European directives & Dutch practice

1. Process of RecognitionForeign Degree Holders Health Care European directives & Dutch practice Committee Foreign Degree Holders Health Care Advice Committee to the Minister of Health in the Netherlands Central Agency for Information on Health Care Professions Warsaw, Poland, April 15th 2004, Mr. Niels P. Wijkhuijs, secretary

2. Content • Sectoral Directives & General System • Dutch numbers in 2002 • Dutch infrastructure • Dutch actors • Cases (after break, with Mrs. d’Artillac Brill)

3. Sectoral Directives & General System (I) European Union (EU): agreements on the recognition of qualifications • General System • Sectoral Directives Applications from outside the EU decision on application important to other member states European Economic Area (EEA) EU + Norway, Liechtenstein, Iceland + Switzerland

4. Sectoral Directives & General System (II) General System: • First Directive (89/48/EU) • Second Directive (92/51/EU) General System Third Directive (99/42/EU) • not Sectoral Directives-professions • mutual trust of EEA-member states in their training and diploma • but in case of ESSENTIAL DIFFERENCES: • adaptation period • aptitude test

5. Sectoral Directives & General System (III) Sectoral Directives Health Care: • Doctor (93/16/EU) • Pharmacist (85/432/EU and 85/433/EU) • Dentist (78/686/EU and 78/687/EU) • Midwife (80/154/EU and 80/155/EU) • Nurse (77/452/EU and 77/453/EU) • diploma automatically recognized by member states • specific diploma mentioned in Sectoral Directive • training’s structure and content is (roughly) harmonized within EEA-member states ACQUIRED RIGHTS possible in case not all conditions are fulfilled for automatic recognition

6. Sectoral Directives & General System (IV) Acquired Rights ‘3 years out of 5 years’-experience “in the case diplomas (…) do not satisfy all the minimum training requirements, each member state shall recognize these diplomas as sufficient proof (…) when accompanied by a certificate stating that [a national] have effectively and lawfully been engaged in the activities in question for at least three (consecutive) years during the five years prior to the date of issue of the certificate.” • Doctor section 9, par. 1 (93/16/EU) • Pharmacist section 6, par. 1 (85/433/EU) • Dentist section 7, par. 1 (78/686/EU) • Midwife section 5, par. 1 (80/154/EU) • Nurse section 4, par. 1 (77/452/EU)

7. Sectoral Directives & General System (V) Acquired Rights ‘declaration from competent authorities’ “in the case diplomas (…) do not confirm with qualifications or designations (…), each member state shall recognize as sufficient proof the diplomas (…), accompanied by a certificate issues by the competent authorities of bodies, stating that diplomas (…) were awarded following training in accordance with (summarized) ‘training requirements’ (…).” • Doctor section 9, par. 5 (see also 42b) (93/16/EU) • Pharmacist section 6, par. 2 (see also 18b) (85/433/EU) • Dentist section 7, par. 3 (see also 23b) (78/686/EU) • Midwife section 5, par. 3 (see also 19b) (80/154/EU) • Nurse section 4, par. 2 (see also 18b) (77/452/EU)

8. Sectoral Directives & General System (VI) ‘Third Countries’ “member states shall examine diplomas (…) in the field covered by the Directive, obtained by the holder outside the EU in cases where those diplomas (…) have been recognised in a member state, as well as of training undergone and/or professional experience gained in a member state.” • Doctor section 42c (93/16/EU) • Pharmacist section 18c (85/432/EU) • Dentist section 23c (78/686/EU) • Midwife section 19c (80/154/EU) • Nurse section 18c (77/452/EU)

9. Sectoral Directives & General System (VII) Challenge for the accession countries: • Implementation of General System & Sectoral Directives in own law • Infrastructure for decision making on applications and registration: • e.g. decision within terms! • e.g. motivation of decision and appeal • e.g. costs, documents, information et cetera

10. Dutch numbers in the year 2002 (Numbers I) Sectoral Directives (number of registered practitioners in the “BIG-register” with a Sectoral Directive-diploma) doctor 531 pharmacist 22 dentist 170 midwife 69 nurse 371 Total1163

