Summary;Judgment — ECLI:EU:C:2022:149
Date: 2022-03-03
Language of the case: Finnish
Court formation: Sixth Chamber
Subject matter: Right of establishment;Freedom to provide services;Free movement of workers
Procedure: Reference for a preliminary ruling
Origin: Finland

Summary of the request for a preliminary ruling pursuant to Article 98(1) of 
the Rules of Procedure of the Court of Justice 
Date lodged: 
25 November 2020 
Referring court: 
Korkein hallinto-oikeus (Finland) 
Date of the decision to refer: 
25 November 2020 
Appellant: 
A 
Other party: 
Sosiaali- ja terveysalan lupa- ja valvontavirasto (Valvira) 
  
Subject matter and legal basis of the main proceedings 
Request for a preliminary ruling – Article 267 TFEU – Recognition of 
professional qualifications and examinations – Healthcare professional – 
Doctor – Directive 2005/36/EC – Articles 45 and 49 TFEU 
Subject matter of the request 
The Korkein hallinto-oikeus (Supreme Administrative Court, Finland) is called on 
to determine whether the national authority (Sosiaali- ja terveysalan lupa- ja 
valvontavirasto, Licensing and Supervisory Authority for Social Affairs and 
Health, Finland, ‘Valvira’) was entitled to grant A, who had obtained an 
undergraduate degree in medicine in the United Kingdom, authorisation to pursue 
the profession of doctor in Finland for a limited period of three years and with the 
restriction that A could pursue the profession of doctor as a licensed professional 
only under the direction and supervision of a licensed doctor authorised to pursue 
the profession independently and that she could do so during that period solely for 
EN 
SUMMARY OF THE REQUEST FOR A PRELIMINARY RULING – CASE C-634/20 
 
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the purpose of completing three years of special training in general medical 
practice in Finland. 
Question referred 
1. Having regard to the principle of proportionality, is Article 45 or 49 TFEU 
to be interpreted as precluding the competent authority of a host Member 
State from granting, on the basis of the national legislation, a person the 
right to pursue the profession of doctor for a limited period of three years 
and subject to the restriction that that person may practise only under the 
direction and supervision of a licensed doctor and must complete three years 
of special training in general medical practice during that same period in 
order to obtain authorisation to pursue the profession of doctor 
independently in the host Member State, taking account of the fact that: 
(a) the person has obtained an undergraduate degree in medicine in the home 
Member State but, when applying for recognition of that professional 
qualification in the host Member State, he or she was unable to provide a 
certificate attesting to the completion of a professional traineeship of one 
year’s duration, which is required as a further condition for obtaining the 
professional qualification in the home Member State; 
(b) for the purposes of Article 55a of the Professional Qualifications Directive, 
in the host Member State, the person has been offered, as a preferential 
alternative, which was declined by him or her, the possibility of carrying out 
in the host Member State, for a period of three years, a professional 
traineeship that is in accordance with the guidelines of the home Member 
State and applying to the competent authority of the home Member State for 
recognition of that traineeship in order subsequently to be able to reapply in 
the host Member State for the right to pursue the profession of doctor 
through the system of automatic recognition referred to in the directive; 
(c) the purpose of the national legislation of the host Member State is to 
promote patient safety and the quality of healthcare services by ensuring that 
healthcare professionals have the training required for their professional 
activity, other sufficient professional qualifications and other skills required 
for the professional activity? 
Provisions of EU law cited 
Articles 45 and 49 TFEU 
Directive 2005/36/EC of the European Parliament and of the Council of 
7 September 2005 on the recognition of professional qualifications (‘Professional 
Qualifications Directive’), as amended by Directive 2013/55/EU of the European 
SOSIAALI- JA TERVEYSALAN LUPA- JA VALVONTAVIRASTO 
 
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Parliament and of the Council of 20 November 2013, recitals 6 and 12, and 
Articles 10, 21, 23 and 55a 
Case-law of the Court of Justice cited 
Judgment of 30 April 2014, Ordre des Architectes (C-365/13, EU:C:2014:280, 
paragraphs 21 and 27). 
Provisions of national law cited 
Laki terveydenhuollon ammattihenkilöistä (559/1994, 1 Law on healthcare 
professionals No 559/1994; ‘Law on professionals’) 
The provisions on healthcare professionals laid down in the Professional 
Qualifications Directive were included in that Law. 
Pursuant to point 1 of Paragraph 1 of the Law on professionals, the purpose of that 
law is to promote patient safety and the quality of healthcare services by ensuring 
that the healthcare professionals within the meaning of that law have the training 
required for their professional activity, other sufficient professional qualifications 
and other skills required for the professional activity. 
Pursuant to Paragraph 6(1) of the Law on professionals, Valvira is to grant, upon 
application, authorisation to pursue the profession of doctor or dentist as a 
licensed professional in Finland to a national of a State belonging to the European 
Union (EU State) or a State belonging to the European Economic Area (EEA 
State) who, on the basis of training completed in an EU or EEA State other than 
Finland, has been awarded in the State in question evidence of formal 
qualifications as referred to in the Union’s rules on recognition, which is required 
in the State in question in order to acquire the right to pursue the profession of 
doctor or dentist. 
Pursuant to subparagraph 1 of Paragraph 6a 2 (as amended by legislative 
amendment No 1659/2015) 3 of the Law on professionals, in force at the time of 
 
