Medical specialists. You work in the hospital, we handle your figures.
For self-employed medical specialists in an MSB, specialists with their own practice BV or holding company, locums and small clinics. Entrepreneurship, your BV alongside the MSB, pension and the licence: Alvelion handles the accounting around it.
Request an introductory meetingWhich DGA salary? Work it outWhat matters for a self-employed specialist?
Since integrated funding, the hospital claims, not the specialist. Self-employed specialists therefore work together in a medical specialist enterprise (MSB). Whether you are a business owner within it depends on the risks you really run.
At the Chamber of Commerce, specialists with their own practice or an independent clinic without overnight stay are registered under SBI code 86.22.1. A clinic with overnight stay is under 86.10.3, psychiatrists under 86.22.2.
According to Statistics Netherlands, there were more than 14,000 businesses of specialists outside psychiatry on 1 October 2026. More than half are legal entities, such as a BV. The Federation of Medical Specialists counts 25,783 affiliated specialists. If you work through your own BV, you deal with DGA salary, dividend and pension. That is where we help.
Where things go wrong for medical specialists
Do you recognise one of these situations? Then your accounting needs attention.
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In the MSB without real risk
Do you receive a fixed income from the MSB without business risk? Then you may not be a business owner for income tax. The self-employed deduction and the SME profit exemption then fall away, and payroll tax may come into play.
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Your own clinic without a licence
Medical specialist care always requires a licence under the Wtza, even for a self-employed specialist with a BV. And a clinic for somatic care may not currently distribute profit to shareholders.
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A cooperative counting on the healthcare exemption
An MSB set up as a cooperative pays corporate income tax. The healthcare exemption does not work if the members, directly or through their BV, are natural persons.
With your accounting in order, you know what the MSB brings you, what stays in your BV and what you set aside for tax.
Business owner in the MSB or your own BV
Business owner in the MSB (income tax)
Do you really run a risk?
If you are a business owner, your profit falls under income tax, with the self-employed deduction and the SME profit exemption. That is only possible if you run real and substantial risks. Specialists are measured by the same standard as other business owners.
Personal practice BV
When does a BV suit you?
Your BV takes part in the MSB. The profit then falls under corporate income tax. You take money out of the BV as DGA salary and as dividend in box 2. The customary salary rule applies to your salary.
As a self-employed specialist, you are a compulsory member of the SPMS pension fund. We include that in every calculation.
How Alvelion handles your figures
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Getting to know you and setting up
We look at how your MSB works, what agreements you have on profit and risk and whether you work through a BV. We set up your accounting accordingly.
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Keeping up to date
Payments from the MSB, locum invoices, costs and bank are processed continuously. Every month you see what has come in and what is in your BV.
Every month
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Payroll and tax returns
Your DGA salary, the payroll tax return, your BV's corporate income tax and your own income tax return go out on time.
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Looking ahead
A holding company on top, locum work alongside your regular work or starting your own clinic? We work out in advance what it costs and brings in.
You work with one dedicated contact who knows your situation, not a changing team or a general helpdesk.
Where Alvelion helps you
Your tax position in the MSB
Are you a business owner or not? We look at the agreements in your MSB and what that means for your tax return and your deductions.
Go to tax advicePractice BV and holding company
A personal practice BV alongside the MSB, with or without a holding company on top. We set up the structure properly.
Go to structure and controlSalary and dividend
Your DGA salary, the payroll tax return and the choice between salary and dividend, reviewed every year.
Go to payroll administrationLocum work
Locum work with the NVZ and FMS model agreement. We check whether your practice matches what it describes.
Go to legal adviceYour own clinic
A licence, no profit distribution and high fixed costs for equipment and premises. We prepare the budget and the cash flow forecast.
Go to cash flow forecastTax returns on time
The corporate income tax of your BV and holding company, and your own income tax return, on time and correct.
Go to tax returnsCalculators
Salary or dividend from your BV?
Do you work through a personal practice BV? Work out what salary the Tax Administration expects from you, and whether you are better off taking salary or dividend from your BV, with the 2026 rates. Still in doubt between being a business owner in the MSB and your own BV? Compare what you keep net.
Calculate your DGA salaryYou are not a business owner because of a registration, but because of the risk you really run.
Your practice and your figures with one team
Knows the rules in healthcare
MSB, entrepreneurship, Wtza, the ban on profit distribution and SPMS: we know the rules that apply to self-employed specialists.
BV and private in one view
Your BV, holding company and personal tax return with the same team. That way you see what you really keep.
One contact
Bookkeeping, payroll and advice with the same dedicated team.
Frequently asked questions
Only if you run real and substantial risks. Because of integrated funding, specialists lost their own right to claim, and with it, in principle, their status as business owners for tax purposes. You have to make up for that with other business risks. Specialists are measured by the same standard as other business owners. If you only receive a fixed income, you are quite likely not a business owner.
If the MSB is a cooperative, yes. The healthcare exemption does not work if the members, directly or through their BV, are natural persons. A cooperative may deduct part of the profit that it distributes to its members. How large that part is, you work out per year, using only the income and costs of that year.
Yes, if the BV provides or arranges medical specialist care. According to the CIBG, a self-employed specialist with a BV then also needs a licence. The application costs €725 and the decision period is in principle 8 weeks. The CIBG may ask for a certificate of conduct or start an integrity screening. So start in good time.
Somatic medical specialist care is currently subject to a ban on profit motive. A clinic may make a positive result, but may not pay dividend to shareholders. Medical specialist care solely for psychiatric conditions, without an overnight stay, is excluded. Under the Wibz, the government wants to let all providers distribute profit under strict conditions and up to a maximum. That law is not in place yet. Have this checked for your situation.
As a self-employed specialist, you must register with the SPMS pension fund. That obligation comes from the Compulsory Occupational Pension Scheme Act. Staff of an MSB or of a clinic that receives money from the government or from health insurance are usually covered by PFZW. We include the contributions in your figures and in the choice between salary and dividend.
That depends on how you really work. NVZ and FMS have a model agreement for locum work in the MSB that the Tax Administration assessed in 2023. You may use it until the end of 2029, if you also work as it describes. The Tax Administration does warn that with care in a hospital, employment is hard to rule out in advance. Your locum work itself is exempt from VAT.
That is uncertain. An amendment asks for €150 million in savings on medical specialists' pay from 2027. According to a VWS decision memo of November 2025, that is not achievable by 2027. Legislation to set standards for earnings, both for salaried and self-employed specialists, has been explored. We have not found a bill. We keep track of it for you.
Not for treatments: care with a therapeutic purpose is exempt, also when you stand in for a colleague. Hospitals and medical specialist enterprises simply apply the exemptions. Medical examinations and liability reports, among other things, are taxable. If you also do that work, you record that revenue separately and file VAT returns.
Knowledge for your trade
All articles on medical specialistsYour figures properly handled?
Tell us how you work now. We deliberately work with a limited number of clients. That is why we first look together at whether we are a good fit. You'll hear back within one working day.
Request an introductory meeting