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 2022, while specialists earned two to five times more (Figure 7.11). The earnings of both GPs and specialists in Germany relative to the national average wage are greater than in other countries.
In most countries, specialists earned more than GPs, but the gap varies. In Belgium, self-employed specialists earned more than twice as much as self-employed GPs in 2022. In Germany, the difference between self-employed specialists and self-employed GPs is much smaller (about 12%).
When comparing doctors’ income, it is important to bear in mind that the remuneration of different categories of surgical or medical specialties can vary widely within a country. For example, in Germany, ophthalmologists and radiologists had on average at least twice the income of paediatricians, neurologists and psychiatrists in 2021 (Destatis, 2023[1]).
In most countries, the remuneration of doctors has increased in real terms (adjusted for inflation) since 2012, but at different rates across countries and between GPs and specialists (Figure 7.12). The increase among both specialists and GPs has been particularly strong in Hungary, where doctors and other health professionals have received large wage increases under a new public sector employment contract that was adopted in 2020. In addition, the new medical service contract for doctors working in the public sector in Hungary granted them with a 120% salary increase over three years (between 2021 and 2023), with the largest increases occurring in the first two years, as an incentive to keep on working in the public sector and to reduce informal payments (OECD/European Observatory on Health Systems and Policies, 2023[2]). The remuneration of GPs and specialists has also increased strongly over the past decade in Estonia and Poland. In several countries (e.g. Belgium, Germany, Poland, Spain), the remuneration of GPs has increased faster than that of specialists since 2012, thereby narrowing the remuneration gap.
In some countries, like the Netherlands, Portugal, Slovenia and Sweden, the remuneration of both GPs and specialists fell at least slightly in real terms between 2012 and 2022, as inflation rate increased faster than nominal income gains. In the United Kingdom, the remuneration of salaried specialists in hospital also fell in real terms over this past decade, as was also the case for nurses and other NHS staff (IFS, 2024[3]).
