How Much Do Doctors in Other Countries Make?

By Catherine Rampell
DESCRIPTIONSource: Congressional Research Service analysis; see notes in table below

In response to Uwe Reinhardt’s recent post on “rationing” doctors’ salaries, a number of readers wrote in asking about physician compensation in other countries.

Doing a direct comparison of remuneration across different countries is tricky because the same salary may allow for different standards of living in different places.

But here are two possible ways to think about these comparisons, taken from a 2007 Congressional Research Service report entitled “U.S. Health Care Spending: Comparison with Other OECD Countries.”

One way to compare cross-country data is to adjust the salaries for purchasing-power parity — that is, adjusting the numbers so that $1,000 of salary buys the same amount of goods and services in every country, providing a general sense of a physician’s standard of living in each nation.

These numbers are in the second, fourth and sixth columns of the chart below.

They show that American general practitioners and nurses earn more than their counterparts in other developed countries, and American specialists are close to the top of the pack.

DESCRIPTIONSource: Congressional Research Service (CRS) analysis of Remuneration of Health Professions, OECD Health Data 2006 (October 2006), available at [//www.ecosante.fr/OCDEENG/70.html]. Sorted by specialists’ compensation. Amounts are adjusted using U.S. dollar purchasing power
parities. Amounts from previous years are trended up to 2004 dollars using the annualized Bureau of
Labor Statistics Employment Cost Index for wages and salaries of health services workers in private
industry. It is not known whether wage growth in health professions in other countries was similar to
that in the United States. Amounts are from previous years for 10 countries: data for Australia,
Canada, Denmark (for specialists and nurses), Finland (for nurses), and the Netherlands are from
2003; data for Belgium (for specialists), Denmark (for general practitioners), New Zealand (for
nurses), and Sweden are from 2002; data for Switzerland and the United States (for specialists and
general practitioners) are from 2001; and data for Belgium (for general practitioners) and the United
States (for nurses) are from 2000. Ratios of salaries to GDP per capita reflect the year the data was
collected and are not adjusted for inflation. For countries that have both self-employed and salaried
professionals in a given field, the amount presented here is the higher of the two salaries. Four
countries have both salaried and self-employed specialists: the Czech Republic (where compensation
is $29,484 for salaried and $34,852 for self-employed specialists), Greece ($67,119 and $64,782), the
Netherlands ($130,911 and $252,727), and the United States ($170,300 and $229,500). One country
has both salaried and self-employed general practitioners: in the United States, salaried general
practitioners earn $134,600, compared with $154,200 if self-employed. All nurses are salaried among
this data.

Another way is look at how a doctor’s salary compares to the average national income in that doctor’s country — that is, gross domestic product per capita. These numbers are in the third column, fifth and seventh columns of the chart.

As a country’s wealth rises, so should doctors’ pay. But even accounting for this trend, the United States pays doctors more than its wealth would predict:

DESCRIPTIONSource: Congressional Research Service (CRS) analysis of Remuneration of Health Professions, OECD Health Data 2006 (October 2006), available at [//www.ecosante.fr/OCDEENG/70.html].

According to this model, the 2007 report says, “The U.S. position above the trendline indicates that specialists are paid approximately $50,000 more than would be predicted by the high U.S. GDP. General practitioners are paid roughly $30,000 more than the U.S. GDP would predict, and nurses are paid $8,000 more.”

But it’s important to keep in mind, the report notes, that health care professionals in other O.E.C.D. countries pay much less (if anything) for their medical educations than do their American counterparts. In other words, doctors and nurses in the rest of the industrialized world start their medical careers with much less student loan debt compared to medical graduates in the United States.

For more data on health spending in O.E.C.D. countries, go here. For a recent American-only survey on the pay of physicians with various specialties, go here.

Comments are no longer being accepted.

Robert July 15, 2009 · 6:10 pm

Hum????

Funny, those euro doctors earn substantially less money then USA doctors but their whole population enjoys health care at far higher levels then Americans.

Socialized medicine! Case closed!

