Main content
The assessment procedure
Physicians who have done their training outside the European Economic Area and have a permanent residence permit in the Netherlands are required to go through a so-called assessment procedure. If they complete this procedure successfully, they can register themselves in the BIG (Professions in Individual Healthcare) register. Without a registration in the BIG register, it is forbidden and a criminal offence to work as a physician. The assessment procedure was introduced in 2005 and comprises two parts. The first part consists of language exams (in Dutch and English reading comprehension) and two subtests: clinical knowledge and clinical skills. The Committee on Foreign Public Health Graduates (CBGV), an agency of the Ministry of Health, Welfare and Sport, is responsible for implementing the assessment procedure. The language component exams are outsourced to various language institutes to increase freedom of choice. The clinical knowledge exam is outsourced to UMC Maastricht, and the clinical skills exam to Radboud UMC Nijmegen.
Obstacles lead to dropouts
Major obstacles have become visible since the introduction of the assessment procedure. Without the target group being aware of it, the language exam was much more difficult than in the previous years. In addition, during information sessions organised by the Committee on Foreign Public Health Graduates (CBGV), participants were told that a successful completion of the State Exam in Dutch as a Second Language was not required. That completely threw off many of the participants. During the first years of the assessment procedure, many participants dropped out. The Foundation for Refugee Students (UAF) published an article on this topic in Medisch Contact. [1] Information about suitable language institutes was also not available, as government institutions are not allowed to advertise. Foreign physicians without any knowledge of the ‘Nt2-jungle’ (Dutch as a second language) [2] were on their own when it came to finding suitable institutes. Making the wrong start could easily cost a year and lead to major expenses. The CBGV did not publish any annual reports, which meant that no official data was available on successful and unsuccessful participation. Parliamentary questions from D’66 in 2010 resulted in the then Minister of Health Welfare and Sport ordering annual reports to be published starting in 2010. The first CBGV annual report revealed that the number of foreign physicians successfully completing the assessment procedure had dramatically declined in comparison to the numbers prior to the assessment procedure. From 2005 up to and including 2010, 41 foreign physicians (an average of 8 per year) were admitted to the final part of the medical training programme (years 5 and 6). In contrast, from 2000 up to and including 2004, i.e. before the introduction of the assessment procedure, more than 100 foreign physicians were admitted per year.[3]
A number of foreign physicians successfully started an initiative to establish an association so that following generations would be better prepared to participate in the assessment procedure. In 2015, the Association of Foreign Public Health Graduates (VBGA) was established. The founders came from all parts of the world. They wished to ensure that foreign physicians who came to the Netherlands after them would not have to go through the same traumatic experiences. The VBGA provided information about the procedure and was available for personal advice as well as advice on suitable language institutes. The VBGA also organised workshops to prepare for the clinical skills exam. The VBGA actually did everything that the government could have done but failed to do.
The CBGV advised candidates against preparing for the clinical knowledge exam. As a result, physicians who had not had any practical experience for some length of time scored poorly on the clinical knowledge exam, which meant that they once again had to register as medical students. Of course, this resulted in delays and higher costs. The VBGA argued against the advice of the CBGV and pointed to the Compendium of Medicine [4], with which foreign physicians could prepare themselves for the clinical knowledge exam. After this, the scores improved dramatically. At present, almost 80% of all foreign physicians obtain the highest possible score, which means that they need only to work for three months under the supervision of a Dutch physician, without having to register as a medical student.
A new obstacle: 22 months waiting time between the Clinical Knowledge subtest and the Clinical Skills subtest
This new obstacle appeared in 2005 when it became clear that there was a capacity problem in providing the clinical skills subtest (part 2 of the assessment procedure).[5] At the request of the CBGV, this part is organised by Radboud UMC Nijmegen. The number of exam opportunities is limited, resulting in a waiting time of 22 months before the assessment procedure can be completed. During this waiting period, these foreign physicians are not registered in the BIG register, cannot work as physicians, and can encounter problems with government agencies responsible for granting benefits and social assistance. During this waiting period, their command of the Dutch language can also deteriorate. Finally, the inability to practice their profession can lead to psychological problems.
An appeal to the Dutch government to organise more exam opportunities at Radboud UMC or another university medical centre has not yet had any success. For 20 years and counting, foreign physicians with permanent residency status in the Netherlands have been on the losing end. As soon as one obstacle is removed, a new obstacle arises. The medical sector is coming under increasing pressure, but the potential available in the form of foreign physicians is apparently being given very little priority.
References
- Veltman P, Both J (2020) Gevluchte arts botst op procedures (Refugee physicians blocked by procedures). Medisch Contact. 2010; 66:432-4.
- The term “Nt2-jungle” refers to the enormous growth of language institutes starting in 2000. To accelerate the integration of migrants into Dutch society, the government encouraged them to follow language courses in Dutch as a second language (Nt2). Municipalities provide funds for that purpose to such migrants. This led to the establishment of new language institutes. Unfortunately, little attention was paid to the quality of the Nt2 training courses provided by these institutes. Traditionally, foreign physicians were best served by university language institutes, but many such foreign physicians were not referred to these specialised institutes.
- Herfs PGP (2013). The assessment procedure for foreign physicians: a review after 7 years. Utrecht. ERCOMER, Utrecht University
- Snijders R, Smit V (2026). Compendium of Medicine. Rotterdam
- Chernova V, Herfs PGP (2025) Waiting times for the Professional Competency Exam for physicians with a foreign diploma. Asiel- en Migrantenrecht (Asylum and Migrant Law) 2025; 26 (5/6): 309-12.
