A Quarter of New Belgian Doctors Hold Foreign Diplomas

More than one in five newly recognised doctors in Belgium holds a foreign diploma, while the share among dentists approaches one in two, according to figures released by the federal public health authority on Wednesday. The data, obtained by N-VA parliamentarian Frieda Gijbels through a parliamentary question to Health Minister Frank Vandenbroucke (Vooruit), has reignited a long-running debate over medical training capacity, entry quotas for domestic students, and language requirements for foreign-trained practitioners.

Between 2020 and 2025, the FOD Volksgezondheid issued 13,918 professional licences to general practitioners and specialists. Of these, 3,014 went to holders of a foreign basic diploma — roughly 22 percent, VRT NWS reported. The pattern is more pronounced among dentists: the past five years saw 1,265 of 2,821 new licences granted to people who completed their master’s outside Belgium, equivalent to 45 percent.

A recognition licence is necessary to work in Belgian healthcare, but it does not necessarily mean the practitioner actually practises in the country. That caveat lies at the heart of the debate now unfolding in Brussels.

Where the diplomas come from

According to a detailed breakdown published by Medi-Sfeer, the most common countries of origin for doctors’ foreign diplomas are the Netherlands (453), Italy (441), Romania (418) and France (385). Belgians who studied abroad are included in these figures, meaning the country of the diploma does not necessarily reflect the practitioner’s nationality. For dentists, Romania leads by a wide margin at 29 percent, followed by Portugal (14.6 percent) and Spain (9.2 percent).

Of the 3,014 licences granted to doctors with a foreign basic diploma, 2,296 — 76 percent — were based on an EU diploma, while 718 (24 percent) involved non-EU qualifications. Only 2,250 of these doctors (75 percent) had since registered with RIZIV/INAMI, the national health insurance agency; the remaining 764 had not.

Gijbels: an ‘unfair’ double standard

The figures have prompted sharp criticism from Gijbels, a dentist and periodontologist by profession who has become a leading voice on the issue. She frames the disparity as a question of fairness between domestic students, who must clear a difficult entrance examination to fit within a fixed quota, and foreign-trained practitioners, who face no such limit.

“It remains extremely unfair that our own students have to struggle through a difficult entrance exam to fit within a fixed quota, while the gate stands wide open for an influx from abroad,” she said, according to her press release. “We impose those quotas for a good reason: we want to maintain high training quality. But at the same time we have no control over the training quality of those who come to us with a foreign diploma.”

Beyond quotas, Gijbels raises language requirements. Today, demonstrating proficiency in French is sufficient to work as a doctor or dentist in Flanders, one of Belgium’s three official language regions. “Whoever treats patients in Flanders must speak Dutch,” she said. “That is not a side issue, but a basic condition for good and safe care.” She has introduced a bill requiring Dutch-language proficiency for practitioners working in Flanders.

Her concerns extend to oversight. According to the data, 55 percent of doctors with a foreign diploma have no specialisation — neither as a GP nor as a specialist — and for 25 percent of visas for foreign doctors, no RIZIV number had been requested (28 percent for dentists). “What exactly do those care providers do? Where do they work? And what treatments do they perform?” she asked. “Without a RIZIV number it is much harder to monitor their activities.”

A structural workforce challenge

The new figures arrive against a backdrop of rapid long-term growth in foreign-trained practitioners. According to OECD data reported earlier this month by Medi-Sfeer, Belgium counted 10,673 doctors with a foreign diploma authorised to practise in 2023, up from 4,380 in 2010 — a 2.4-fold increase. Their share of the doctor corps rose from 8.2 percent to 14 percent, and they accounted for 27 percent of the growth in that workforce over the period.

Belgium’s reliance on foreign-trained doctors is moderate by international standards. France stands at 11 percent and the Netherlands at 3.8 percent, but Switzerland (40.3 percent), Ireland (43.4 percent) and Norway (44 percent) far exceed Belgium. The OECD notes that international recruitment can quickly fill staff shortages, but adds uncertainty to workforce planning and can worsen shortages in countries of origin. It also cautions that recognition and licensing procedures can leave qualified doctors unable to work.

Legal constraints and an unimplemented law

Efforts to tighten the rules have repeatedly run up against European law. Under the EU directive on the recognition of professional qualifications, EU physicians’ and dentists’ credentials are automatically recognised across member states. Minister Vandenbroucke has previously stressed that restricting a foreign doctor’s access to Belgium conflicts with European rules on mobility and proportionality. Language knowledge is required to practise, but is not a valid criterion to refuse recognition or a visa.

A 2019 law intended to introduce quotas for foreign-trained doctors and dentists has never been given implementing decrees and remains without effect. Since 2024, licence issuance is no longer automatic after diploma recognition; candidates must provide certificates of good conduct and proof of sufficient language proficiency.

Enforcement and transparency concerns

The Flemish Dentists’ Association (VBT) has documented that Romanian dental diplomas serve as a common route into the Belgian system, including for non-EU nationals who obtain an EU-recognised Romanian qualification and then move to Belgium. The association has warned that poor command of Dutch, social legislation and the RIZIV nomenclature is a recurring problem among foreign-diploma dentists. The medical evaluation and control service found that 15.6 percent of files exceeding agreed fee thresholds involved a foreign-diploma dentist — representing 34.3 percent of the total overshoot amount.

The VBT has called for mandatory training on social legislation and billing rules, alongside stronger enforcement. “We must know who provides care here, what qualifications they hold, and whether patients can count on safe, quality treatment,” Gijbels said.

What to watch

The debate cuts across Belgium’s federal structure: healthcare training and diploma recognition are partly community competences, while licensing is federal — a recurring source of friction. Gijbels’ language bill, the unimplemented 2019 quota law, and the growing share of foreign-trained practitioners in the workforce are all likely to remain live political questions. For now, the clearest picture the data offers is one of growing reliance on internationally educated healthcare professionals — and persistent uncertainty about how many of them are actually treating patients in Belgium.