Employing a dentist or dental hygienist from abroad

We are asked on a regular basis what the legal steps are for employing a dentist or dental hygienist from abroad, and whether it is possible to have a foreign dentist or dental hygienist join the practice. In this blog, in collaboration with Orion Immigration Law (who are handling the immigration law aspects), we will discuss the legal considerations when entering into this partnership.

We would like to emphasise that a dentist or dental hygienist in the Netherlands must, in all cases, be BIG-registered. Furthermore, BIG registration (the official Dutch registry for healthcare professionals) must have taken place before the IND (the Immigration and Naturalisation Service)grants a residence permit. As the process of qualification recognition and BIG registration can take several months, it is advisable to start this process in good time (early on/well in advance).

Immigration rules for foreign dentists/dental hygienists

To obtain a residence permit on the basis of working as a dentist or dental hygienist in the Netherlands, you can choose to apply either on the basis of salaried employment or as a self-employed person (ZZP). The chosen legal form (sole proprietor (eenmanszaak), private limited company (besloten vennootschap), professional partnership (maatschap)) partly determines which immigration route applies. The conditions for the various permits are set out below.

Employment as a salaried employee

To carry out work as a dentist or dental hygienist as a salaried employee, you can apply for a combined residence and work permit. The most common residence permit is the highly skilled migrant permit, under which the highly skilled migrant must meet a specific salary threshold (see below). In addition, the employer must be recognised as a sponsor by the IND. You can consult the list of recognised sponsors here.

The gross monthly salary thresholds required to meet the salary requirement for a highly skilled migrant permit are as follows for 2026. These salaries are indexed annually. 

If an employer is not a recognised sponsor, the European Blue Card residence permit may be chosen. The employee must then hold a higher education qualification with a duration of at least three years. This is demonstrated by means of a Nuffic assessment. For dentists and dental hygienists, this will generally not be a problem. The following salary standards will apply from 2026. These amounts are also indexed annually.

Category

Self-employment

Dentists who do not work as employees, but rather work as self-employed persons require a ‘self-employment’ residence permit. The IND assesses this application on the basis of three cumulative requirements:

1. the work serves a substantial Dutch economic interest;
2. the dentist derives a sufficient and sustainable livelihood from that work independently; and
3. the dentist meets the qualification requirements (including BIG registration).

The assessment process depends on the chosen legal form.

Route 1: sole trader or partnership (natural person)

A dentist who is going to work as a sole trader or as a partner in a partnership does not need to undergo the formal DGA test (see route 2 below). That test is intended exclusively for legal entities. However, the IND does assess, in substance, whether the dentist is actually carrying out ‘work as a self-employed person’. This is not a formal checklist but a factual assessment based on the overall picture: who takes the decisions, who manages the finances, does the dentist actually bear entrepreneurial risk, do they have multiple clients, and do they present themselves to the outside world as an entrepreneur? The fact that someone is formally registered as a partner or shareholder with the Chamber of Commerce is not sufficient in itself.

If the IND determines that the work is genuinely self-employed, the RVO (Rijksdienst voor Ondernemend Nederland) will then carry out an assessment using the points-based system (see below).

Route 2: legal entity (B.V., N.V. or foreign legal entity such as an LLC)

In the case of business entities with legal personality, the IND must first determine whether the dentist actually qualifies as self-employed or should in fact be regarded as an employee. The IND applies three criteria for this. The dentist must meet all three to be considered an entrepreneur:

1. The applicant holds a stake of 25 per cent or more in the company;
2. The applicant bears the business risk; and
3. The applicant can influence the level of their salary.

If the dentist does not meet these criteria, the IND will regard them as an employee and the employee route must be followed (highly skilled migrant permit or European Blue Card). If the dentist does meet all three criteria, the RVO will then assess the application using the points-based system (see below).

Points-based system

For both Route 1 and Route 2 — once it has been established that the dentist is genuinely operating as a self-employed person — the RVO assesses whether the proposed business activities serve a ‘substantial Dutch economic interest’. To this end, the IND transfers the file to the RVO, which issues a recommendation. In practice, the IND almost always follows this advice; it is regarded as expert advice on which the IND may rely, unless there are concrete grounds for doubting its accuracy or completeness. The assessment is carried out using a points-based system divided into three categories: 

The points system is designed such that applicants must achieve a total of 90 points across the three categories in order to receive a positive recommendation from the RVO – following which the IND will approve the residence application. These 90 points may be distributed across the three categories in two ways: an applicant must either score (at least) 30 points in all categories, or score 45 points in each of categories A and B. In the latter case, category C does not count.

Category C is generally the most difficult. In practice, 30 points are rarely awarded in this category. For this reason, most applicants aim to achieve at least 45 points in both category A and category B. This renders an assessment of category C unnecessary.

Treaty Exceptions

Different rules apply to American, Japanese and Turkish entrepreneurs on the basis of international treaties and an international association agreement.

Employment contract vs. self-employed status

The choice between working as an employee or as a self-employed person is not only relevant to the application for a work permit in the Netherlands, but also has consequences under civil law. It is important that the intended working arrangement aligns with the intended immigration route, and vice versa.