1 Finlex: https://www.finlex.fi/fi/laki/ajantasa/1994/19940559. 
2 Paragraph 6a of the Law on professionals was amended by Law No 347/2017, which entered 
into force on 19 June 2017. Pursuant to subparagraph 1 of Paragraph 6a of the Law on 
professionals which is now in force, Valvira is to grant, upon application, to a person who has 
obtained an undergraduate degree in medicine in an EU or EEA State in which the right to 
pursue the profession of doctor is contingent upon completion of a postgraduate professional 
traineeship, authorisation to pursue the profession of doctor in Finland as a licensed professional 
under the direction and supervision of a licensed professional, designated in writing, who is 
entitled to pursue the profession in question independently in a health care institution within the 
meaning of point 4 of Paragraph 2 of the Law on the status and rights of patients (No 785/1992). 
The right to pursue a profession is granted for a limited period of three years. Valvira may 
extend the three-year period, where there are just grounds for doing so. Finlex: 
https://www.finlex.fi/fi/laki/alkup/2017/20170347. The Supreme Administrative Court takes the 
SUMMARY OF THE REQUEST FOR A PRELIMINARY RULING – CASE C-634/20 
 
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the decision, Valvira is to grant, upon application and subject to the conditions 
determined by it, to a person who commenced medical studies before 1 January 
2012 in an EU or EEA State in which the right to pursue the profession of doctor 
is contingent upon completion of a postgraduate professional traineeship and who 
has obtained an undergraduate degree in medicine in that State, authorisation to 
pursue the profession of doctor in Finland as a licensed professional under the 
direction and supervision of a licensed doctor entitled to pursue the profession in 
question independently in a health care institution within the meaning of point 4 
of Paragraph 2 of the Law on the status and rights of patients (No 785/1992). The 
right to pursue a profession is granted for a limited period of three years. If the 
applicant has worked as a doctor in accordance with the conditions specified by 
Valvira for the period provided for in subparagraph 1, Valvira is to grant, in 
accordance with subparagraph 2 of this paragraph, upon application, to the 
applicant authorisation to pursue the profession of doctor independently in 
Finland. Valvira may extend the three-year period provided for in subparagraph 1, 
where there are just grounds for doing so. 
Brief summary of the facts and procedure 
1 A started studying medicine at the University of Edinburgh in 2008. On 6 July 
2013, she obtained her undergraduate degree in medicine: ‘Bachelor of Medicine 
and Bachelor of Surgery’. The degree completed by A corresponds to the 
evidence of formal qualifications (Primary qualification) referred to with regard to 
the United Kingdom in point 5.1.1. of Annex V to the Professional Qualifications 
Directive. 
2 By virtue of the degree that she had obtained, A had a restricted right to pursue the 
profession of doctor in the United Kingdom. She was entered as a ‘provisionally 
registered doctor with a licence to practise’ in the register of the General Medical 
Council of the United Kingdom. A was eligible to work in a postgraduate 
programme (‘UK Foundation Programme’). The Supreme Administrative Court 
takes the view that a doctor who has obtained an undergraduate degree cannot 
work during that period in roles other than those belonging to the programme in 
question. 
3 After completing her degree, A returned to Finland and applied to Valvira for 
authorisation to pursue the profession of doctor in Finland as a licensed 
professional on the basis of the degree that she had obtained in the United 
Kingdom. 
4 However, when applying for the right to pursue the profession of doctor, A was 
unable to provide the certificate accompanying the evidence of qualifications 
      
