Working as a Doctor in the Netherlands: BIG Register Guide 2026

The Netherlands is attractive for international doctors: a strong primary care system built around the general practitioner, a high standard of hospital medicine, and a working culture that values clear communication and shared decision-making. The entry route, however, is demanding. Everything runs through the BIG register, and doctors with a diploma from outside Europe go through a structured assessment that includes a high level of Dutch and a professional content test.

This guide explains the route as of October 2026 in practical terms. For details on the register itself, see our page on the BIG register.

Key facts

The Dutch health system in brief

Dutch healthcare is organised around the general practitioner as gatekeeper: patients usually see their GP first and are referred to hospital specialists when needed. Hospitals range from academic medical centres to general and regional hospitals. Care is financed through a compulsory health insurance system with private insurers, which shapes how practices and hospitals work.

For a foreign doctor this has practical consequences. Communication with patients is direct, patients expect to be involved in decisions, and documentation and referral letters are written in Dutch. This is one reason the language bar is set high.

Who is responsible

• BIG register (CIBG): keeps the register of healthcare professionals, handles applications from doctors with foreign diplomas, and issues the decision on recognition.
• Commission for Foreign Healthcare Graduates (CBGV): an independent commission that assesses the content of an application, taking the BI test result into account.
• Nuffic or SBB: assess your diploma and course overview as part of the process. You do not arrange this yourself; the BIG register requests it.
• Medical specialist training bodies and hospitals: decide on training posts once you are registered.

Recognition of foreign degrees

The route depends on where you obtained your diploma.

Diplomas from the EU/EEA or Switzerland

Doctors with certain qualifications obtained in Europe can be registered directly through automatic recognition. This is much faster than the non-EU route. You still need to submit certified documents and you are still expected to be able to work safely in Dutch, which in practice your employer will check.

Diplomas from outside Europe

If your diploma was obtained outside Europe, you apply for a certificate of competence (in Dutch, verklaring vakbekwaamheid). Only after a positive decision can you apply for BIG registration. The certificate shows that your education, diploma and work experience are comparable to the Dutch standard, or what you still need to reach it.

The procedure step by step

1. Prepare. Read the BIG register's preparation guidance and start learning Dutch early. The language requirement is often the longest part of the route.
2. Collect documents. Many documents must be certified and some need translation. The BIG register advises submitting only once you have everything.
3. Log in to the online portal (mijn.bigregister.nl) with DigiD or a BIG login.
4. Complete the online application, including any profession-specific appendix for doctors.
5. Upload what you can and send the remaining documents by post after submitting.
6. Diploma assessment. Nuffic or SBB assesses your diploma and course overview on behalf of the BIG register.
7. Take the BI test. The professional content test is required for doctors.
8. CBGV assessment. The commission reviews your file and BI test result and may invite you for an interview.
9. Intended decision. You receive an intended decision and have two weeks to respond before the final decision. You can object to the final decision.
10. Certificate of competence. A positive decision gives you the certificate. The commission can also require extra training, an adaptation internship or a practical skills test first.
11. Register in the BIG register before you start working.

Request any foreign documents you will need for BIG registration as soon as it is clear you will be recognised, because these can take time to arrive.

The BI test

The BI test assesses which areas of your knowledge and skills already match the Dutch level and which may not yet. It is not a simple pass/fail licensing exam like PLAB or USMLE; the result feeds into the CBGV's advice on whether you can be recognised directly or need extra training.

In October 2026 the BIG register states that the BI test for physicians is full for this year, and it is not yet known when new places open. Plan for a waiting period and check the BIG register website regularly. The test carries a fee; confirm the current amount with the BIG register before you book.

Clinical knowledge practice helps here. Working through structured question banks, such as the practice questions in MediFlow Exam Prep, is a practical way to find weak areas before the test.

Costs

Do not budget with older figures from forums. Fees for the tests have changed over the years, and the application fee is expected to be introduced.

Duration

The BIG register gives an average processing time of 6 to 18 months once your application is complete. The real timeline is usually longer because it also includes:

• reaching B2+ Dutch, which for many doctors takes more than a year of serious study;
• collecting and certifying documents from your home country;
• waiting for a BI test place;
• any extra training or internship the CBGV requires.

A realistic plan treats the Netherlands as a multi-year project rather than a quick move.

Language requirements

Doctors belong to the academic professions and need Dutch at B2+, which the BIG register describes as higher than B2 but lower than C1.

The rules for the certificate are strict:

• Only B2+ certificates from the institutions on the BIG register's list are accepted. The list includes several language schools and programmes aimed at healthcare professionals.
• The test must cover reading, writing, speaking and listening.
• The certificate must show a pass, not just participation.
• It must be no more than two years old when you apply.

Doctors are also expected to read English professional literature. The BIG register has a separate page on English reading skills; check it for the evidence it accepts.

Specialist training

Once you are in the BIG register as a doctor (basisarts), you can work in non-training posts and apply for specialist training. Training posts are competitive and are filled by hospitals and training institutions, not by the BIG register. Specialists trained outside Europe can also have their specialist qualification assessed, but the general recognition as a doctor comes first.

Many international doctors start in a non-training position, often called an arts niet in opleiding role, to gain Dutch clinical experience before applying for a training post.

Working conditions

Salaries and working hours in Dutch hospitals are set largely through collective labour agreements. Because figures change with each agreement, we do not quote them here; check the current agreement for your sector or ask the employer directly.

What you can expect in practice:

• strong emphasis on teamwork and flat hierarchies;
• shared decision-making with patients;
• documentation and handovers in Dutch;
• a well-developed GP system, so hospital doctors see referred patients.

A realistic plan by phase

Because BI test places for physicians are scarce, keep your clinical knowledge current during the wait so you are ready as soon as a place opens.

Typical mistakes

• Starting with documents instead of Dutch. Language is usually the bottleneck; start courses before you apply.
• Taking a B2 exam that is not on the list. Only B2+ certificates from listed providers count for doctors.
• Letting the language certificate expire. It must be no more than two years old.
• Assuming the BI test is available on demand. Places for physicians are currently full for the year.
• Sending an incomplete file. Missing certified documents delay the assessment.
• Expecting a specialist post straight away. Recognition as a doctor and access to specialist training are separate steps.

Next steps

1. Read our page on the BIG register.
2. Start a B2+ Dutch course with a listed provider.
3. Gather certified copies of your diploma, transcript and work history.
4. Check the BIG register website for BI test dates.
5. Keep your clinical knowledge up to date with regular practice questions.
6. Compare other European routes, for example working as a doctor in Sweden, Norway or Germany.

Checklist

• B2+ Dutch certificate from a listed provider, not older than two years
• Certified copies and translations of diploma, transcript and certificates of good standing
• Proof of work experience
• DigiD or BIG login for the online portal
• Budget for the BI test, language courses and documents
• Time buffer for waiting lists and possible extra training