Employment contract

If an employment contract is chosen, it is more difficult for the dental practice to terminate the working relationship (even before the end of the contract); the dentist is protected against dismissal. Termination (including early termination) is only possible in the event of ‘reasonable grounds’ (such as substandard dental care or a disrupted working relationship) for dismissal, or ‘urgent cause’ for summary dismissal (such as refusal to work or theft). A fixed-term employment contract may, of course, end upon expiry of the agreed term.

In addition to protection against dismissal, a salaried dentist is also entitled to, for example, holiday pay, a transition payment upon dismissal (unless there is serious culpable conduct) and annual leave. At present, dental practices are not obliged to offer a pension scheme to salaried dentists (only to dental assistants) or to adhere to a specific collective labour agreement.

Self-employed (ZZP) arrangement

In the Netherlands, dentists often work under a self-employed (ZZP) arrangement, whereby they receive a percentage of the turnover attributable to their work as remuneration.

None of the employee rights mentioned above apply in such cases unless specifically agreed. If such agreements are nevertheless made, this can have unexpected (and, for the pseudo-employer, often negative) consequences.

Risk of bogus self-employment

If, in practice, the arrangement resembles an employment contract too closely, there is a risk of ‘bogus self-employment’. This means that the self-employed arrangement may (retrospectively) be classified as an employment contract. The consequences are threefold:

Firstly, tax consequences: the Tax and Customs Administration will impose additional payroll tax assessments with retroactive effect and may impose a fine. The retroactive effect does not extend further back than 1 January 2025, as the Tax and Customs Administration resumed enforcement on that date (having not done so for many years prior to that). Furthermore, in 2026, the Tax and Customs Administration will not impose a default penalty (though it may impose a penalty for an offence).

Secondly, civil law consequences: the dentist may invoke employees’ rights such as the aforementioned protection against dismissal and back payments of holiday pay and holiday entitlement. It is irrelevant in this regard that the parties, in principle, intended not to enter into an employment contract.

Thirdly, possible consequences under immigration law: the residence permit was granted for ‘work as a self-employed person’. If it subsequently transpires that there was in fact an employment contract, the basis for the right of residence may be undermined.

Relationship of authority

The main distinction between a self-employed arrangement and an employment contract is that, in the case of an employment contract, there is a ‘relationship of authority’. For example, compared to a dentist in salaried employment, a self-employed dentist will not be bound by internal staff regulations, will not attend meetings, and will have greater freedom to determine their working methods and hours.

Whether an employment contract exists is currently determined by the so-called ‘Deliveroo criteria’. This would change if the ‘Self-Employed Persons Act’, which is currently still being drafted, were to be passed. Under this Act, greater weight would (still) be given to whether the dentist acts as an entrepreneur by, for example, keeping their own accounts, engaging in client acquisition and having adequate provisions for sickness and old age. This Act would also make it possible to obtain clarity in advance by submitting the situation to the Assessment Framework Review Committee. The committee’s ruling on the classification of the contract is binding (including on the tax authorities).

At present, such clarity cannot yet be obtained in advance and risks therefore remain. These risks can be mitigated by making clear agreements and ensuring that these agreements are actually implemented correctly in practice. In any case, the sector-specific model agreement – which has been drawn up specifically for dentists and approved by the Tax and Customs Administration – can still be used at this stage. Until 1 January 2030, the Tax and Customs Administration guarantees that, provided this agreement is used and its practical implementation complies with the terms, there is no employment contract. From 1 January 2030, the Tax and Customs Administration will cease to use model agreements.

Joining the practice

Sometimes it may be a logical step for the new dentist or dental hygienist to become a co-owner of the practice (whether immediately or in due course). It is important to make clear agreements on this to prevent disputes. How this works depends on the legal form under which the practice is organised. If the recruitment of a foreign dentist or dental hygienist is being considered, it is important to ensure that this is consistent with the dentist’s or dental hygienist’s immigration status (or application for such status).

Traditionally, many practices have been organised as a partnership. Nowadays, oral healthcare professionals also regularly opt for a private limited company (‘B.V.’). The arrangements between partners or shareholders are set out in a partnership agreement or a shareholders’ agreement, depending on the legal form. It is important to include the following arrangements, amongst others, in the agreement:

• division of duties and remuneration for these;
• profit distribution;
• management and deadlocks;
• the admission and withdrawal of partners/shareholders and the compensation payable in such cases;
• mandatory offer of the share(s) under special circumstances; and
• sale of the practice (if this is envisaged in the long term).

Experience shows that the absence of such agreements tends to lead to disputes. We regularly draft partnership and shareholders’ agreements, and frequently handle disputes between partners/shareholders.

Before joining the practice, agreements must also be reached regarding (among other things) the purchase price, its financing, guarantees and indemnities. This is set out in a purchase agreement. The new partner would be well advised to carry out an audit or due diligence of the practice they are joining prior to joining.

Approvals

NZa approval is required where a dentist’s entry into a practice constitutes a concentration (acquisition of control through partnership, a company or the acquisition of shares) and at least one of the healthcare providers involved generally provides care to fifty or more people.

Contracts with health insurers often stipulate that a change in control must be approved by, or submitted to, the health insurer. Whether this plays a significant role depends primarily on the practice’s specialism.

Considering employing a foreign dentist or dental hygienist, or allowing them to become a partner in the practice? For questions regarding forms of collaboration, please contact Imbert van Weverwijk or Reggy Thielen. For enquiries regarding immigration law, please contact Charley Nieuwesteeg of Orion Immigration Law.