The Netherlands has been ranked among the top 5 happiest countries, known for a bike- and family-friendly lifestyle. Understandably, many American-trained physicians would be interested in living here.
This is the last part of a four-part series on the Ultimate Guide to Practicing Medicine in the Netherlands. In the first part, I introduced the Dutch Health Care System; in the second part, I outlined the process to obtaining Medical Registration in the Netherlands, known as the BIG-registration; and in the third part, I offered initial insights into the process of specialty recognition and finding a job. In this final part, let’s talk about Work Culture, Salary, and Immigration.
Dutch Work Culture
In general, Dutch labor laws, which must comply with EU labor laws, are more protective of the individual worker than in the U.S. The principle of solidarity in Dutch culture drives laws ensuring reasonable worker supports and accommodations, such as paid parental leave, sick leave, and vacation. Also, the Netherlands values time off from work. The most generous employers give up to 40 days of vacation per year, in addition to several public holidays, most of which are recognized days off, especially for public institutions.
Dutch work culture often embraces the motto of “leaving work at work,” protecting your personal and family time. Even making a social call or visit to someone’s home during dinnertime without an invitation would go against Dutch cultural and societal norms. Also, spontaneity is definitely not part of the average professional or social norm: you’re most often expected to make appointments for everything (Outlook or Google calendar invitations abound).
One fascinating part of Dutch work culture and support is the specialty of arbeidsgeneeskunde or bedrijfsgeneeskunde, for which the closest American equivalent is Occupational Health. One key difference for this role in The Netherlands is that this type of specialist physician is permitted to evaluate workers for burnout and poor mental well-being. This means that a bedrifsarts, or occupational health physician, can evaluate a worker for mental health conditions just like physical health conditions, and offer recommendations for workplace accommodations that the employer is legally bound to follow to permit a worker to continue their job.
As a general rule of thumb, the salary for a full-time position at a given level of training or specialty is less than the salary you would expect for that same position in the U.S. However, the value of benefits that you gain is likely much higher, considering the leave and occupational health benefits above, along with additional societal benefits. The difference in salary will depend on your degree of specialization, other skills you might offer, and the sector in which you are practicing.
Salaries are always reported as bruto maandsalaris or nettoloon, your take home pay after taxes. A basisarts salary is approximately 3,026-4,749 euro’s per month (post-tax), or about 57,000 euro’s annually, just over $68,000 annually (using a conversation rate 1 euro = $1.20 USD). But keep in mind a basisarts is someone who has graduated medical school and has not completed residency training. You could also see it as postgraduate years of work experience as ANIOS, since such jobs often are gateways for further training as a resident physician, or AIOS. I’ve certainly seen job vacancies that offer a higher monthly salary, but definitely not more than the 5,000-6,000 euro per month range.
For specialists (if you have your RGS recognition as a specialist), salary depends on your work setting (academic or non-academic), years of experience, and academic appointment such as a professor. According to the Dutch Hospitals Association, the 2020 maximum bruto maandsalaris is just above 15,000 euro’s per month (post-tax), or 180,000 euro’s annually, or $215,160 USD (post-tax). This is for a professor-level specialist physician at an academic medical center; unfortunately, I have yet to identify a non-Dutch physician who has such a position.
Medical malpractice as we know it in the U.S. is different in The Netherlands. One law governs the procedures for patient complaints about their care providers, which includes physicians and other clinicians. In the most general terms, this can lead to an investigation and possible fines or other actions that a clinician would be obliged to follow (you can read more about tribunal procedures here). Rarely do complaints go to court for trial; if so, then indeed having beroepsaansprakelijkheidsverzekering (professional liability insurance) is important; this is different from aansprakelijkheidsverzekering voor particulieren (personal liability insurance), which doesn’t even exist in the U.S. For professional liability insurance, while it isn’t a line item on an employment contract, it’s likely to be included as a part of the healthcare employers’ business.
If your primary objective is to have a high salary, moving to the Netherlands and pursuing professional medical recognition is probably not the right fit. The investment of time, money, and effort required to be recognized as a Dutch specialist physician are substantial, so considering other job opportunities might be worthwhile as an alternative.
Your strategy for visa application will depend on your family circumstances (if you have a partner with Dutch or EU/EEA nationality) and personal/professional preference (if you have aspirations to work in academia either as an instructor or researcher, have special additional skills to offer, or might wish to register a Dutch business which may or may not be healthcare related).
One option is to consider applying for an employer-sponsored job where you could receive a visa as a kennismigrant, or knowledge migrant visa. This permits also application, with your prospective employer’s sponsorship, for the 30% tax ruling. This tax ruling offers a variety of benefits, including reducing the tax rate on a portion of your salaried income for five years, and offering you the option for an easy driver’s license exchange (which is very helpful because getting a Dutch driver’s license from scratch is time-consuming and costly), among other benefits. Once you live within 150 km of the borders of The Netherlands, however, your five years of eligibility for this benefit begins counting down regardless of whether you live or work in The Netherlands. Of course, applying for any employed job in advance also offers you something to do in country while you’re completing the (long) recognition procedures.
If you’re moving to The Netherlands “voor de liefde” or “for love,” as the Dutch like to say, then you have other options to be able to apply for a married or unmarried partner visa. For more information on family-related visas (also for children under 18 years of age), check out the official visa information online (in English).
For more information on immigration, you can visit the Holland Expat Center and I Am Expat.
The road to transitioning to the Netherlands is long, slow, and hard. It is best suited for those who are making a permanent move.
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.