The remuneration of various categories of doctors affects the financial attractiveness of general practice and different specialties. Differences in remuneration levels of doctors across countries can also act as a “push” or “pull” factor when it comes to physician migration. In many countries, governments can determine or influence the level and structure of physician remuneration by regulating their fees or by setting salaries when doctors are employed in the public sector.
In all European countries, the remuneration of doctors (both GPs and specialists) is substantially higher than the average wage of all workers. In most countries, GPs earned two to four times more than the average wage in each country in 2020, while specialists earned two to five times more (Figure 7.12).
In most countries, specialists earned more than GPs, but the gap varies. In Belgium, self-employed specialists earned at least twice as much as self-employed GPs in 2020. In Germany, the difference between specialists and GPs is much smaller (about 20%).
In most countries, the remuneration of doctors has increased in real terms (adjusted for inflation) since 2010, but at different rates across countries and between GPs and specialists (Figure 7.13). The increase among both specialists and generalists has been particularly strong in Hungary. The Hungarian Government increased substantially the remuneration of specialists and generalists over the past decade to reduce the emigration of doctors and shortages.
In some countries, like Portugal, Slovenia and the United Kingdom, the remuneration of both GPs and specialists fell in real terms between 2010 and 2020. In Portugal, the reduction occurred between 2010 and 2012: since then, the remuneration of doctors has increased, but remained lower in 2020 than in 2010 in real terms. In the United Kingdom, the remuneration of doctors fell in real terms over the past decade as was also the case for nurses and other NHS staff (The Health Foundation, 2021[1]).
In several countries, the remuneration of specialists has gone up faster than that of generalists since 2010, thereby increasing the remuneration gap. However, in Austria, Belgium and the Netherlands, the gap has narrowed slightly, as the income of GPs grew more than that of specialists.
