Specialists in internal medicine are deeply rooted in the healthcare system.

The importance of specialists in internal medicine is exhibited by the sheer size of this specialist group compared to any other group in the entire medical profession. In 2015, the specialists for internal medicine in Germany comprised of 50,834 people while the total number of physicians was 371,302 people (BÄK, 2016a, Statista, 2016a) . In Switzerland, the statistical evaluation for 2015 shows a total of 35,325 physicians, with 8328 specialists for General Internal Medicine (Hostettler & Kraft, 2016) , followed by the specialists for psychiatry and psychotherapy. The same applies to Austria, in 2015, the internists made up the largest specialist medical group with 4204 members. The total number of physicians the same year was 44,002 (Statistik Austria, 2016a) . Thus, the physicians specialized in internal medicine represent the largest group with a specialisation in Germany, Switzerland and Austria.

The main reason why internists make up the largest specialist medical group is due to the increase in life expectancy. The share of older citizens with care needs in the field of internal medicine has grown substantially as a result of the generally increasing life expectancy (Sieber, 2007, Statistisches Bundesamt, 2015) . Furthermore, early diagnosis and long-term therapy of chronic diseases, as well as current surgical therapy options often require life-long aftercare (such as type I diabetes mellitus) (Orchard et al., 2015) .

A parallel phenomenon is the deficit of physicians due to the migration movements within the specialist groups (BÄK, 2015, Schmidt & Gresser, 2014) . Migration movements to Germany, especially from Austria, have been documented (in 2015, 2573 doctors moved to Germany from Austria (BÄK, 2016a) ) and Eastern European countries, with a negative migration balance for Germany (Schmidt, 2014; Wismar et al., 2011) . At the same time, there is a movement of physicians from Germany to Switzerland (in 2015: 629 Germany doctors moved to Switzerland, in contrast to 252 physicians from Switzerland to Germany). Austria is in second place (in 2015: 264 doctors moved to Switzerland) (BFS, 2015, BAG, 2016a) . In Switzerland, German physicians are the highly represented group of foreign physicians (Statista, 2016b) .

The preceding data thus show the intensive transfer of doctors between the three countries.

This raises the question whether the commonly used term “internist” or “specialist physician for internal medicine” in the three countries under consideration is based on the same or equivalent education, in particular regarding the quality standards. Can patients and employers rely on the fact that the physician trained abroad can meet the qualifications required in the target country?

The results section starts with a comparison of the exchange of physicians between the three reviewed countries. Then, the organisation of the medical profession in the three countries and the access requirements for the specialist medical training are shortly summarized. More focus has been put on the structure and content of the specialist’s training as well as on the requirements for keeping the specialist’s name. The main and most relevant commonalities and differences in the specialist’s training in internal medicine are then emphasized in the discussion section. The conclusions section gives then a short summary of the most important insights and a prospect of the situation.

In Germany, the number of working physicians has risen by 21.1% from 306,400 (BÄK, 2005) to 371,302 (BÄK, 2016a) between 2005 and 2015. Nevertheless, one speaks generally of a medical deficit (Adler and Knesebeck, 2011, Stackelberg, 2010) .

For German physicians, Switzerland is followed by Austria as the most popular migrant countries (BÄK, 2016a; Kopetsch, 2010, Statistisches Bundesamt, 2011) . In 2014 and 2015, respectively, 285 and 264 German physicians (BÄK, 2016a) migrated to Austria. In 2014 and 2015, 629 German physicians migrated to Switzerland (BÄK, 2016a) .

In Germany, emigration is caused by unsatisfactory working conditions both in the inpatient as well as in the outpatient sector (van den Bussche et al., 2012) .

In Austria, the main reasons for emigration are long working hours, low wages compared to neighbouring countries and deficits in medical education (Scharer and Freitag, 2015; Wismar et al., 2011) .

The highest exchange is with the neighbouring countries. Germany and Switzerland are the most popular migrant countries of the Austrian medical community (Wismar et al., 2011; Zimmermann and Purger, 2015) . This is justified by the common language (Wismar et al., 2011) .

Switzerland is a country of immigration for physicians (Jaccard Ruedin & Widmer, 2010) . The number of doctors in Switzerland is assured by feminization and immigration (Kraft and Hersperger, 2011) . Nevertheless, there is a shortage of doctors in Switzerland, since the number of doctors trained in Switzerland does not cover the needs (Kraft and Hersperger, 2011) .

In 2014, 17% of physicians working in Switzerland had a German degree (Hammer, 2015; Statista, 2016b) . In 2015 it was already 17.7% (Hostettler & Kraft, 2016) .

The same language (at least for the German-speaking part of Switzerland), higher salaries and better health system conditions compared to Germany are cited as reasons for their relocation (Bundesrat, 2011) .

The migration movement in the countries of Germany, Austria and Switzerland therefore differs significantly. For Germany, emigration is predominant over immigration (BÄK, 2016a; BÄK, 2015; BÄK, 2014a; BÄK, 2013a; BÄK, 2012; BÄK, 2011a; Wismar et al., 2011) . In Austria, emigration and immigration are largely balanced (Wismar et al., 2011) . Switzerland shows a positive immigration balance (BAG, 2016a; Hostettler & Kraft, 2016) .

In Germany, the medical profession is organized in the Federal chamber of physicians as well as the corresponding 17 provincial chambers (BÄK, 2014b) . The provincial chambers are subdivided hierarchically into district and circuit associations. The membership in the regional chamber of physicians and the district chamber is obligatory for every physician active in Germany and is regulated in the Heilberufe-Kammergesetz (HKaG, 2002) of the respective federal state. This obligatory membership leads to the indirect membership of every physician working in Germany to the Federal chamber of physicians (BÄK, 2016b) by means of the affiliation of the regional chambers. The chamber of physicians is also responsible for the continuing medical education (HKaG, 2002) .

The medical profession in Austria is organized in the Austrian medical association (ÖÄK, 2016a) . As an umbrella association, all nine provincial chambers are members of the Austrian chamber of physicians (ÖÄK, 2016a) . Doctors are, by law, members of the medical chamber responsible for them (ÄrzteG, 1998) . The Austrian Chamber of Physicians is also responsible for further training as a specialist (ÄrzteG, 1998; ÖÄK, 2015a) .

The central body of the medical profession in Switzerland is the Swiss medical association “Foederatio Medicorum Helveticorum”, FMH (FMH, 2016a) . All cantonal and specialist medical societies (FMH, 1998) are organized in the FMH. In order to become a member of the FMH, a federal or equivalent medical diploma (FMH, 1998) is required. The membership is not mandatory per se, but is required to carry an FMH specialist medicine title earned in Switzerland (FMH 1998). The legal provisions for the acquisition of a specialist doctor’s title are laid down in the training regulations (SIWF FMH ISFM, 2002a) , for which the FMH is responsible (FMH, 1998) .

Table 1 summarizes the essential information on the organization of the profession in Germany, Austria and Switzerland.

In Germany, training to become a specialist can only be started after the suc-