Living among tulips, canals, cheese, and a thriving coffee culture might be appealing to many American-trained physicians looking for a modern society with cultural and historical significance. That said, the medical licensure process in the Netherlands is long for physicians with a medical degree from a non-EU/non-EEA country.
Dutch Medical Recognition
There is no automatic recognition of foreign medical training in The Netherlands, even if you have an EU/EEA medical degree, know professional-level Dutch, and can prove it by passing an official Dutch language exam. The typical time frame to complete the registration process is 3–6 years, with a probable median between 4–5 years, including learning the language. This timeframe could be shorter if you already speak Dutch fluently (even conversationally), speak another Germanic language as the grammar may be similar, have a taalknop or a tendency to learn languages quickly, do well on exams, and have the required time for clinical supervision.
There is no reported average timeframe, so this information is anecdotal and based on informal conversations with other buitenlandse artsen, or foreign physicians, going through this process.
The CIBG is the governing body which regulates and administers the medical licensure process. You can check your eligibility requirements here. This is the application procedure for the Verklaring van Vakbekwaamheid, or the Certificate of Competence (i.e. MD recognition); I’ll refer to this as BIG-registratie, or BIG-registration, from now on.
Below, I outline the 8 steps to obtaining a Dutch Medical License for an American doctor.
Step 1: Master the Dutch Language
Let’s start with language. Learning Dutch is essential and non-negotiable in the Netherlands for treating patients in clinical practice. You are expected to have a CEFR C1 level of proficiency in the Dutch language; this is equivalent to professional level language proficiency. If you’re looking for study materials to get an idea of the level of language proficiency you need, check out Hoe Zit Het Met Staan and Volksgezondheid en Gezondheidszorg.
Step 2: Apply for MD Professional Recognition
Gather the necessary medical training documents and complete an application for MD professional recognition. Begin the process in the U.S. if possible, as it is much easier to notarize, mail, receive, and coordinate documentation from training programs (medical school, residency, and, if applicable, fellowships) and prior employers. It can take months to officially document your entire training and work history for the application. Translation from English to Dutch is not required. There are additional documents that would also need to be notarized or verified in the Netherlands. Gathering documents while simultaneously learning Dutch will save you time.
Step 3: Pass the AKV Language Exam
Once you submit your BIG-register application and address any clarifications, you will be invited to take the AKV language exam (Algemene kennis- en vaardighedentoets).
The AKV evaluates professional level language competency in Dutch and English (reading, writing, listening comprehension, and oral communication), and your knowledge of the Dutch Healthcare System. The AKV comprises 4 parts spread over two separate test sessions.
Test Session 1
- Part A: Includes reading comprehension and then a written summary about a news type article about a medical topic, then preparing and giving a short presentation with time for Q&A. This is in Dutch.
- Part B: Includes taking a history from a standardized patient then writing the HPI. It does not include a physical exam. This is in Dutch.
Test Session 2
- Part C: Includes an English-language test. This is the only English-language component of the entire process.
- Part D: Complete a multiple-choice exam about the Dutch public health and healthcare system. This is in Dutch.
If you do not pass all 4 parts, it is possible to retake parts of the exam (i.e. part A+B or part C+D only), but to a certain limit. Many people prepare for this exam with a paid test preparation course, or by practicing some of the skills with a language teacher, or with a study buddy.
Step 4: Pass the BI Medical Exams
After passing the AKV exam, you have typically up to one year to take the BI exams (beroepsinhoudelijke toets). This is a set of three exams, the DKV, the VGT, and the DKK to assess basic medical knowledge and clinical skills. Most people take at least 6 months to prepare for these exams, although this might vary depending on how fresh your medical school knowledge is, and how subspecialized you might already be. These exams are offered in “rounds” spanning a 6-week period during which you take the three exams. Each year, about three rounds are usually scheduled.
Here’s a quick rundown of each of these full day exams, along with my opinion on U.S. equivalency:
DKV (Deeltoets Klinische Vaardigheden): Similar to USMLE Step 2CS*
iVGT (Interuniversitaire voortgangstoets): Similar to USMLE Step 1
DKK (Deeltoets Klinische Kennis): Similar to USMLE Step 3
* USMLE Step 2CS is discontinued in the U.S., however, I doubt this will occur in the Netherlands.
Step 5: Post-Assessment Interview
After taking all the BI exams, take a vacation! There is a waiting period of 2–3 months to have a “post-exam interview.” I had a less-than-five minute phone call during the COVID-19 pandemic. During this conversation, they will assess a few items:
Duration: They will determine how many months of clinical work under supervision you are expected to do (3 months is the absolute minimum).