view that the legislative amendment referred to above has not brought about any substantial 
change to the previously applicable legislation. 
3 Finlex: https://www.finlex.fi/fi/laki/alkup/2015/20151659. 
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referred to with regard to the United Kingdom in point 5.1.1. of Annex V to the 
Professional Qualifications Directive (Certificate of experience), which is a 
prerequisite in the United Kingdom for the right to full registration with a licence 
to practise. 
5 As A did not hold the aforementioned certificate, Valvira suggested that she 
convert the application for a licence to practice as a doctor into an application for 
a temporary licence. A agreed to this. According to Valvira, in order to obtain 
authorisation to pursue the profession of doctor independently in Finland, A had 
to do one of the following within a period of three years: (a) complete a 
professional traineeship in Finland in accordance with the guidelines of the United 
Kingdom and apply to the competent authority in the United Kingdom for 
recognition of that traineeship in accordance with Article 55a of the Professional 
Qualifications Directive in order subsequently to be able to apply for the right to 
pursue the profession of doctor in Finland through the automatic recognition 
system referred to in the directive; or (b) complete special training in general 
medical practice in Finland. A chose alternative (b), which does not lead to the 
automatic recognition of professional qualifications in other EU/EEA Member 
States within the meaning of the Professional Qualifications Directive. 
Valvira 
6 By decision of 3 November 2016, Valvira granted A, for the period from 
2 November 2016 to 2 November 2019, authorisation to pursue the profession of 
doctor in Finland as a licensed professional under the direction and supervision of 
a licensed doctor authorised to pursue the profession independently. A was 
authorised to pursue the profession of doctor during that period solely for the 
purpose of completing three years of special training in general medical practice 
in Finland. 
7 By decision of 4 May 2017, Valvira rejected an objection lodged by A. According 
to the grounds for that decision, A was granted the right to pursue the profession 
of doctor under Paragraph 6a (as amended by Legislative Amendment 
No 1659/2015) of the Law on professionals in a situation where she lacked the 
certificate of experience referred to in point 5.1.1. of Annex V to the Professional 
Qualifications Directive, which the United Kingdom had defined as being a 
component of the basic medical training harmonised at Union level. 
Helsingin hallinto-oikeus (Helsinki Administrative Court) 
8 A appealed to the Helsinki Administrative Court, requesting that the decision be 
annulled and the case be referred back to Valvira for reconsideration. 
9 The Helsinki Administrative Court dismissed A’s appeal by decision of 
5 December 2017. According to the grounds for the decision, automatic 
recognition under the Professional Qualifications Directive was not possible 
because A had not provided the certificate referred to with regard to the United 
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Kingdom in point 5.1.1. of Annex V to the Professional Qualifications Directive. 
According to the Administrative Court, the general system of recognition was also 
out of the question, since A had not completed the basic medical training before 
the reference date specified in point 5.1.1. of Annex V (20 December 1976). 
According to the Administrative Court, the right granted to A in another EU 
Member State cannot be better than that granted in the home Member State. 
10 According to the grounds for the Administrative Court’s decision, in A’s case it 
was necessary to apply Paragraph 6a (as amended by Legislative Amendment 
No 1659/2015) of the Law on professionals, on the basis of which a person who 
has obtained an undergraduate degree in medicine in another EU/EEA State has 
the possibility to complete a postgraduate professional traineeship in Finland and 
obtain the right to pursue the profession in Finland. According to the 
Administrative Court, Valvira was entitled to grant A the restricted right pursuant 
to Paragraph 6a (as amended by Legislative Amendment No 1659/2015) of the 
Law on professionals to pursue the profession of doctor in the period from 
2 November 2016 to 2 November 2019 under the direction and supervision of 
another licensed doctor entitled to exercise the profession independently as a 
licensed professional. 
Supreme Administrative Court 
11 Before the Supreme Administrative Court, A claimed that her application for 
recognition of the undergraduate degree in medicine obtained in another Member 
State of the EU should be dealt with by applying the rules on the general system 
of recognition in the Professional Qualifications Directive, if the conditions for 
automatic recognition are not met. 
12 According to A, the three-year limitation imposed on her right to pursue the 
profession of doctor is contrary to the freedom of establishment under Article 49 
TFEU. The three-year period set by Valvira is discriminatory because it is nine 
times longer than the four-month compulsory medical internship included in the 
Finnish undergraduate degree in medicine, that is to say, the licentiate in 
medicine. She submits that Valvira did not make the individual comparison 
required by the general system for the recognition of professional qualifications 
between the undergraduate degree in medicine obtained in the United Kingdom 
and the Finnish licentiate degree in medicine. It is contrary to EU law to impose a 
three-year period of supervision as a condition for the grant of the right to pursue 
the profession independently without evidence of substantial, uncompensated 
differences compared to the national standard. The three-year period under 