Robert
Washington, DC

Richard Savela July 15, 2009 · 6:30 pm

Seems to me that its unreasonable to ask a congress to make right a health care system they themselves don’t have to deal with from a cost perspective. When did we grant Congressman free health care and while we are at it, full pension benefit in retirement? Perhaps if they lived in the world of their constituents, they would think and act more in our best interests.

Mason July 15, 2009 · 6:39 pm

Robert – Where, like the Netherlands! Did you look at the data, and did you factor in the cost of 8-12 yrs lost wages for training and $200K in debt. If you want to find out why your health care is underperforming look at wages of your insurers CEO, and the pharma CEO.

Richard July 15, 2009 · 6:43 pm

Did anyone take into account the fact that at the higher levels business people, academics, even politicians in other countries do not make as much as in the US? The US has an income distribution which allows for much higher income than elsewhere. Relative to this, US doctors appear lower on the scale of business executives than in other Western countries, and when you allow for the fact that others have virtually no student debt (nor do other educated people in Western countries excluding the US), and do not have to pay high health insurance premiums – (yes, doctors pay those too), I suspect that they are quite well off indeed – and it is nothing to do with “socialized” medicine, usage of which term advertises ignorance of how the systems work (in various ways).

Deborah July 15, 2009 · 7:07 pm

These are meaningless figures unless one knows what the doctor’s expenses are, how many hours they are working for their “salary” and what kind of benefits they receive, if any.
Doctors in Europe have paid pensions, for example.

$175,000 over 48 weeks working 75 hours a week = $48.hr. with unpaid vacation time.

Henry July 15, 2009 · 7:11 pm

So am I to understand that some folks would prefer that MDs make less money?

Does that mean that they are also willing to run the risk that the “best and brightest” college students will go aspire to careers in technology, banking, and consulting at higher rates than they already are?

Let me know how that works out for you.

(Oh right; I guess if the all-knowing government begins to regulate wages across the board — along with everything else, for that matter — all problems will be solved.)

Never mind!

AJ, Anchorage AK July 15, 2009 · 7:19 pm

In order to have true parity, one needs to factor in several things that aren’t mentioned:

-the cost of schooling
-the amount of malpractice exposure
-the burdensome regulations (HIPAA, JCAHO licensing)
-the time spent on paperwork for documentation and insurance claims
-the cost of “acceptable” CME
-overhead costs

I think you’ll find that physicians spend a lot more to maintain a practice in the US than in any other country for exactly the reasons just enumerated. Looking exclusively at salary is pandering to people whose objectivity about the costs of health care is already questionable.

Jonathan July 15, 2009 · 7:29 pm

The study concludes that the average doctor graduates with approximately $130,000 of debt, an amount covered in merely 3 years of additional salary (discounted however you would like).

To that number I would also add approximately $200,000 of lost earnings due to being in school for the additional 4 years, assuming a salary of $50,000 per year. This brings the total cost of schooling in the U.S. to an estimated $330,000 more than a heavily subsidized or free OECD program.

Over a lifetime of earnings at a doctor´s salary, $330,000 does not strike me as that much. That amount easily recovered in less than 8 years of $50,000 additional dollars in salary.

The larger question that the study fails to address is the recurring cost of insurance. What is the average malpractice insurance rate, and how does that compare to malpractice insurance rates in europe? Accounting for the insurance differences would reveal a clearer comparative salary number.

Martin July 15, 2009 · 8:08 pm

What’s the story with Norway? It looks like an outlier to me. If so, the modeled relationship between per capita GDP and specialist compensation would trend higher faster, and the U.S. would be less of an outlier than is otherwise suggested.

a July 15, 2009 · 8:20 pm

This is why medical schools and the medical insurance industry needs to be reformed as part of health care reform.

First of all, the AMA monopoly on medical school formation needs to be revoked. Monopolies are illegal and un-american and should be crushed wherever they appear. The AMA has artificially limited the supply of doctors for years in a blatant attempt to manipulate the market. We need a lot more schools training a lot more medical practitioners at all levels.

