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 third part of a four-part series on the Ultimate Guide to Practicing Medicine in the Netherlands. Part 1 introduced the Dutch Health Care System and Part 2 outlined the process for medical registration in the Netherlands (BIG-registration). This post is all about specialty medical recognition in the Netherlands, including total costs of the medical registration process and strategies on finding a job.
Specialty Medical Recognition
For specialty medical recognition in the Netherlands, you must apply to the Registratiecommissie Geneeskundig Specialisten (RGS, or the Medical Registration Specialty Commission), which is a part of the Koninklijke Nederlandsche Maatschappij tot bevordering der Geneeskunst (KNMG). There’s a complete guide on the RGS website, with an English and Dutch version.
When you apply for medical registration (BIG-registration), you’ll have already submitted information about your specialty training and also probably checked a box on that application to indicate your intent to later apply for specialty recognition. If you checked this box, the CIBG will automatically send that part of your dossier to the RGS. The RGS will then contact you about any missing information for your specialty recognition and the timeline for submission. They adhere strictly to these deadlines, so if you need more time, you should request an extension as soon as possible.
In terms of the timing for the RGS application, I’ve heard other specialists apply for specialty recognition in parallel with the BIG-registration application. It doesn’t necessarily expedite the overall process, although might offer a little bit of clarity, if you need it, regarding whether more specialty work under clinical supervision might be needed after you obtain your BIG-registration number. But it’s not a guarantee that you’ll get that added clarity, since this process depends in part on which specialty you have.
There is one unique consideration regarding specialty recognition in The Netherlands, which unfortunately will be determined on a specialty-by-specialty basis: Directive 2005/36/EC of the European Parliament on recognition of professional qualifications. In brief, this directive indicates the minimum necessary number of years of specialty training for a medical doctor to have completed in certain specialties in order to receive at least some recognition of their training. For example, for Internal Medicine specialists, the RGS recognizes 5 years of training; this (probably) works fine for U.S.-trained subspecialists who have completed 3-year Internal Medicine residency plus 2 or more years of subspecialty training. But it may not be enough for a U.S. General Internal Medicine physician. That said there is a lot of nuance and interpretation involved.
Total Costs of Medical Registration
First off, time is a cost. Committing to this entire process, preparing for and taking the exams, is equivalent to having at least a part-time job.
Then, finances are a cost, both direct and indirect costs. For MD recognition and becoming a basisarts (a non-specialty trained physician), the estimated cost is about €5000. For specialty recognition, add at least another €600 for the RGS application fees (check the website for the current application fee, which may change). There are additional costs for obtaining original notarized documentation and paying for postage and other related expenses that are required throughout the registration process.
Finding a Job
Getting a job as a basisarts (i.e. when you have your unrestricted BIG-registration number) can mean working as an arts niet in opleiding tot specialist (ANIOS, or physician not training towards becoming a specialist) in the Netherlands might not be too difficult. But keep in mind that an ANIOS always works under the supervision of a registered specialist. Depending on the job, it might be a lot like resident work; Dutch nationals or non-Dutch physicians seeking recognition who are ANIOS often use the role as a stepping stone towards a specialty residency training spot, or arts in opleiding tot specialist (AIOS, or physician in training towards becoming a specialist). Also, not all ANIOS jobs are clinical; some involve research or other activities, but all are salaried. As a basisarts it is possible to work in the GGZ as a municipal health physician, in an outpatient or inpatient setting within a particular specialty team, but you can not work completely independently.
In general, Linkedin is a popular way for professionals to engage in the Dutch labor market, so having an updated profile and connecting with others and following companies that have a Dutch presence can be helpful. Aside from the traditional clinical pathway, non-clinical work in the Netherlands at any stage is always a consideration. For example, non-clinical work that could still be possible as a physician at any stage, with or without registration locally, could include working for a pharmaceutical company, health insurance company, or a health technology or health information technology vendor. While many of these positions might not require having recognition as a basisarts or even a specialist in the Netherlands (i.e. your existing U.S. credentials could be enough), they do typically still require Dutch language fluency. Being a non-clinical physician in the Netherlands is common in the Netherlands.
I’ve also seen job vacancies once in a while for basisarts to work for travel companies, like KLM (Royal Dutch Airlines), at the airport. You can also browse listed vacancies at Medisch Contact, scout ANIOS vacancies or specialist vacancies (with corresponding Dutch registration) at one of the eight Dutch academic medical centers, or search for vacancies in your specialty at each academic hospital or non-academic hospital. If you have aspirations to work as an academic physician (clinical or non-clinical) in The Netherlands, for example, as a clinician-researcher or clinician-educator, having a PhD is virtually mandatory. If you don’t have one, there are pathways to obtaining one, which is another conversation that we can have in another blog post!
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.