This chapter focuses on the recognition in the Netherlands of medical certificates that were obtained in countries outside the European Union (EU) or the European Economic Area. Refugees or family makers who have graduated as doctors will at some point ask whether their medical certificate is recognised in the Netherlands and which institution is responsible for the recognition procedure. The Department of Health is responsible for dealing with requests for recognition of foreign doctors’ testimonials. If requested, bearers of medical certificates from one of the ‘old‘ EEA countries can obtain a declaration of professional competence from the Health Secretary. They are enrolled in the BIG register, provided they also have the nationality of the EEA country in question. A request to the Department of Health for recognition of foreign medical certificates can result in any of the following three outcomes: 1. Equivalence of the foreign medical certificates with Dutch medical certificates: doctors are fully qualified. This group is referred to as Category I doctors. 2. Near equivalence of the foreign medical certificates with Dutch medical certificates. People from this category3 can be temporarily admitted to the profession, but with limitations. This entails that for a maximum of two years medical graduates have to work under the supervision of a Dutch doctor, who they have to find themselves. Finding a colleague who is willing to act as a supervisor for one or two years has turned out to be an extremely difficult task. This group is referred to as Category II doctors. 3. No equivalence of the foreign medical certificate with Dutch medical certificates: rejection. The people concerned are referred to the Committee for the Influx of Foreign Doctors (CIBA), a joint venture of eight Dutch universities with a medical faculty.4 This group is referred to as Category III doctors. An increasing number of doctors who had been educated outside the EU and EEA presented themselves at one of the eight Dutch universities with a medical faculty. University student counsellors noticed that foreign doctors displayed shopping behaviour: they submitted admission requests at several medical faculties at the same time. From an efficiency point of view this was an undesirable development; therefore, in 1996 a national registration agency was created: the Committee for the Influx of Foreign Doctors (CIBA). Its aim was to regulate the distribution of admission requests by foreign doctors. Every medical faculty had a representative in CIBA. CIBA determined a number of criteria that the requests should meet. 1. The doctor had to have submitted a request for recognition with the Department of Health and the verdict needed to be ‘no equivalence’ (Category III). 2. The doctor had to have a permanent residence permit for the Netherlands (as a refugee or as a result of having a Dutch partner). 3. The doctor had to have passed the State exam Dutch as a foreign language (NT2; programme 2). The CIBA divided the requests over the eight medical faculties. However, the final decision on the admission to a medical training programme was not taken by CIBA but by the executive board of the University or by the board of the medical faculty. The number of available places for entry into a higher year of medical training was limited. This non-central and therefore inconsistent decision-making process led to the situation that the exam committee at one university could reach a different conclusion about the same diploma than the exam committee of another university. It was expected that closer co-operation between the eight medical faculties within CIBA would lead to more uniform inclusion results. Section 7.54a of the Dutch law on higher education and scientific research (WHW) states that an institution can limit admission to the post propaedeutic phase. Most medical faculties set aside a limited number of places (10-15) in the post propaedeutic phase of medical training for students who did not need to acquire a place through allocation of lots by the Central Application and Admission Office (CBAP) of the Ministry of Education. These students had at least to have exemption from the propaedeutic medical exam and they had to have important reasons for continuing their medical training in the Netherlands. Such important reasons included a permanent stay in the Netherlands resulting from recognition as a refugee and/or from having a Dutch partner, in combination with a foreign medical certificate. From 1996-2007 the CIBA dealt with more than 1,000 requests for admission by foreign doctors. The CIBA focused mainly on foreign doctors who had been delegated by the Department of Health to Category III (no equivalence). As a matter of course, the ministry referred these people to CIBA. In previous years most medical graduates from eastern Europe, Asia and Africa had been assigned to Category III. Until 2002, the Department of Health only dealt with requests for recognition. Doctors who had been classified as Category II (near equivalence) were referred to SIBIO, an organisation for intercultural business aspects and intercultural entrepreneurship. The results of this organisation were certainly not always a great success. A number of doctors who had reached a dead end with SIBIO, later reported to CIBA where there was more chance of obtaining a Dutch medical certificate. Until 2002, little priority was given at the Department of Health to policy-making with regard to foreign doctors. This may well have been a result of the huge success of the university CIBA route. 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