Type of Clinical Experience: They will determine the type of training you might need during clinical supervision. For example, it could be clinical work in any setting at your own discretion for the specified number of months. In this case, your work is similar to that of a U.S. PGY-1. Or, the determination might require doing a coschap, or Dutch internship, in which you are expected to follow a more extended number of months of medical education like a medical student; in this case your work is like a compressed version of the U.S. years as MS-3, MS-4, and PGY-1.
Exam Results: They will provide an electronic copy of the exam results, including detailed skills and knowledge reports by discipline or subject.
Determination and Forms: They will send an electronic copy of your determination and the forms needing completion at the end of supervision.
Step 6: Apply for a BIG-registration Number
For clinical work under supervison, you must have a geclausuleerde BIG-nummer, or a restricted BIG-registration number. The application is similar to the CIBG application from Step 2, though it is shorter, and is likely faster to complete. Processing this application can take up to eight weeks.
Having an unrestricted BIG-register number as a health professional is the Dutch equivalent of having a license to practice; but there’s an important distinction here in contrast to the U.S. medical licensing system. That is, to be an independently practicing physician, you must also be in the Dutch Specialty Register. More on Specialty Registration in the next blog post.
Step 7: Arrange Your Clinical Supervision or Coschap
While waiting for the BIG-register to issue you a number, if you haven’t already found a place to do the clinical work under supervision, don’t wait – start looking and asking around! Do not fear cold emailing, cold calling, and asking both Dutch and non-Dutch physicians at any stage. The work does not have to be at an academic medical center. It does have to be under the supervision of a registered, independently practicing physician who will take their supervisory role seriously, and sponsor your way through by filling out your evaluation form.
Step 8: Get an Unrestricted BIG-registration Number
After you fulfill the clinical requirements set out by your determination from Step 5, complete the necessary forms to obtain your ongeclausuleerde BIG-nummer!
Congratulations!!! You are officially a Dutch doctor (basisarts)! You are also joining a rare breed of North American physicians. According to an article from the Dutch Journal of Medicine only three North Americans (including U.S. and Canada) out of 176 physicians completed the MD recognition procedure in its entirety from 2005-2015!
Bottom Line
I admittedly had a much rosier (and incomplete) view on Dutch professional recognition when I first wrote about it in 2018. As of this writing, I finished my 3-month period of clinical supervision with a geclausuleerde BIG-nummer and submitted my supervisor’s attestation of completion and evaluation. I also applied for specialty recognition in Internal Medicine through the RGS and am awaiting their reply. There’s a whole other sequel to this story regarding this part of the professional recognition process (more to come on Specialty Recognition in a later post).
The road is long, slow, and hard, and I think made partially so because I’m still relatively early in my medical career: I don’t have an international reputation that can sometimes make it easier to obtain sponsorship to continue similar work in a different country. That said even that is not a guarantee as I learned from an experienced clinician-educator and mentor who sought recognition in Australia. Yet, there is absolutely no other personal or professional development and growth experience like this.
I committed myself to this journey just over four years ago – and I’m determined, quite stubbornly, to finish it. One could say I’ve put too much effort into this to quit now. But the journey has been self-defining: I have learned so much more about myself as a person and professional and am grateful for the many opportunities to be challenged and to keep on growing. I’m also grateful for the many sponsors and mentors, whether Dutch, American, and from many other global regions, who have helped me at various points along this very unusual professional journey!
Have you begun or achieved physician professional recognition in more than one country? Participate in an anonymous survey of physician-migrants! The survey aim is to understand the unique experiences, challenges, and learnings acquired in relation to migration. The first page of the survey link provides eligibility criteria and consent information for this anonymous survey.
Tiffany I. Leung, MD, MPH, FACP, FAMIA, FEFIM is a U.S.-trained Internal Medicine physician and Assistant Professor at the Faculty of Health, Medicine and Life Sciences and PhD candidate at the Care and Public Health Research Institute at Maastricht University in The Netherlands. Her PhD work focuses on understanding and mitigating job distress among physicians especially when healthcare systems undergo redesign.
She has a special interest in physician suicide prevention, and promotion of physician well-being, gender equity, and diversity and inclusion in medicine. She is Co-executive Producer of The DEI Shift, a podcast promoting diversity, equity, and inclusion in medicine, and Editor-in-Chief of the Society of General Internal Medicine’s official newsletter SGIM Forum. Read more about Dr. Leung’s work on her website, find her on Twitter and Instagram @TLeungMD, and learn more about her experience with the Dutch Healthcare System. She has an active state medical license in the U.S. and maintains U.S. board certifications in both Internal Medicine and Clinical Informatics.