Second, we need to get medical school tuition under control by whatever means necessary. Flagship public schools like UC Berkeley have produced some of best graduate students in the world while keeping tuition very low. We should not be saddling potential doctors with hundreds of thousands of dollars in debt, or dissuading people from pursuing a career in medicine due to their fear of this debt.

Third, we need to regulate the insurance industry and get rid of the completely out-of-control malpractice situation in this county. Doctors currently require very high salaries because they have to pay so much in needless malpractice insurance.

chrisLV July 15, 2009 · 8:21 pm

As in the old adage, “there are 3 kinds of lies, lies, damn lies and statistics. This is an excellent example of the latter. As listed in comment #7, no one has taken into consideration the unique factors that make a doctors remuneration so high in the USA. This study is not worth reading.

CCinNYC July 15, 2009 · 8:28 pm

Very interesting. Of course you would need to consider other factors (taxes, free social services, other quality of life measures).

And also I would like to see the same salary v. GDP graph for other professions. As a primary care physician I am astonished at how much recent law graduates or MBAs can earn compared to my stagnant salary after 10 years in the field.

Shine July 15, 2009 · 8:30 pm

Part of the problem is that the US system encourages having some very specialized fields where people earn a huge amount of money, draining money from everybody else.

Executives of pharmaceutical companies and banks are equal in this respect. They have very high salaries, but is it because they are so useful? So productive? So intelligent? No, it is because they can force the rest of the people to pay them that. And according to the rules of capitalism, whoever has the leverage to do that has “earned” the money.

JT Guy July 15, 2009 · 8:34 pm

I am A physician [retired] and I sincerely hope this country gets the health care they deserve. You make take that any way you please!

Fritos July 15, 2009 · 9:10 pm

Hola Amigos:

Living here in Peru I can tell you that “Cost of Living” is a big factor in comparing “income”. Don’t judge too quickly that US is over paid. We have costs in the US that people in this part of the world never heard of.

That is my arguement. Why doesn’t congress do something about LOWERING the cost of living in the US rather than pass legislation that constantly increases our cost of living. A nice place to start would be Medical Liability Insurance but there are tons of others!!

nrm July 15, 2009 · 9:11 pm

Echoing the comments of others…..one has to consider the burden of educational costs, liability insurance, the cost of time (and therefore lost income) in dealing with insurance companies for reimbursement AND to obtain the benefits their patients have already paid for via insurance plans when considering physician incomes in this country. There are many benefits of foreign medical systems which many physicians in this country recognize (the AMA notwithstanding). What about the income of lawyers in other countries? Let’s consider that at some point.

In the arena of health care, we need to think about hospital execs often exorbitant compensation. The system here is faulty but focusing only on physician compensation will be a disservice to both physicians and patients.

metoo July 15, 2009 · 9:12 pm

When and if the AMA is forced to allow more (twice would be a good number as a beginning) bright students to enter medical school and physician assistant programs service pricing issues will be resolved in the market place. Until then doctors need to be on salary as Mayo Clinic (excellence is their forte) physicians are.

RB July 15, 2009 · 9:13 pm

While I understand that this is a complex issue, this particular article does not factor in the work hour differences between countries. In many European countries, physicians work 40 hours or even less. In the US, the expectation is 80 hours but usually more – thus twice the hours of many people in other countries. Therefore it might be appropriate to examine $/hr.

Daniel Allan, MD July 15, 2009 · 9:19 pm

If the Federal government is going to control what we we are paid, then it should control our expenses. If fees are flat or decline, the we must see more patients to as our expenses inexorably increase. The Gov’t was happy with this arrangement, because it appeared that more patients were being seen without a concomitant increase in expenditures. The system broke down because more patients mean more lab and x-ray charges, more physical therapy and pharmacy charges, etc. Frankly, I would rather be a Gov’t employee, just like the TSA, and I';m a plastic surgeon. (So much for the Nip-Tuck stereotype.) Most of my practice is cancer and reconstruction. I will be happy to give my employer 40 hours a week and let the Gov’t take over the administrative headaches. Need care nights or week-ends; it won’t be my problem. Washington knows this, so it will never happen. As far as the number of medical students is concerned, there is a limit to the number that can be educated in a given school. If you want more medical schools, ask Congress to pony up the money. Don’t hold your breath. It’s cheaper to loot other countries of their physicians.