supervision cannot be justified on the ground of ensuring patient safety either, she 
submits. Paragraph 6a of the Law on professions does not take into account the 
principles arising from the judgment of the Court of Justice in Case C-340/89, 
Vlassopoulou, EU:C:1991:193. 
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Succinct presentation of the reasons for the request 
13 Valvira subsequently granted A authorisation to pursue the profession of doctor 
independently as a licensed professional in Finland on 1 November 2019. As A 
has not withdrawn her appeal before the Supreme Administrative Court, and the 
latter considers that an answer to a question concerning the interpretation of EU 
law is required in order to be able to resolve the case, the Supreme Administrative 
Court has referred that question to the Court of Justice for a ruling. 
14 The Supreme Administrative Court considers that it is evident that A could not be 
granted authorisation to pursue the profession of doctor independently in Finland 
on the basis of the principle of automatic recognition within the meaning of 
Article 21 of the Professional Qualifications Directive, since A did not have the 
certificate of experience referred to with regard to the United Kingdom in 
point 5.1.1. of Annex V to that directive, which is to accompany the evidence of 
formal qualifications. 
15 The Supreme Administrative Court considers that it is also evident that A could 
not be granted authorisation to pursue the profession of doctor independently in 
Finland on the basis of the general system for the recognition of evidence of 
training provided for in Chapter I of Title III of the Professional Qualifications 
Directive either, since she did not fulfil the conditions for the application of the 
general system for recognition set out in Article 10(b). 
16 The Supreme Administrative Court takes the view that, since A did not fulfil 
either the conditions of the automatic system of recognition that are applicable to 
the profession of doctor or the conditions for the recognition of the professional 
qualification under the general system of recognition, Valvira was not obliged 
under the Professional Qualifications Directive to make a comparison to clarify 
the extent to which the content of the undergraduate degree in medicine obtained 
by A in the United Kingdom is equivalent to that of the undergraduate degree in 
medicine obtained in Finland (licentiate degree in medicine). Accordingly, the 
host Member State is precluded from imposing requirements for automatic 
recognition other than those laid down in the directive and the annexes thereto 
(judgment in Case C-365/13, Ordre des Architectes, paragraph 21 and the case-
law cited). 
17 The Supreme Administrative Court takes the view that neither the Professional 
Qualifications Directive nor the case-law of the Court of Justice relating thereto 
contains any express, legally binding rules for a situation such as that at issue in 
the present proceedings, in which a person applied in the host Member State for 
recognition of a doctor’s professional qualification on the basis of an 
undergraduate degree in medicine obtained in the home Member State, without 
being able to provide an additional certificate attesting to the completion of a 
professional traineeship, as required by the home Member State for the purpose of 
obtaining the professional qualification. 
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18 In Finland, the national legislature has sought to resolve the problems caused by a 
situation such as that at issue in the present proceedings. Pursuant to 
Paragraph 6a(1) of the Law on professionals, Valvira is to grant, upon application, 
to a person who has obtained an undergraduate degree in medicine in an EU or 
EEA State in which the right to pursue the profession of doctor is contingent upon 
completion of a postgraduate professional traineeship, authorisation to pursue the 
profession of doctor in Finland as a licensed professional under the direction and 
supervision of a licensed professional, designated in writing, who is entitled to 
pursue the profession in question independently. The restricted right to pursue a 
profession is granted for a period of three years. 
19 Pursuant to Paragraph 6a of the Law on professionals, Valvira offered A two 
alternatives for obtaining authorisation to pursue the profession of doctor 
independently in Finland. A had to do one of the following within a period of 
three years: (a) complete a professional traineeship in accordance with the 
guidelines of the United Kingdom and apply to the competent authority in the 
United Kingdom for recognition of that traineeship in accordance with Article 55a 
of the Professional Qualifications Directive in order to be able to apply for the 
right to pursue the profession of doctor in Finland by virtue of the system of 
automatic recognition referred to in the directive; or (b) complete special training 
in general medical practice in Finland. Alternative (a) was offered as a preferential 
option, but A opted for alternative (b), which does not lead to automatic 
recognition of professional qualifications in other EU/EEA Member States within 
the meaning of the Professional Qualifications Directive. 
20 The Supreme Administrative Court considers that, since neither the Professional 
Qualifications Directive nor the case-law of the Court of Justice relating thereto 
contains any express, legally binding rules for a situation such as that at issue in 
the present proceedings, in which the competent authority ultimately decided the 
case on the basis of national legislation, the decision of the competent authority 
and the national legislation on which it is based must still be substantively 
assessed in the light of Articles 45 and 49 TFEU. 
21 For this reason, the Supreme Administrative Court considers the submission of the 
request for a preliminary ruling to be indispensable for the resolution of the case.