How Numerus Clausus Works for Medicine Across Europe
By Muntasir Minhaz • Published Jun 03, 2026 • Guides, Study in Europe, Fields of Study
Medicine places are capped in most European countries, and the selection method differs by country. France uses a first year filter through PASS or LAS, Germany ranks applicants by Abitur grade and the TMS test, Italy replaced its entrance exam with an open filter semester from 2025-26, and Belgium runs an entrance exam with a quota for non-resident students.
🎓 France: PASS or LAS pathway now, a single first-year route planned from 2027
Germany: 30% Abitur-best quota, 10% aptitude quota, 60% university selection weighted by the TMS test
Italy: entrance test dropped for Italian-taught medicine, open filter semester instead, from September 2025
Belgium: entrance exam since 2017-18, non-resident quota around 30% nationally, 15% in the French Community
Netherlands: each university runs its own decentralized selection
Why medicine has capped places
Most European countries train far fewer doctors than the number of people who apply for medical school. Governments cap places to match teaching hospital capacity and control long-term healthcare spending. This cap is the numerus clausus, and each country sets its own formula for who fills the places.
The formula usually mixes secondary school grades with a standardized test, and sometimes an interview. Where you apply changes your odds more than most applicants expect, because the weighting differs sharply between countries.
France: PASS or LAS, with a bigger reform on the way
French students enter medicine through one of two first-year routes: PASS (Parcours Accès Santé Spécifique), a health-focused year with a secondary subject, or LAS (Licence avec option Accès Santé), a standard degree with a health option attached. Both feed into the same end-of-year selection for medicine, dentistry, pharmacy and midwifery, and only a portion of each cohort qualifies to continue.
The government announced in April 2026 that PASS and LAS will close from the 2027 intake, replaced by a single first-year health pathway built around three blocks: health, disciplinary and transversal. Students starting PASS or LAS before that point finish under the current system, according to the Ministry of Higher Education .
Germany: hochschulstart quotas and the TMS test
Germany allocates every human medicine and dentistry place through hochschulstart.de , split across three quotas: 30% by Abitur grade alone, 10% through an additional aptitude quota, and 60% through each university's own selection procedure (AdH).
Inside the AdH quota, up to 30 points come from your Abitur grade and up to 50 from the Test for Medical Studies (TMS) , used by 36 medical faculties for human medicine and 28 for dentistry. The TMS runs twice a year, and one resit is allowed if you want a second score. A strong TMS result lifts your odds at almost every German medical school, whatever your final grade looks like.
Italy: the entrance test is gone, the filter semester is in
Italy scrapped its old IMAT-style entrance test for Italian-taught Medicina e Chirurgia starting with 2025-26 admissions. Every applicant who meets the pre-enrollment conditions now starts an open Semestre Filtro (filter semester) covering chemistry, physics and biology.
You sit standardized national exams in each subject and need at least 18 out of 30 to pass. Only students who pass and rank high enough nationally move into the second semester as confirmed medicine students. The reform applies only to Italian-taught programs. English-taught medicine courses in Italy still use their own entrance test.
Belgium: an entrance exam plus a quota on non-residents
Belgium has required an entrance exam for medicine and dentistry since the 2017-18 academic year, covering maths, physics, biology, human sciences and a section on communication and empathy. Belgian and long-term resident students only need to pass. Non-resident applicants compete for a capped share of places.
The non-resident quota sits around 30% nationally, though the French Community sets it at 15% for students who have not lived in Belgium for at least three years, according to ULiège's admissions page . Ranking within that quota depends on your exam score.
Netherlands: each university selects its own students
Dutch medical faculties dropped the old weighted lottery years ago and now run decentralized selection (decentrale selectie), combining school grades, motivation and sometimes a test or interview. There is no single national formula. Each medical faculty sets its own criteria and timeline, so check the admissions page of every university on your list.
Comparing the five systems at a glance
| Country | Selection method | Key number to know |
|---|---|---|
| France | PASS or LAS, ranked at end of year one | Reform to a single pathway from 2027 |
| Germany | hochschulstart quotas plus the TMS | 60% of places go through university selection |
| Italy | Open filter semester, ranked nationally | Pass mark of 18/30 in each subject |
| Belgium | Entrance exam, resident vs non-resident quota | Non-resident quota near 30%, 15% in the French Community |
| Netherlands | Decentralized selection per university | No fixed national formula |
Applying as an international or non-resident student
Every system above treats non-residents differently from nationals, even within the EU. Belgium's quota is the clearest example, but France, Germany and Italy also weight your prior education and language proof differently if you completed secondary school outside the country. Contact each university's international office early, since document requirements such as equivalence certificates and language tests take longer to process than the domestic paperwork.
What decides your chances
Your home country and residency status decide which quota you fall into.
A strong entrance test score, whether that's the TMS, the Belgian exam or Italy's filter semester exams, usually outweighs a middling school grade.
Applying in your own country gives better odds than applying as a non-resident abroad.
Deadlines sit early and fixed. Miss the pre-enrollment window in Italy or France, or the hochschulstart application period in Germany, and you wait a full year for the next intake.
Check each country's official portal directly before you apply. Quotas and pass marks shift from year to year, and a change announced in April affects the intake the following autumn.