A guide for non-EU/EEA doctors: how to practice medicine in the Netherlands

The BIG register: your Dutch license to practice

Function and purpose

The BIG register is the cornerstone of medical regulation in the Netherlands. It’s a legally mandated, public online database of healthcare professionals, governed by the BIG Act (Wet BIG). Registration in this database is the Dutch equivalent of a state license to practice medicine.

Protected titles and reserved procedures

Only professionals registered in the BIG register are entitled to use a protected professional title, such as arts (physician or doctor), and to independently perform «reserved medical procedures» (voorbehouden handelingen). These include invasive procedures like injections, surgical interventions, and other actions that carry inherent risks for the patient.

Oversight and accountability

All registered professionals are subject to Dutch disciplinary law, which protects patients from malpractice and incompetence. Registration is not permanent; it must be renewed every five years based on criteria of ongoing professional experience or continuing education.

The recognition process for non-EU/EEA diplomas

For doctors who earned their degree outside the European Union (EU) or European Economic Area (EEA), the path to BIG registration is complex and lengthy. It requires obtaining a «Certificate of Professional Competence» (Verklaring van Vakbekwaamheid).

The 9-step procedure

The official procedure established by the BIG register consists of nine sequential steps:

Preparation: Gather all necessary documents and begin learning Dutch.
Application: Register and start your online application on the mijn.bigregister.nl portal.
Form completion: Enter all required information, including profession-specific forms.
Document submission: Upload digital copies and mail original or certified copies of your documents.
Diploma evaluation: Your diploma will be assessed by organizations like Nuffic or SBB on behalf of the BIG register.
Professional knowledge test (BI-test): A mandatory exam for doctors, dentists, and nurses that assesses professional knowledge and skills.
Commission assessment (CBGV): The independent Commission for Foreign Healthcare Graduates reviews your entire application and test results.
Decision: You will receive a preliminary and then a final decision on your application.
Certificate issuance: Upon a positive decision, you will be issued the Certificate of Professional Competence.

The BI-test bottleneck

One of the most significant hurdles is the BI-test. Due to high demand and limited capacity, the waiting list for this exam can be extremely long. According to recent information, registration for the test for the current and upcoming year was closed, creating a delay that can exceed two years. This waiting period often becomes the longest part of the entire process.

Clinical internships

Even after passing the tests, the CBGV commission may determine that a candidate has gaps in their knowledge or practical experience compared to Dutch standards. If this happens, you will be required to complete supplementary clinical internships (coschappen). University medical centers, such as Erasmus MC in Rotterdam, offer a limited number of these placements for foreign doctors each year.

Realistic timeline

The officially stated processing time for an application is between 6 and 18 months. However, this estimate does not include the time required for preparation and, crucially, the multi-year wait for the BI-test. A realistic timeframe for a non-EU doctor to achieve full BIG registration is not 1.5 years but rather 3 to 5 years. This has significant financial and personal implications.

Table 1: Document checklist for the Certificate of Competence and BIG registration (for non-EU doctors).

Document	Key Requirements	Issuing Authority
Medical Diploma	Original or certified copy; translation	University
Diploma Transcript	Original or certified copy; translation	University
Curriculum/Syllabus	Original/certified copy; must contain your full name and years of study; translation	University
Valid Passport/ID	Clear copy	Government Authorities
Certificate of Good Standing	Not older than 3 months; from the country of your diploma and any country where you worked >3 months	Medical Council/Regulator
Police Clearance Certificate	Not older than 3 months; from the country of your diploma and any country where you lived >3 months	Ministry of Justice/Internal Affairs
Dutch Language Certificate	B2+ level; not older than 2 years	Language Center / Examination Board
Curriculum Vitae (CV)	In Dutch or English; detailed history of education and experience	Candidate
Proof of Work Experience	Official letters from employers detailing your role and period of employment	Employers
Specialist Diploma (if applicable)	Original or certified copy; translation	Educational Institution/Authority

Mastering the language of healthcare: Dutch level B2+

Proficiency in the Dutch language is an absolute, non-negotiable requirement for practicing medicine in the Netherlands.

The B2+ level requirement

For academic professions, including doctors, a heightened language standard is required: level B2+. It requires not only fluency in everyday conversation but also the ability to confidently discuss complex professional topics, understand subtle nuances, and maintain accurate medical records.

Recognized certificates

The language test must evaluate all four skills: reading, writing, listening, and speaking. The certificate submitted to the BIG register cannot be more than two years old at the time of your application. Reaching this level demands significant time and effort, so a candidate should plan for at least 1-2 years of intensive language study.

Recognition of your medical specialty

Obtaining BIG registration as a basisarts (foundational doctor) is just the first step. To work as a specialist, you must undergo a separate recognition process.

A separate process

The recognition of a foreign medical specialization is handled by the Medical Specialists Registration Committee (RGS), which is part of the Royal Dutch Medical Association (KNMG). This process is entirely independent of the BIG register.

