exam. Candidates were ranked on training and publications, and had to declare adequate knowledge of Italian.

Nurses, midwives, pharmacists and others

Our directory lists the same pattern for the other five professions: registration with the small state's own health authority, based on a qualification from elsewhere. The authorities are the Amt für Gesundheit, Monaco's Direction de l'Action Sanitaire, Andorra's Ministeri de Salut and San Marino's ISS. Liechtenstein's leaflet covers several health professions, including pharmacists, dentists and laboratory diagnosticians, under the same licence logic. To our knowledge Andorra's university teaches nursing, but most professionals in all four states qualify abroad.

What every file needs, and the cross-border catch

The four procedures differ in form but ask for the same core items. Prepare them once and adapt.

• Identity and nationality evidence. Liechtenstein asks for proof of citizenship or a passport copy.
• A clean record. A recent criminal record extract in Liechtenstein, and a statement of no serious sanctions in the last four years for Andorra's CASS accreditation.
• Fitness and insurance. A recent medical certificate in Liechtenstein, and professional liability insurance in both Liechtenstein and Andorra.
• Language. German at B2 in Liechtenstein, and a declaration of adequate Italian in San Marino.
• Proof of qualification. Degree, specialty certificate and, where the degree is foreign, certified equivalence, as San Marino's notice asks.

The catch is cross-border work. In Liechtenstein, cross-border activity is generally subject to notification or a permit, and residence questions go to the immigration office. If you plan to live in a neighbouring country, ask about the permit and the residence rules together, because the licence alone does not settle where you may live.

Where graduates go next, and what they face

Within the EEA, graduates move between countries under the qualifications directive. Monaco, Andorra and San Marino are outside the EU and EEA, so the directive does not give EEA graduates automatic rights there, and non-EEA degrees face each country's own recognition process. Doctors from the microstates who want to leave the continent meet the usual exams: PLAB for the UK, USMLE for the US, the AMC MCQ for Australia. Their small home registers add no exam, but registration there can serve as evidence of good standing.

Medical education

None of the four is a medical-training destination that we know of. Doctors generally qualify in neighbouring countries, for example Switzerland, Austria or Germany for Liechtenstein, France for Monaco, Spain or France for Andorra, and Italy for San Marino. Instruction follows the language of the host country, and the degree runs about six years. After graduating, doctors complete residency in the host system, and then apply for the microstate permit with a diploma, specialty certificate and good-standing letter in hand.

For a student, the sensible plan is to choose the training country by its recognition rules, since the home state will accept it. For an experienced doctor moving in, the file is the key: apostilled or legalised documents, a certified translation into the working language, and evidence of language level. Liechtenstein's B2 German requirement is explicit. The others did not state a language test in the documents we read, but employers will expect the working language.