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Introduction
Many countries in Europe face aging populations characterised by longer life expectancy and persistently low birth rates, intensifying pressure on already strained healthcare systems. This demographic shift has contributed to significant workforce shortages, which combined with rising care demands have led to longer waiting times and reduced access to services, declining quality of care, increased patient safety risks, and growing pressure on emergency and acute care services.
Amid these challenges, foreign healthcare graduates (FHGs), including international medical graduates (IMGs), represent a critical yet underutilised resource. In many European countries, the healthcare workforce is not fully representative of the increasingly diverse populations it serves, contributing to communication barriers, unequal access, and disparities in patient outcomes.[1] When effectively integrated, FHGs alleviate workforce shortages while contributing to a more representative healthcare workforce. This enriches the linguistic and cultural competence of care teams, thereby improving the trust, access, quality, equity, and overall responsiveness of healthcare delivery.
In the Netherlands, the potential of FHGs remains largely unfulfilled. According to OECD data, in 2021, only 3.6% of all practicing doctors and 1.4% of all practicing nurses in the Netherlands were trained abroad.[2] In contrast, approximately 13% of the Dutch population is foreign born – a discrepancy suggesting a substantial lack of representation of FHGs within the overall healthcare workforce.
At the same time, the country faces a projected shortage of up to 135,000 healthcare workers by 2031 [3], underscoring the urgency of more effective utilisation of internationally trained professionals. In this article, we argue that the Dutch healthcare system and its stakeholders must rethink its approach to FHG integration, highlighting the UMC Utrecht Newcomers module as a promising model for systemic change.[4]
The integration paradox in the Netherlands
Despite a growing number of newcomers with healthcare backgrounds, the Netherlands poses a challenging route for qualification recognition and integration in the Dutch healthcare system. FHGs, both refugee and non-refugee groups, often invest much time and resources into their medical qualification recognition process, besides other challenges they face upon migration and integration. The most common barriers include:
1. Language Barriers
Language proficiency remains one of the most significant obstacles. As insufficient language preparation affects workplace communication, patient interactions, and exam performance, FHGs must progress to B2/C1 level (i.e., advanced‑intermediate language proficiency) in Dutch to be able to work in healthcare, often without subsidised training or structured support.
2. Cultural and systemic differences
The Dutch healthcare system’s emphasis on shared decision-making, flat hierarchies, and the central role of the general practitioner can be unfamiliar to newcomers. Without structured orientation, these differences can lead to misunderstandings, reduced confidence, and slower integration.
Based on early observations within our project, a further challenge is the limited cultural humility among healthcare staff. Many professionals have little experience working with colleagues or patients from different cultural backgrounds. As a result, their expectations of newcomers’ behaviour or communication may not match reality, leading to misunderstandings and slower integration. This aligns with previous research showing that limited cultural humility can hinder effective collaboration in healthcare teams.[5]
3. Credentialing and licensing
The credentialing and licencing procedure (BIG-procedure) to obtain qualification recognition and a medical license for FHGs is widely regarded as complex, costly, and slow. While the assessment procedure aims to guarantee the quality of healthcare providers, the waiting time until the assessment, currently up to 18 months, is frustrating for highly motivated colleagues. There is a risk of facing long periods without access to practical training, creating a paradox where IMGs must prove competence without many opportunities to acquire medical experience.
4. Loss of professional capital
Many FHGs experience a ‘career rewind’ [6] as their professional titles are frequently not fully recognised. For example, recognition as a medical doctor can be obtained, but the trajectory for medical specialist recognition requires following the entire specialisation process again, which is hardly possible in the current medical landscape in the Netherlands, due to a scarcity of medical specialist training opportunities. Career rewind can force FHGs into taking on lower-skilled jobs or working in unrelated sectors. This loss of professional identity contributes to emotional distress and financial instability.
5. Lack of professional networks
The Dutch medical labour market relies on informal networks. The lack of a professional network in the Netherlands is a major hindrance, disproportionately disadvantaging newcomers.
Collectively, these barriers delay workforce entry, limit career progression, and prevent the Dutch healthcare system from leveraging the expertise of highly trained professionals.
Existing initiatives: valuable but fragmented
The Netherlands hosts several valuable initiatives aimed at supporting FHGs — including the ‘University Asylum Fund’ (UAF), ‘BIG Navigator’, ‘Education for You’ (EDU4U), ‘Association of Foreign‑Trained Doctors (Vereniging Buitenlands Gediplomeerde Artsen, VBGA)’ and training programmes like ‘Newcomers in Their Strength’ (‘Nieuwkomers in hun Kracht’), ‘Heart Academy’ (‘Hart academie’) and others. These programmes offer medical training, career coaching, language support, guidance on credential recognition, or support for integration into a specific sector of healthcare like nursing or cardiac sonography.
However, many initiatives are not embedded within the formal training infrastructure of university medical centres. This fragmentation limits scalability, sustainability, and long-term impact. What is needed is a coherent, academically anchored, and clinically integrated national approach.
Best practice in development: The UMC Utrecht Newcomers module
The ‘Newcomers module for introduction to Dutch Healthcare’, developed at UMC Utrecht, represents a significant step towards such an integrated model. [7] It is one of the first programmes embedded within The Utrecht University Medical Centre in collaboration with its two affiliated regional hospitals, Diakonessenhuis and St. Antonius Hospital. The programme has three main components.