Combined application

Although they are two different procedures, you can indicate your intent to seek specialist recognition when you first apply to the BIG register.

RGS assessment

The RGS committee conducts a detailed evaluation of your foreign specialty training program, comparing it to Dutch standards by assessing the duration, curriculum, and clinical experience.

A mandatory prerequisite

Registration in the BIG register as a physician (arts) is a mandatory prerequisite for obtaining registration as a medical specialist.

Career paths: ANIOS, AIOS, and medical specialist roles

After registering as a basisarts, a doctor can choose from several career paths.
ANIOS (Arts Niet in Opleiding tot Specialist): A doctor who is not in a formal specialty training program. This is the most common starting position for new medical graduates and newly registered foreign doctors. Working as an ANIOS provides valuable clinical experience essential for a residency position.
AIOS (Arts in Ooleiding tot Specialist): A doctor in specialty training (a resident). This is a formal training position with a defined curriculum and rotations. Admission into an AIOS program is highly competitive.
Medical specialist: After completing an AIOS program and registering with the RGS, a doctor gains the status of a medical specialist and can work independently in a hospital, clinic, or private practice.

Medical salary analysis (2025-2027)

Salaries for medical professionals in the Netherlands are primarily regulated by collective labor agreements (CAO).

ANIOS Salary: Typically corresponds to a gross monthly salary ranging from approximately €4,546 to €6,987, depending on experience.
AIOS Salary: The gross monthly salary ranges from €4,450 (no experience) to €5,812 (8+ years of experience).
Medical Specialist Salary: Varies significantly, with a monthly salary range from €7,555 to over €14,219 in the hospital sector.

Table 2: Medical professional salary scales in the Netherlands (Gross Monthly €, 2025-2026).

Role	CAO	Experience Level	Salary (Aug 2025)	Salary (Feb 2026)	Salary (Aug 2026)
ANIOS	Ziekenhuizen (FWG 65)	0-5 years	€4,546 – €6,987	€4,637 – €7,127	€4,730 – €7,269
AIOS	Ziekenhuizen	0 years	€4,450	€4,539	€4,629
AIOS	Ziekenhuizen	4 years	€5,193	€5,297	€5,402
AIOS	Ziekenhuizen	8+ years	€5,812	€5,928	€6,047
Medical Specialist	Ziekenhuizen	Starting	~€7,855	~€8,012	~€8,172
Medical Specialist	Ziekenhuizen	Experienced	>€13,764	>€14,039	>€14,320

Labor market dynamics and future demand

The Dutch healthcare system is facing an acute and worsening staff shortage, creating both challenges and opportunities.

Widespread staff shortages

The number of job vacancies in the sector is at a record high, leading to long waiting lists for patients and increasing the workload for existing staff.

Capaciteitsorgaan forecasts

The Capaciteitsorgaan, a government advisory body, consistently reports a growing demand for specialists. The greatest shortages are in psychiatry, internal medicine, anesthesiology, pediatrics, and radiology.

An aging workforce

In the next decade, 28% of current general practitioners and over 30% of specialists are expected to retire, creating a massive number of job openings.

Alternative career paths

Beyond clinical practice, the Netherlands offers extensive opportunities for doctors in related industries, especially relevant for those navigating the lengthy registration process.

Careers in pharma and HealthTech

The Netherlands is a European hub for major pharmaceutical and technology companies like Philips, MSD, and Bristol Myers Squibb, which actively recruit professionals with medical backgrounds for key roles:
Medical Advisor / Medical Science Liaison (MSL): Serves as a scientific expert, engaging with key opinion leaders and supporting clinical research.
Regulatory Affairs Specialist: Ensures products comply with national and international regulations.
Clinical Research / R&D: Participates in the design, monitoring, and analysis of clinical trials.

The Zoekjaar (search year) visa

The Zoekjaar visa is an invaluable tool for recent international graduates and researchers. It is a one-year residence permit that allows holders to freely look for a job or start a business without needing a separate work permit. For a foreign doctor, this visa can be a game-changer, providing a legal basis to stay in the country while you intensively study Dutch, build your professional network, and secure your first job as your BIG registration is being processed.

Conclusion

The Dutch medical sector offers world-class standards and immense demand, yet access is guarded by formidable barriers. Success demands a long-term, comprehensive strategy.

Recommendations for doctors with foreign qualifications:

Prepare for a marathon: Realistically plan for the entire registration process to take 3 to 5 years. Develop a detailed financial and career plan for this period.
Prioritize language and networking: Make learning Dutch your top priority. Use the Zoekjaar visa or other legal means to be in the country, find related work, and actively build professional connections through observerships (hospiteren).
Adopt a dual-track career strategy: Actively explore opportunities in the pharmaceutical and HealthTech industries. This can provide an income stream during the registration process and may even become a fulfilling alternative career path.

Егор Кугно