VAT exemption for medical services
Medical services that fall under "healthcare of the human person" are VAT-exempt. This applies to most treatments by BIG-registered healthcare professionals. Important implication: reclaiming VAT on purchases stays locked for your BV (input VAT deduction excluded). Medical equipment and office fittings are therefore more expensive than for a VAT-registered business.
The exemption has edges: cosmetic procedures free of medical necessity, insurance medical examinations and expert reports may be VAT-liable.
Partnership vs. BV for medical specialists
Doctors traditionally worked in partnerships (maatschappen). The shift to BVs is accelerating. BV advantages over a partnership: limited liability (in a partnership, all partners are jointly liable for each other's mistakes), tax optimisation (retain BV profit at 19% Vpb vs. 49.5% income tax), and flexible income via salary and dividend.
Customary salary for doctor-DGA
The customary salary for doctors is typically high: a GP earns €140,000–€180,000 as an employee, a specialist €200,000–€350,000. The Tax Authority will set the customary salary at market level for your specialisation. This limits tax optimisation compared to lower-earning DGAs.
Where this leads
Further along the same line: Incorporating a BV, Incorporating a Holding BV and Incorporating a BV as an IT Consultant.