Dutch Medical Doctors Global Health are worth the investment

Written by

Medical Doctor - Global Health (in training, first year resident)
larad4carter@gmail.com

Published in October 2026

Editorial

Recent changes to the Dutch training curriculum for Medical Doctors Global Health (MDGH) have brought an end to the subsidy that trainees relied on to cover the costs of their training abroad and the mandatory Global Health core course. The consequences are far-reaching.
Doctors already enrolled now face unexpected expenses, while those considering the specialisation must think carefully about whether they can afford the additional costs.

The decision also raises a fundamental question: does the Dutch government still recognise the value that MDGH specialists bring to the Dutch healthcare system? Having worked in resource-limited settings, these doctors return with broad clinical experience, adaptability and a practical understanding of global health challenges that increasingly affect healthcare at home.

In this two-part series, two doctors currently in MDGH training share their experiences and reflect on the implications of these changes for their training, their future careers and the place of Global Health within Dutch healthcare.

Main content

I started my training to become a Medical Doctor Global Health (MDGH) last December 2025 in a large paediatric hospital in The Hague. I was accepted into residency in September (two months earlier), after having worked in obstetrics and gynaecology for little over a year. I had been contemplating applying to the training programme for many years even though I knew that choosing this career path would not be lucrative from a financial point of view. However, when I applied, I was still counting on financial support for the final year, which includes a 3-month long academic Global Health course at the KIT (Royal Tropical Institute) and six months of working abroad in one of the collaborating hospitals. The course alone costs over seven thousand euros to complete and one may imagine the costs involved in working abroad voluntarily for half a year. Over the past five years (from 2021 until 2026), the Dutch government has offered a subsidy of seventeen thousand euros to all MDGH residents to cover these costs. The first two years of training, which consist of two one-year-long clinical placements in either paediatrics or surgery and obstetrics and gynaecology are financed via the teaching hospitals’ payrolls.

I was already a few months into the training programme when I realised that the chances of me ever receiving the funds for the final year were becoming very slim, as the government had announced that the temporary provision of funding, which was apparently set to last for five years only, was coming to an end. Initially I was struck by a feeling of discouragement. Recently being relocated to a new hospital in another city – for which I had to move – had asked a substantial effort and time. With great motivation I started to adjust to a new working environment and medical specialty. And then came the news of the proposed funding cuts which gave me the feeling that the Dutch government was not exactly enthusiastic about my training programme.

While reflecting on the position I was now in, I recalled a conversation I had once had with an ex-humanitarian aid worker, who had quit her “field” job to do a PhD in medical anthropology. I asked her what had made her decide on a career switch. “Have you ever heard of the four Ms?” she asked in response. Truly clueless on what she was about to explain, I shook my head. “The Ms stand for millionaires, madmen, missionaries and misfits”. She went on to explain that many humanitarian workers seemed to fit into one of these categories and that her decision to go in another direction had been mainly influenced by her former colleagues’ behaviours. I was in my final year of medical school at the time and already steering slightly towards a future career path in global health, with a 3-month long internship in Tanzania already planned and booked. I remember feeling very confronted by her words at the time. If I decided to dedicate the next few years of my life to working abroad and trading Dutch comfort and a more than decent medical doctor’s salary for low-resource and low-income circumstances, in which “M category” would that put me? Having been raised an atheist in a typical middle-class family in Amsterdam, I could cross off millionaire and missionary. I guess the other two categories are mostly subjective and for others to judge.

Persistent as I am, I decided to continue along my career path, which simply felt right to me. What that makes of me was something to be discovered later. But now, my new situation forces me again, assessing how we, Dutch doctors – trained to work in low resource settings – are being perceived by our government. There seems to be an assumption that we are more than wealthy enough to cover a substantial part of the training programme by ourselves. Which is simply not true. I have already heard many other fellow residents having doubts whether to continue the training in case the funding is being discontinued. As, like other citizens, we have bills and mortgages to pay for leaves little room to save a considerable amount for the final year of the programme.

Perhaps also, there is an underlying assumption that choosing a career out of “good will” must require an intrinsic motivation stronger than any kind of financial or other incentive. Which either puts us right in the missionary category or portrays us as “madmen” idealists. These assumptions completely overlook another important reason for young doctors wanting to spend time working abroad in other (low resource) settings. That there is a great deal that can be learned from these work experiences, and that acquired skills can be applied back in the Netherlands thereby contributing to a more sustainable and accessible healthcare system, serving an increasingly globalising society. I wonder what ever happened to the post-World War II political consensus that preserving international collaboration is essential for worldwide human welfare. Yet the current Dutch government has decided that even a relatively low annual budget covering global health and the training programme for a few dozen young doctors is not worth the investment – even despite the fact that the majority of them will return to work in the Netherlands and as such will contribute to the Dutch health care system. Currently, the Dutch government is cutting funds across multiple sectors, including health care and social security, with the main goal being to finance the military’s preparations for an increasingly present threat of global conflict.

So what’s next for me? You can call me and my peers idealists, madmen or one of the other Ms. This however will not make me give up on my training just yet. To cover the costs for the final year of the programme, I will have to be more careful about my spending and probably partially rely on the generosity of friends and family. In my opinion, this is not how it should be. The training programme should remain accessible to everyone with the right resumé and motivation, including those without a social environment that can support them financially. Therefore, adequate funding is needed to train globally-minded medical doctors who can represent the Netherlands in an appropriate and non-colonial way. This in turn will allow the trained professionals to contribute to establishing and preserving sustainable and symbiotic relations that benefit healthcare locally – at the site of their employment – as well as back in the Netherlands. This, in my opinion, is well worth the investment.