Emigrating as a Doctor to the Netherlands: BIG Registration and Language Requirements

What the BIG register is and why nothing happens without an entry

The BIG register is the statutory, publicly accessible professional register for individual healthcare in the Netherlands. Its legal basis is the Wet op de beroepen in de individuele gezondheidszorg, or Wet BIG for short; the register is maintained by the CIBG on behalf of the Ministry of Health, Welfare and Sport. Eleven professions are covered, including doctor, dentist, pharmacist, midwife, nurse, physiotherapist, physician assistant and clinical technologist. As at 1 July 2026 the register showed 407,244 entries.

The entry is not a formality but the precondition for everything else. Only those listed in the BIG register may use the legally protected title, carry out the acts reserved to the profession independently, begin specialist training, and are subject to Dutch professional disciplinary law. Among doctors, the entries as at 1 August 2026 were split between 31,846 people in the basic profession and 50,949 people with a registered specialisation.

Registration is valid for five years. For renewal, the Wet BIG requires of doctors, according to the KNMG, 2,080 working hours within those five years in their own field. Anyone who does not reach the hours can re-register through a training and examination programme leading to a Periodiek Registratiecertificaat. Those listed as specialists in the specialist register of the Registratiecommissie Geneeskundig Specialisten automatically remain listed in the BIG register for as long as that registration runs.

Automatic recognition under Directive 2005/36/EC

The basis for recognition is the European Professional Qualifications Directive. Article 21 of Directive 2005/36/EC provides that evidence of formal qualifications listed in Annex V is recognised in the other member states without the training content being re-examined. Article 24 sets the minimum standard: at least five years of study and at least 5,500 hours of theoretical and practical training. The BIG register applies this procedure to doctors, dentists, pharmacists, midwives and nurses.

For applicants this means, according to the BIG register, a processing time of up to three months from receipt of a complete application and a statutory fee of 85 euros, which is not refunded even if the application is refused. The register expressly points out that the deadline only begins once the application is complete, and that applications pile up in July and August.

Two special cases matter. If the degree was completed more than five years ago, the criteria for re-registration must additionally be met. And anyone trained outside the European Economic Area goes through a substantive assessment under Dutch law rather than automatic recognition; the KNMG gives a decision period of four months for that, against three months for automatic recognition.

Dutch at B2+ as the decisive switch

Language is the point at which the Dutch route differs from many others. The BIG register requires proof of language as a condition of registration and grades the level according to the educational level of the profession. For academic health professions, that is doctors, dentists and pharmacists among others, the register expressly names level "B2+" and explains it as higher than B2 and lower than C1. For professions at university of applied sciences level B2 applies, and for those at intermediate vocational level B1.

The register sets formal requirements for the proof itself:

• The certificate may be no more than two years old at the time of application.
• It must cover all four skills: writing, listening, reading and speaking.
• The underlying course must have been completed with an examination, test or assessment.
• Equivalents include vocational training completed entirely in Dutch or a secondary school qualification taught entirely in Dutch.

For later entry in a specialist register a second language hurdle appears. According to the KNMG, the Registratiecommissie Geneeskundig Specialisten accepts either the diploma of a Dutch-language specialist training programme or a language certificate at B2 level. Anyone arriving with a German qualification therefore meets the language twice: once on entry to the profession and once for the specialist title.

In practice this means: building up the language is the longest part of the whole route. The three months' processing time and the 85 euro fee are a footnote beside it. Anyone planning the move plans the language first.

ANIOS and AIOS – two roles, one diploma

After the degree you are initially a basisarts in the Netherlands. From there two routes lead into the clinic, and the distinction shapes the entire start of a career.

ANIOS stands for arts-assistent niet in opleiding tot specialist. This is a regular medical post on a ward, with full clinical responsibility within supervision but without a formal training contract. AIOS stands for arts-assistent in opleiding tot specialist. Here there is a training relationship within a programme recognised by the Registratiecommissie Geneeskundig Specialisten, at the end of which comes entry in the relevant specialist register.

How the basic-doctor population is distributed was surveyed by the Capaciteitsorgaan at the end of 2023, with 5,778 basisartsen taking part, a participation rate of 27 percent. 49 percent of respondents were AIOS, 37 percent ANIOS, 10 percent worked as arts-onderzoeker in research and 4 percent in non-clinical roles.

For those arriving from abroad the order is almost always the same: entry is as an ANIOS. There is a substantive reason for this. In the Netherlands the ANIOS period is the phase in which you prove yourself professionally, linguistically and within the team – and it is at the same time the usual precondition for later obtaining a training post.

Access to specialist training and how tight it is

In the Netherlands specialist certification does not lie with the state but with the medical profession's own governing bodies. The College Geneeskundige Specialismen issues the rules and the Registratiecommissie Geneeskundig Specialisten maintains the specialist registers; both sit within the KNMG.

Anyone already holding a specialist title from an EU state can have it registered. Alongside automatic recognition of the title, the KNMG names the following conditions: an unconditional, that is non-provisional, BIG registration, proof of language, a Certificate of Good Standing from every country in which specialist work was carried out, professional activity averaging at least 16 hours a week over the preceding five years, and, where the title is more than five years old, an average of 40 hours of continuing education a year over the same period.