1. Dutch language Training
Participants enrol with a required language level of B1 and progress over an intense language training of 4 months to level B2/C1, while learning medical terminology and practicing patient communication. This directly addresses the language barrier and provides a foundation for clinical integration.
2. Introduction to the Dutch healthcare system
This part covers a structured orientation, essential for navigating the cultural and systemic differences that often hinder FHGs, with topics ranging from healthcare culture, professional norms, protocols and guidelines to ethical issues such as end-of-life care.
3. Career orientation and clinical exposure
Participants are offered structured guidance and engage in short workplace observation through job shadowing, networking, personalised career coaching, and exploration of pathways such as further education, employment, or the BIG registration process. This final phase tackles the structural barriers of networking, career mobility, and lack of supervised practice opportunities — issues that existing programmes rarely address comprehensively. It also has team trainings for hospital teams, dealing with intercultural competencies and the integration of FHGs.
Why this model matters
Being embedded in a University Medical Centre ensures academic rigor, clinical relevance, and legitimacy in the eyes of employers and regulators. At the same time, the involvement of regional hospitals ensures a wider range of clinical environments and exposure to a broader, more diverse patient population. This diversity not only enriches the learning experience for newcomers but also strengthens social inclusion and community cohesion within the regional healthcare system. The programme intentionally replaces the term ‘status holders’ with ‘newcomers’, signalling a shift toward inclusion.
A call for systemic change
The Dutch healthcare system cannot afford to overlook the expertise of internationally trained professionals. Workforce shortages are projected to worsen, and demographic pressures will only intensify. To unlock the full potential of FHG integration, the Netherlands must:
- Streamline the BIG-procedure and shorten waitlists for the assessment;
- Expand supervised practice opportunities like the “Working on Commission”, an option that enables FHGs to work in Dutch healthcare without a BIG-registration during their recognition procedure, in which they work under supervision of a BIG-registered doctor; [Reference: BIG‑register. Werken in opdracht Wet BIG [Internet]. Available from: https://www.bigregister.nl/registratie/werken-in-opdracht-wet-big]
- Embed newcomer programmes within all university medical centres;
- Invest in long-term mentorship and career development both by offering opportunities and using existing medical networks
- E.g. the scope and experience of (former) International Health and Tropical Medicine doctors, skilled in international and intercultural competences, could contribute meaningfully to sustainable network creation and a sense of belonging for FHGs*
- Create national standards for bridging programmes.
The UMCU Newcomers module offers a compelling model, but it should be the beginning, not the exception. In parallel, a broader shift in mindset is essential. Both the healthcare sector and the public would need to embrace the professional value that newcomers bring along with the cultural and linguistic diversity that enriches patient care. Without this cultural humility, even the most well‑designed programmes will struggle to reach their full potential.
Choosing the right path forward
Newcomer healthcare professionals bring resilience, expertise, diversity and a strong commitment to patient care. However, without structural support and a cultural shift their potential remains unfulfilled. The UMCU programme is designed to demonstrate that it is possible to remove barriers for newcomers entering the Dutch health care system, opening up new pathways.
If the Netherlands wishes to prioritize its healthcare workforce crisis, it must embrace and expand such initiatives. The future of Dutch healthcare depends not only on training new professionals, but also on welcoming those who arrive with skills, experience, and the determination to contribute.
*Call for support: if you are employed in Dutch healthcare and willing to support foreign graduated colleagues in their integration process in the Netherlands by offering networking, internship, job or other career opportunities, please reach out to the BIG-consultants of the CIBG by sending an e-mail mentioning your availability to: consulentEBD@minvws.nl
References
- https://www.ucdenver.edu/docs/librariesprovider68/default-document-library/jmna-articles-bonuscontent-2.pdf?utm_source=copilot.com en? Gomez LE, Bernet P. Diversity improves performance and outcomes. J Natl Med Assoc. 2019;111(4):383‑392. doi:10.1016/j.jnma.2019.01.006
- Data Explorer – Health Workforce Migration [Internet]. Paris: OECD; [year unknown]. Available from: https://data-explorer.oecd.org]
- ABF Research. Arbeidsmarktprognoses Zorg en Welzijn. Delft: ABF Research; 2025.
- Stortelder E, Huizenga F, Homan I, Miaei H, Horenberg R, van Royen‑Kerkhof A, van Rijen HVM, Browne JL. Bridging the Gap: Designing Medical Integration Curricula for Foreign Healthcare Graduates in the Netherlands. Perspect Med Educ. 2026;15(1):270‑278.
- Hook JN, Boan D, Davis DE, Aten JD, Ruiz JM, et al. Cultural humility and hospital safety culture. J Clin Psychol Med Settings. 2016;23(4):353‑360.
- van Riemsdijk M. Career rewind: professional trajectories of pharmacists with a refugee background. Globalisation Soc Educ. 2025;23(3):657‑668. doi:10.1080/14767724.2023.2236581.]
- Stortelder E, Huizenga F, Homan I, Miaei H, Horenberg R, van Royen‑Kerkhof A, van Rijen HVM, Browne JL. Bridging the Gap. Perspect. Med. Educ. 2026 Mar; doi:10.5334/pme.1994.].
