While Europe's financial crisis has thrown millions out of work, mostly in Spain, Italy and Greece, Germany faces a drastic labour shortage because of its aging workforce and one of the European Union's lowest birth rates.

Immigration may be the only hope, according to a recent report by the Organization for Economic Co-operation and Development (OECD).

"If Germany doesn’t tackle [the problem] in the right way … there would be a negative impact on not only the potential growth but the real economic growth," OECD Deputy Secretary General Yves Leterme says, adding Australia, Denmark and Britain hire five times as many immigrants.

Germany is also not as attractive a destination as English-speaking countries such as United States, Canada or Britain, partly because of the German language.

As well, people who have mid-level training such as plumbers, nurses and electricians aren't taken into account by current immigration policies.

"This is a particular problem for small and medium-sized companies that are already suffering acutely from a lack of qualified workers," Leterme said

On the move

Of course, there are people moving to Germany from some of the southern and eastern European countries, looking for economic opportunity and a chance for a better life.

When Dr. Antoaneta Pana finished her radiology degree in Romania last year, she left her family, friends and familiar life —and moved to Freiburg.

"I first came as a tourist. I came in Bavaria, Munich, I fell in love," she told CBC News in halting English.

"I come back to home and started to learn German. After a year, when I started to find a job, I had a big surprise. (There are) no jobs for younger doctors in Romania. So I think, why not in Germany?"

Pana is one of a handful of students in a new course for physicians that the German-language school, the Goethe Institute, is piloting in Freiburg.

CBC in Berlin Karen Pauls is in Berlin to enhance CBC's European coverage at a time when the continent is struggling through one of the most unpredictable periods in recent history. Germany's prosperity is being closely watched as the ongoing fiscal crisis puts the European Union under great strain. Pauls has covered national affairs in Canada for CBC Radio, and was previously posted in London, U.K., and Washington, D.C. Follow her on Twitter @karenpaulscbc.

After an eight-month general language program, they get one month of intensive classes focusing on medical terminology and the German medical system.

A second month in a university-based medical clinic gives them practice doing examinations, making diagnoses and giving bad news to patients — all in German.

"This helps the students feel more confident in the clinic," Goethe Institute director Angelika Ridder said.

The institute hopes to bring this co-operative program to other cities with medical schools. Part of the problem for newcomers is that each state has different systems and eligibility rules, making mobility within Germany complicated.

"The idea is to equalize the standards across different states," Ridder said.

"If Germany looks for people to come, they need a simple, understandable system. They need a clear line for success in the end. If (the government) did that, they would have more people interested."

As she struggles to learn the German words for appendicitis, pancreas, and other medical terms, Pana hopes it will be all worth it in a few months.

"I look for a job and I think two companies answer me," she said. "I have promises. Now I’m here and for future I want a good job and family. All this effort, a good job and a good life."

That’s exactly the message the German government must send in order to attract skilled workers from both European Union countries and abroad.

"Before, it was not possible to come to Germany from countries outside of the EU, as a skilled worker," Germany’s Labour Minister Ursula von der Leyen told a news conference in Berlin last week.

"There was merely an agreement with Croatia for nurses and hospital staff, that's it. Besides that, the German job market was basically closed.

"A change of attitude in Germany is becoming evident …. We don't ask where someone comes from, but we ask what he or she can do, and whether he or she moves our country forward. That is crucial."

Last year, Germany introduced the Blue Card to make it easier for skilled workers to take jobs in Germany. The card also makes it easier to get a residency permit.

There are also new programs aimed at university students from overseas to help them stay and work in Germany after graduation, and the Bundestag will soon vote to approve an employment list that would match job shortages with skilled workers from other countries.

Still, von der Leyen concedes, more needs to be done to fill 850,000 vacant positions, from nurses and train operators to plumbers and electricians.

"Now, we want to reorganize this, by mainly moving from this defensive and dismissive stance to a clear and offensive stance, that shows who we need, and that they are wholeheartedly welcome," she said.

"Even when the legal framework is adjusted and modernized, and more flexible, the most important factor is available information about it, so that those who are searching, whether it's businesses, or individuals seeking work, know of one another, and also know how low the hurdles are, as well as guidelines with which immigrants would be able to find appropriate jobs."

Retention a challenge

Recruiting is one problem — but so is the issue of retaining foreign workers.

Across the country in Potsdam, Dr. Sotiria Theodosiadi is halfway through her specialty training in plastic surgery at a medical centre there.

She moved to Germany from Greece two years ago when she discovered she would not be able to start her specialization there until 2019.

The economic crisis there has meant the government is unable to create more training spaces or jobs for new graduates.

At the same time, Theodosiadi heard Germany needs 11,000 doctors.

"For me, staying in Greece was a dead end," she told CBC News during a break between surgeries.

"I had two opportunities to work in Greece in a private practice, a clinic for plastic surgery, but waiting for 2019 was out of the question. I had an opportunity to get well-paid but not get me closer to my specialization, and doing the hard work I’m doing now in 10 years, I don’t know if I have the patience to do that. … Also, my salary here is two or three times my salary in Greece."

Theodosiadi plans to stay in Germany when she is finished her training, but she admits she misses her friends and family — and the sea and sun of her homeland.

She sometimes dreams of moving back to Greece, but doesn’t know if that will ever be possible.

"I am happy with my work and I think I’m getting further, but I cannot know what’s going to happen in three or five or 13 years. I can’t know what the financial situation in Europe is going to be in three months. How can I guess what my future will be?"

If Germany wants to secure its own economic future, it will need to provide answers to questions like that.