11. Dutch numbers in the year 2002 (Numbers II) Sectoral Directives (number of “not-regular- cases”) doctor 13 pharmacist 2 dentist 10 midwife 2 nurse 23 Total50 Acquired Rights (possibility)

12. Dutch numbers in the year 2002 (Numbers III) General System (number of applications for a training title) physiotherapist 16 psychotherapist/psychologist health care 6 assistant nurse 2 occupational therapist 9 speech therapist 2 radiographic laboratory worker 2 podiatrist 1 dental hygienist 1 assistent pharmacist 5 Total44

13. Dutch numbers in the year 2002 (Numbers IV) Number of applications from outside EEA doctor 303 pharmacist 15 dentist 134 midwife 14 nurse 147 physiotherapist 15 psychotherapist/psychologist health care 4 assistant nurse 11 occupational therapist 6 speech therapist 2 radiographic laboratory worker 10 dental hygienist 2 assistent pharmacist 5 Total668

14. Dutch numbers in the year 2002 (Numbers V) Applications from outside EEA - accession countries Doctor (303)31 eq. 114 a.e.158 n.e. Poland (28) 7 eq. 19 a.e. 2 n.e. Hungary (6) 6 a.e. Czech Rep. (1) 1 a.e. Slovakia (3) 1 a.e. 2 n.e. Pharmacist (15)2 eq. 13 n.e. Poland (1) 1 eq. Lithuania (1) 1 eq. Dentist (134)18 eq. 54 a.e. 62 n.e. Poland (6) 1 a.e. 5 n.e. Hungary (1) 1 a.e. Czech Rep. (1) 1 n.e. Lithuania (2) 2 n.e. Latvia (1) 1 n.e. eq. = equivalent a.e. = almost equivalent n.e. = not equivalent

15. Dutch numbers in the year 2002 (Numbers VI) Applications from outside EEA - accession countries Midwife (14) 14 n.e. Poland (5) 5 n.e. Hungary (1) 1 n.e. Nurse (147) 28 eq. 29 a.e. 90 n.e. Poland (14) 3 eq. 2 a.e. 9 n.e. Hungary (3) 3 n.e. Czech Rep. (4) 2 a.e. 2 n.e. Slovakia (4) 3 eq. 1 n.e. Lithuania (3) 3 n.e. Estonia (2) 2 n.e. Physiotherapist (15)3 eq. 3 a.e. 9 n.e. Poland (1) 1 n.e. Hungary (2) 1 a.e. 3 n.e. eq. = equivalent a.e. = almost equivalent n.e. = not equivalent

16. Dutch numbers in the year 2002 (Numbers VII) Applications from outside EEA - accession countries Psychotherapist/psychologist health care (4) 1 eq. 1 a.e. 2 n.e. Czech Rep. (1) 1 a.e. Assistant nurse (11)1 eq. 10 n.e. Poland (1) 1 n.e. Radiographic laboratory worker (10) 2 eq. 8 n.e. Poland (1) 1 n.e. Czech Rep. (1) 1 n.e. Assistent pharmacist (5) 2 eq. 3 n.e. Poland (1) 1 eq. eq. = equivalent a.e. = almost equivalent n.e. = not equivalent

17. Infrastructure (I) Individual Health Care Act (“BIG-act”) regulation of quality in Dutch health care Aim “BIG-act” • promote and safeguard the quality of professional practice in individual health care • protect patients from unprofessional treatment Two categories of regulated professions in “BIG-act”: • Professions with ‘registered titles’ • Professions with ‘training titles’

18. Professions (8) with ‘registered title’ Infrastructure (II) doctor pharmacist dentist Sectoral Directives-professions midwife nurse physiotherapist psychotherapist General System psychologist health care • registration in legal “BIG-register” Numbers in “BIG-register”

19. Professions (8) with ‘registered title’ Infrastructure (III) Registrations February 1st 2004 “BIG-register” • doctor 56.690 • pharmacists 4.970 • dentists 9.842 • midwife 2.836 • nurse 226.517 • physiotherapist 33.924 • psychotherapist 6.020 • psychologist health care 9.709 350.508

