The Dutch government provides funding for each junior doctor starting one of the country’s seven GP training programmes. The amount of funding is determined by the Dutch Healthcare Authority (NZa). Most of the money goes towards GP trainees’ salaries, while a smaller share goes to the programmes themselves. According to Matthijs Limpens, director of the programme in Maastricht, this is where the main problem lies: “The bulk of the costs of a GP training programme are made up of teaching staff salaries, which have risen sharply in recent years. While NZa contributions have also increased slightly, they haven’t kept pace with the rising costs.”
Cost-cutting measures
As a result, the programme has been operating at a loss since 2023. In 2025, it recorded a €400,000 deficit on a €6 million budget. Various cost-cutting measures have already been taken: “We now hire fewer external lecturers and guest speakers, and we make less use of external venues for staff and training days. And instead of immediately replacing staff members on long-term sick leave, we first see if we can cover it internally.” Has the programme suffered as a result? “Not so far. We meet all quality standards. But inevitably, you’re paring back teaching.”
Limpens says they’ve done all they can in terms of spending cuts, “but staff costs may still decrease through natural turnover. Several employees will be leaving in the near future. There will be no compulsory redundancies, but we may need to offer some people alternative positions elsewhere within the department or faculty. We’re already increasingly sharing staff with the specialty training programme in geriatric medicine and the Living Lab Family Medicine.”
Additional places
A complicating factor is the steady increase in the number of training places since 2023, through which the Dutch government and doctors’ organisations aim to address the national shortage of GPs. The number of training places in Maastricht increased from 96 to 112. Programmes prepared for the increase, but most have struggled to fill the additional places. Across the Netherlands, around seven hundred junior doctors start GP training each year, with eighty to 85 in Maastricht. Despite recruitment campaigns, those numbers have remained more or less stable for years. “If we were to have ninety trainees next year, the problem for that year would be solved. But the programmes have little influence on the number of applicants.” According to Limpens, Maastricht isn’t the only programme struggling. “Only Leiden and Utrecht manage to fill all places and break even each year.”
He sees no easy solution. “You’d have to increase the intake of students in the medicine programme, or lure junior doctors away from other specialties.” The first option, he acknowledges, wouldn’t bring short-term relief. “We wouldn’t see the effect for another 6 to 8 years. As for the second option, we’d have to ask ourselves if that’s what we want.”