An invoice for 300,000 złoty. Doctors' salaries were checked – who earns the most and who the least?

• Most specialist doctors work on contracts where remuneration depends on the number of procedures performed, points or hours of work
• The median contract is PLN 24,600, but the highest-valued contracts exceed PLN 100,000 per month.
• There is currently no system for assigning multiple contracts to one person, which makes it difficult to assess real earnings
• The Ministry of Health plans to introduce changes that will regulate contracting rules and limit excessive remuneration

Minimum wages in healthcare, including physicians' salaries, are defined by the Act (on the Method of Determining the Minimum Basic Remuneration for Certain Employees in Healthcare Facilities). In practice, this applies to most interns and non-specialized physicians. However, the majority (73%) of specialized physicians receive their salaries based on contracts, not employment agreements.

A contract physician is an independent contractor, running their own business, not an employee. As a company, they invoice the hospital for services performed. Hospitals bill contract physicians in various ways, depending on the negotiated terms. In the case of specialists, it is most often payment for results, meaning for a completed procedure or a number of points earned, according to data from the Agency for Health Technology Assessment and Tariff System (AOTMiT) presented at a meeting of the Tripartite Group for Healthcare. Hourly rates and mixed methods are also possible.

According to AOTMiT data, the median contract value for a specialist physician is PLN 24,600 (data for September 2024). A physician may have several contracts signed with different hospitals.

AOTMiT currently has no way to assign contracts to a single person. Therefore, it is not known what the earnings of this professional group are (average, median, etc.). It is also unknown what the contract value would be per full-time position.

- There is no obligation or practice to record working time under contractual agreements - AOTMiT noted in a response sent to PAP.

The value of some contracts is controversial – the top 1% of contracts range from PLN 100,000 to PLN 300,000. AOTMiT recorded 431 such contracts in September 2024.

In a July interview for Rynek Zdrowia, the president of AOTMiT, Daniel Rutkowski, said that there are between 450 and 500 doctors whose salaries exceed PLN 100,000 per full-time position.

Health Minister Izabela Leszczyna wants hospital contracts with doctors to include specific requirements . During a meeting with journalists in July, she pointed out that contract requirements can be imposed on the employer, meaning a hospital using public funds.

According to Leszczyna, it would be beneficial for a doctor to work under a contract at one primary hospital, and for the employer to grant them permission to work at another hospital. She emphasized that the contract should stipulate that the doctor in a given hospital receives at least half the salary they would receive if they were working under an employment contract (half-time equivalent).

The topic of medical contracts came up at Thursday's meeting of the Tripartite Group for Healthcare.

As Rynek Zdrowia (Health Market) has learned, Deputy Minister of Health Jerzy Szafranowicz has also proposed that hospitals be prohibited from entering into contracts that stipulate remuneration as a percentage of the procedure. Another proposal involves enabling the Agency for the Treatment of Occupational Health and Treatment (AOTMiT) to collect data on contract remuneration, so that contracts concluded by them can be assigned to specific individuals.

The highest salaries can be negotiated by specialists performing procedures that are most highly valued by the National Health Fund and for which hospitals compete.

Twenty-five percent of medical specialists work under employment contracts. According to AOTMiT data, their median salary is PLN 21,500 – this figure is calculated without converting to full-time equivalents.

The training required to become a specialist physician lasts at least 12 years. This period consists of six years of study, a 13-month internship, and several years of specialization training.

Interns receive the lowest salaries among doctors. As of July 1st, the minimum salary for these doctors is PLN 7,772.63 gross . Additional allowances, including those for night shifts, Sundays, and holidays, and overtime pay, must be added to the base salary for interns. Data from the AOTMiT (Attorney-at-Law and Administration) show that 80% of the salary paid to interns is base pay, and nearly 16% is on-call pay.

Doctors undergoing specialist training earn more. The minimum base salary for a doctor without specialization is PLN 9,736.24 gross , according to the law.

Physicians pursue specialization either through residency or non-residency. Residency is regulated and requires a physician to have an employment contract. However, residency slots are limited. For physicians pursuing non-residency specialization training, an employment contract is not required.

According to AOTMiT data, 59% of the salary paid to non-specialized physicians is base pay . 26% of this figure is on-call pay, and 8% is a seniority bonus. Additionally, there are bonuses, awards, and overtime pay.

AOTMiT data were obtained from 535 hospitals operating within the system of basic hospital health care services (PSZ, the so-called hospital networks).

This represents 95.7% of all hospitals in the so-called network , which corresponds to 95% of the value of contracts with the National Health Fund for these hospitals. The data was for September 2024.

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