20. Professions (14) with ‘training title’ Infrastructure (IV) General System assistant nurse dental prothesis maker skin therapist occupational therapist speech therapist podiatrist orthoptist optometrist Mensendieck therapist Cesar therapist radiographic laboratory worker (therapeutic/diagnostic) dental hygienist dietician assistent pharmacist • no legal register • no legal disciplinary rules

21. Infrastructure (V) Individual Health Care Act (“BIG-act”) (besides the regulation of Dutch health care professions) Implementation of the Sectoral Directives and the General System “BIG-act”-chapter foreign degree holders

22. Infrastructure (VI) “BIG-act”-chapter foreign degree holders 1.‘Regulation on the Registration of Foreign Health Care Qualifications’ (contains list of Sectoral Directive-diplomas and possible bilateral agreements) direct application for registration in “BIG-register”

23. Infrastructure (VII) Registration in “BIG-register”: Dutch diploma • completed and signed application form • original diploma or certified copy • payment of registration fee (€ 59,-) EEA diploma (sectoral directives) • completed and signed application form • original diploma/certificate • letter of good conduct • copy of passport • payment of registration fee (€ 59,-)

24. Infrastructure (VIII) “BIG-act”-chapter foreign degreeholders 2.‘Application for a Declaration of Professional Competence’ • ‘Not-regular-case’ Sectoral Directive • General System-cases • Applications from outside the EEA

25. Infrastructure (IX) Declaration of Professional Competence: • request to Minister of Health • optional: • advice Committee Foreign Degree Holders with • evaluation of the diploma - information on the foreign educational system - by Nuffic or Colo (Naric) • final decision by Minister of Health • possible appeal: General Administrative Act

26. Infrastructure (X) Declaration of Professional Competence list of documents for file (compulsory): • application form • certified copy of passport • certified copy of the qualification • grades, etcetera • professional course program (hours) • proof of registration (if available) • proof of permit to practice • proof of professional experience, etcetera

27. Infrastructure (XI) Declaration of Professional Competence possible results: • ‘Not-regular-cases’ Sectoral Directive: • registration in “BIG-register” or other • General System: • equivalent or essential differences: • adaptation period • aptitude test • Applications from outside EEA: • equivalent, almost equivalent or not equivalent (conditional) registration “BIG-register” add. training

28. Actors (I) -Ministry of Health • recognition of qualifications of medical professions • regulation of ‘Training requirements and Areas of Competency’ of the “BIG-act”-professions - Ministry of Education (+ training institutes) • training/education In case of adjustments in ‘training requirements’: negotiations between these two ministries - Ministry of Social Affairs • work permit (not for EEA) - Ministry of Justice • residence status (not for EEA)

29. Ministry of Health in the Netherlands Actors (II) Central agency: Centre for Information on Health Care Professions “assignment of executive power” Other departments “BIG-register” Department Declarations of Professional Competence Information and Referral Desk Foreign Degree Holders

30. Department Declarations of Professional Competence Actors (III) Bureau of Foreign Degree Holders: “decision on application” Secretariate Committee Foreign Degree Holders: “advice” Chairman Committee Foreign Degree Holders Members of the Committee Foreign Degree Holders (176 members) • 4 Members (+ 4 deputy-members), appointed by the Minister of Health: • 2 (+ 2) members from the training/educational institutes • 2 (+ 2) members from the professional organizations

31. Information and Referral Desk Foreign Degree Holders Actors (IV) • General information on the application of a foreign degree holder (telephone and personal) • Referral to “BIG-register” in case of Sectoral Directive-diploma “BIG-register” Help desk Staff Registration desk • Registration of Dutch diplomas (8 professions) • Registration (automatically) of Sectoral Directive-diploma • Registration in case of positive decision on application of professional competence

32. Actors (V) “BIG-register” Public information restricted to the following information: • whether a person is registered • whether a person is recognised as a specialist and for which specialism • whether the registration is suspended and for how long • whether part of the competence is revoked • whether conditions apply and for how long

33. Information & questions: Mr. N. (Niels) P. Wijkhuijs, secretary Committee Foreign Degree Holders Health Care PO Box 16114 2500 BC The Hague The Netherlands Telephone: 0031-70-3406156 Fax: 0031-70-3405105 E-mail: np.wijkhuijs@minvws.nl Website: www.buitenlandsediplomahouders.nl (English pages under construction)