v July 15, 2009 · 9:19 pm

Jonathan,

Unfortunately, its not just 4 years of training but 7-12 depending on the field given that residency is little more than slave labor supposedly for “educational purposes.” In contrast, junior doctors in other countries such as Ireland, Great Britain, etc. are paid market wages not just given the equivalent of taxable stipends (as per the IRS). The opportunity cost alone is huge along with the fact that you start having a real income only in your 30s…

In fact, when you factor in we work double the hours (80 vs. 39 in most EU countries) our per hour pay is significantly worse for a very long period.

On that note, shoudn’t an attempt be made to standardize this pay scale for amount of hours worked? Isnt that the very first variable that should be controlled? Call shifts are treated as overtime not as salary in most European countries and are not mandatory…

Artemis July 15, 2009 · 9:21 pm

Henry,

Absolutely… yes, doctors should earn less. The “Best and the Brightest” are not motivated by maximizing the amount of money they can earn. It would be far better for society of doctors were instead motivated by the desire to heal the sick.

Capitalism has nothing to do with the “best.” Most self-interested, perhaps.

Tom C July 15, 2009 · 9:22 pm

Are there any military medical professionals out there who would care to comment? A couple dozen years ago I met a dentist who decided that rather than hang a plaque on a building, buying equiment, paying insurance, hiring staff, and basically running a small business for himself; he preferred to practice destistry as a U.S. Army officer. He gave up the bills and the big salary for much lower pay and steady hours, with additional education if he earned it. He even enjoyed the all-expense paid “adventure-travel” camping trips via helecopter. I guess he was in a State-sponsored Socialized medical system. I know the joke about “military medicine” being an oxymoron, but can somebody explain its relatitive merits or pit-falls?

bob July 15, 2009 · 9:28 pm

we should also look at output. most european countries have longer vacation time and less work hours.

how many patients does a physician treat? meaning if i get paid 200k and i treat 1000 patients a year that should be more effective than if i get paid 100k a year and i only treat 250.

Chaotician July 15, 2009 · 9:29 pm

The queer question in our long-suffering representatives striving to fulfill their obligation to “represent” their “voters” rather than those blood-sucking corporate lobbyists always stirving to enrich their sponsors with extortion and bribery of our “poor” congress men and women… is why does America which already spends twice as much per capita to provide the “failed” health care to much less than the total population… needs to spend more money to get a system that covers all but continues to allow the blood-sucking insurance companies to “cherry-pick” their insureds, offload the sick and the poor onto a government program, while no doubt forcing the owners and senior executives to feel guilty as they “legally” plunder the Health Care of our nations citizens! While Doctors make a very good income, its is these blood-sucking insurance company owners and executives which have not one part of providing health care for anyone and in fact are an obstacle at every contcat point in anyone getting needed health care; while the doctors and other health care providers actually provide services, keep abreast of medical advances, deal with the blood-sucking insurance companies to get paid for their services, treat with the petty deniers of service so critical to the blood-sucking business of the insurance parasites, and take on very large debt to be allowed to provide the needed services.

Nationalizing these blood-sucking parasites, and taking back their criminal blood-soaked monies; ending the racketeering practices associated with “claims” collection and processing; denying the criminal practices of industry lobbyists bribing our venal representives, the courts, and our politcial parties is vital to the well-being of America and its peoples!

Susan MD July 15, 2009 · 9:32 pm

Interesting. There are very few “general practitioners” in the US because now physicians are required to perform a residency. If by “general practitioner” you mean a primary care physician, that would include pediatricians, family doctors, internal medicine doctors, and geriatric specialists (some would argue to add ob/gyn to the mix). Salaries vary widely among these different specialties. Are your data for the old-school “GPs” (of whom few are still in practice) or an amalgamation of salaries for primary care doctors? Did you include OB/GYN (who make significantly more than primary care doctors due to performing more procedures and taking care of less sick people)? Please get more specific, GP doesn’t have a meaning in the US the way it does in other countries.