The position is different for those wanting to begin specialist training in the Netherlands. The number of training places is set politically. On 22 May 2026 the Rijksoverheid announced that the minister was following the recommendations of the Capaciteitsorgaan: 99 training places will be added for the medical specialties, raising the number to 1,320 places a year. She follows the recommendations for general practice, geriatric medicine and medical care for people with intellectual disabilities in full; for GZ psychology 691 places are provided.

How competitive access is, is shown by a single figure from the Capaciteitsorgaan survey more clearly than by any description: the average duration of the ANIOS phase at the end of 2023 was 3.7 years, up from 3.4 years the year before. Between graduating and starting training there are therefore several years of clinical work on average. Anyone planning this route should not understand the ANIOS period as a holding pattern but as a career stage in its own right.

Anyone weighing up whether a medical degree elsewhere in Europe suits their own starting position, and how a career in the Netherlands might follow from it, can book a free consultation at any time.

Pay, working hours and the collective agreement

Most non-university hospitals fall under the Cao Ziekenhuizen. According to the LAD it applies to more than 220,000 employees in general hospitals and rehabilitation facilities. University hospitals have their own agreement in the Cao UMC, and salaried specialists have their own arrangement under the abbreviation AMS.

Add holiday allowance and year-end payment together and around 16.7 percent comes on top of the basic salary. That is the most important point often overlooked when comparing with German pay figures: a Dutch gross monthly salary is not directly comparable with a German one.

On absolute amounts, the parties to the agreements publish tables that differ by contract. The specialist portal artsensalaris.nl gives a starting salary for AIOS as at 1 February 2026 that usually lies between 3,400 and 4,000 euros gross a month and rises with experience. For ANIOS the staffing provider Maandag gives a range of around 2,800 to 3,600 euros gross a month for 2026, with supplements for evening, night and weekend duties on top. For extramural AIOS paid under the Cao SBOH, salaries rose by 4 percent for all groups on 1 January 2026 according to the LAD.

Cost of living and working culture

A higher gross salary says little as long as the price level is left out of account. According to Eurostat's price level indices, the Dutch figure for private consumption in 2024 was 116.0, measured against an EU average of 100. Germany came to 108.6, Austria to 112.8, Norway to 124.0 and Switzerland to 174.4. The difference is particularly clear in housing: for housing, water, electricity and fuels, Eurostat gives 129.8 for the Netherlands and 113.1 for Germany.

Set against that is a working model with few equals in Europe. According to figures from the Centraal Bureau voor de Statistiek, in the second quarter of 2026 around 4.8 million of 9.8 million people in employment worked part-time, about 49 percent. Part-time work in the Netherlands is neither an exception nor a brake on a career but the statistical norm. For medical careers this has concrete consequences: reduced hours are planned for organisationally in hospitals, and the agreed standard working week of 36 hours is already below what counts as full time in many neighbouring countries.

The German-Dutch border region

One of the longest internal borders in the EU runs between the two countries, and in medical education it is already permeable. The European Medical School Oldenburg-Groningen has since 2012 been a model medical degree run jointly by the University of Oldenburg and the University of Groningen. Oldenburg is admitting 200 first-year students for the first time in the 2026/27 winter semester; Groningen reports 400 places a year on its own bachelor's in medicine. Those who meet the requirements can obtain Dutch qualifications alongside the German state examination: the Bachelor of Human Life Sciences and the Master in Geneeskunde.

For the question of moving abroad, this model is instructive. It shows that the two training systems are compatible enough to share a curriculum. And it shows where the difference really lies: not in professional training but in language and knowledge of the system. Those are precisely the two points addressed by the BIG register's B2+ requirement.

International comparison: Switzerland, Austria and Norway

All four countries compared here apply the same directive to EU and EEA diplomas. Differences arise not in the recognition of the diploma but in three other areas: the responsible body, the language requirement, and the question of who demands proof of language at all.

The comparison brings out three findings. First, the Dutch language level is the highest of the four: B2+ is above the Swiss B2 and above the Norwegian recommendation. Second, who checks differs. In the Netherlands and Switzerland language is a condition of registration; in Norway, under the Helsedirektoratet's rules, it is a matter for the employer; in Austria the procedure requires proof without publishing a level. Third, the bottleneck shifts by country: in the Netherlands it is the training post after an average of 3.7 ANIOS years, in Norway the centrally advertised LIS1 post, whose number rose from 950 in 2019 to 1,218 in 2025 according to the Helsedirektoratet.

Placing the salaries in context requires the price level. Switzerland pays the most in nominal terms but also shows a consumer price level of 174.4 against an EU average of 100 in the Eurostat figures. Norway is at 124.0, the Netherlands at 116.0 and Austria at 112.8. Anyone comparing offers from several countries would therefore sensibly factor in the price level and the collectively agreed additional payments first, and only then the gross monthly salary.

This article reflects the position as at 14 August 2026 and serves general information purposes. It does not replace legal, tax or careers advice in an individual case; what is authoritative is the version of the rules in force at the time and the decisions of the competent bodies.