As a rule, anyone who wants to practice medicine in Germany needs the Approbation, the state license. Only a person with this license, or with a special permit, may use the professional title Arzt or Ärztin. The license requires a medical degree of at least 5,500 hours over at least six years. It also requires that the person has not behaved in a way that shows them to be unworthy of the profession or unreliable in it. If that condition lapses later, the license must be withdrawn.