European directives

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
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Content

• Sectoral Directives General System
• Dutch numbers in 2002
• Dutch infrastructure
• Dutch actors
• Cases (after break, with Mrs. dArtillac Brill)

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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

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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

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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
• trainings structure and content is (roughly)
  harmonized within EEA-member states
• ACQUIRED RIGHTS
• possible in case not all conditions are
  fulfilled for
• automatic recognition

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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)

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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)

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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)

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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

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(Numbers I)
Dutch numbers in the year 2002

• 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
• Total 1163

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(Numbers II)
Dutch numbers in the year 2002

• Sectoral Directives (number of not-regular-
• cases)
• doctor 13
• pharmacist 2
• dentist 10
• midwife 2
• nurse 23
• Total 50
• Acquired Rights (possibility)

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(Numbers III)
Dutch numbers in the year 2002

• 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
• Total 44

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(Numbers IV)
Dutch numbers in the year 2002

• 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
  
• Total 668

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(Numbers V)
Dutch numbers in the year 2002

• 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
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(Numbers VI)
Dutch numbers in the year 2002

• 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
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(Numbers VII)
Dutch numbers in the year 2002

• 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
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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

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Infrastructure (II)
Professions (8) with registered title

• doctor
• pharmacist
• dentist Sectoral Directives-professions
• midwife
• nurse
• physiotherapist
• psychotherapist General System
• psychologist health care
• registration in legal BIG-register
• Numbers in BIG-register

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Infrastructure (III)
Professions (8) with registered title

• 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

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Infrastructure (IV)
Professions (14) with training title

• assistant nurse
• dental prothesis maker
• skin therapist
• occupational therapist
• speech therapist
• podiatrist
• orthoptist
• optometrist
• Mensendieck therapist
• Cesar therapist
• radiographic laboratory worker (therapeutic/diagno
  stic)
• dental hygienist
• dietician
• assistent pharmacist
• no legal register
• no legal disciplinary rules

General System
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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

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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

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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,-)

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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

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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

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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

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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

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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)

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Actors (II)
Ministry of Health in the Netherlands

• assignment of executive power

Central agency Centre for Information on Health
Care Professions
Other departments
BIG-register
Department Declarations of Professional Competence
Information and Referral Desk Foreign Degree
Holders
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Actors (III)
Department Declarations of Professional Competence
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

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Actors (IV)
Information and Referral Desk Foreign Degree
Holders

• 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

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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

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Information questions

• Mr. N. (Niels) P. Wijkhuijs, secretary
• Committee Foreign Degree Holders Health Care
• PO Box 16114
• 2500 BC The Hague
• The Netherlands
• Telephone [phone]
• Fax [phone]
• E-mail np.wijkhuijs_at_minvws.nl
• Website www.buitenlandsediplomahouders.nl
• (English pages under construction)