Australia, Austria, Belgium, Canada, Czech Republic, Denmark, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Japan, Korea, Luxembourg, Mexico, Netherlands, New Zealand, Norway, Poland, Portugal, Slovak Republic, Spain, Sweden, Switzerland, Turkey, United Kingdom, United States,
Remuneration of general practitioners

General Practice: General practice includes fully-qualified general practitioners (GPs). Physicians in training should normally be excluded.

Note: To the extent possible, average annual income should refer to physicians working full-time.

Salaried: Physicians who are employees and who receive most of their income via a salary.

Self-employed: Physicians who are primarily non-salaried. That is, they are either self-employed, or operate independently, usually receiving (mainly) either capitation or fee-for-service reimbursement.

For physicians who are both salaried and operate in a self-employed or independent capacity, they are presented in the category under which they receive the majority of their compensation.

Inclusion:
- the values of any social contributions, (income) taxes, etc. payable by the employee even if they are actually withheld by the employer and paid directly to social insurance schemes, tax authorities, etc. on behalf of the employee
- all gratuities, bonuses, overtime compensation and "thirteenth month payments"
- any supplementary income (income from private practices for salaried physicians or salaried work for self-employed physicians).

Exclusion:
- for salaried physicians, social contributions payable by the employer
- for self-employed physicians, practice expenses.

Sources and Methods

Australia

Self-employed general practitioners:
Australian Department of Health and Ageing, Medicare Statistics, Table B2:
http://www.health.gov.au/internet/main/publishing.nsf/Content/Medicare+Statistics-1
* Data are for fees charged by self-employed GPs providing services on a ‘fee-for-service’ basis for which Medicare benefits were paid. Salary and sessional payments are not included as these are not available from Medicare data.
* The average annual remuneration presented is gross income net of practice expenses. Practice expenses have been deducted by applying the average across OECD countries (30% of gross remuneration).
* Data is calculated per headcount. The numbers of GPs are Medicare billers to 2001 and Australian Institute of Health and Welfare (AIHW) GP labour force estimates thereafter. Full-time equivalent data is not available from Medicare.
* Years reported are financial years 1 July to 31 June (e.g. 2006–07 is reported as 2006).

Austria

Self-employed general practitioners:
National Audit Office, Income Reports http://www.rechnungshof.gv.at/berichte/einkommensberichte.html.
* Data refer to self-employed GPs.
* Data are calculated per headcount.
* Data refer to income before taxes and exclude social insurance payments.

Belgium

Self-employed general practitioners:
Institut national d’assurance maladie-invalidité (INAMI).
* Data based on fee reimbursements by social security health care insurance to self-employed GPs and do not include additional incomes from other payment methods.
* Data refer to gross income and include practice expenses (resulting in an over-estimation).
* Figures are means calculated per head-count.

Canada

Salaried:
* There are no data available at the national level on the income of physicians who are paid exclusively on salary.
Self-employed general practitioners:
Canadian Institute for Health Information, National Physician Database.
Canadian Medical Association, Physician Resource Questionnaire.
* 2006 data refers to 73% of all practising GPs:                                                                  
Physicians who received fee-for-service payments in excess of CAD 60 000 in 2006/07*
Total practising physicians excluding residents on 31 December, 2006**
Physicians in private practice who received
fee-for-service payments in excess of CAD
60 000 as a % of total physicians
Family medicine
23 500
31 989
73%
* CIHI, Average fee-for-service Payment Per Physician Report, Canada, 2006/07.
** CIHI, Scott’s Medical Database (SMDB), formerly Southam Medical Database.
* Data refer to average fee-for-service payments by provincial medical care plans to family physicians in private practice who billed the plans at least CAD 50,000 annually in 1997 and 1999 and at least CAD 60,000 annually in 2001 onwards.
* The physicians who received less than CAD 50,000 before 1999 and CAD 60 000 after 2001 in fee-for-service payments are either self-employed physicians working part-time (or self-employed physicians who were not in practice during the full year) or full-time physicians obtaining a portion if not most of their remuneration on alternative payments modes. In Canada, alternative modes of remuneration refer to payments made for clinical services provided by physicians and not reimbursed on a fee-for-service basis. Classifications vary across provincial/territorial jurisdictions.
* Figures are gross income, net of practice expenses. Information on overhead expenses reported by family physicians in the annual Physician Resource Questionnaire of the Canadian Medical Association (CMA) was used to estimate practice expenses. The average practice expenses of family physicians primarily on fee-for-services was roughly estimated as 35% of gross earnings in 2002 to 2006, based on information on the share of overhead costs collected by the CMA for the last time in 2002.

Czech Republic

Salaried general practitioners:
* Data not available.
Self-employed general practitioners:
Institute of Health Information and Statistics of the Czech Republic. National Health Information System.
* Data come from the survey on independent establishments of out-patient care.
* Figures apply to about 85% of all GPs (source: IHIS CR, Registry of Physicians, Dentists and Pharmacists).
* Data cover both full-time and part-time workers but reflect the workload of physicians, i.e. income is divided by the estimated number of full-time equivalent physicians.
* Data are gross income, net of practice expenses. Practice expenses consist of material, wages of employees, social and health insurance of employees, overhead cost (energy etc.) and other expenditure.

Denmark

* Data not available.

Finland

Salaried general practitioners:
Statistics Finland, Structure of Earnings.
* GPs include medical doctors who are assistants and work as assistant physicians or at health centres.
* Data do not include GPs who are working only part-time. GPs are included in figures only if their working time is more than 90% of the general working time in the collective agreement. The general working time for GPs is generally 37.00 or 38.25 hours/week.
* Data refer to the total earnings which include annual salary and additional earnings. Annual salary consists of monthly salaries, result-based bonus, compensation based on years in service, additional holiday pay and other salary items that are paid once a year. Additional earnings include payments such as overtime pay, fringe benefits and shift premiums.
* The statistics refer to all employer sectors. Data related to the private sector include only salary earners that work in a company that employ five or more employees.

France

Self-employed general practitioners:
Direction de la recherche, des études, de l’évaluation et des statistiques (DREES), Ministère de la Santé, de la Jeunesse et des Sports, based on data from the Système National Inter-Régimes (SNIR) prepared by the Caisse nationale d'assurance-maladie des travailleurs salariés (CNAMTS) and déclarations contrôlées des bénéfices non commerciaux (BNC).
* Data refer to physicians from metropolitan France (excluding replacement staff). Since 2000, the SNIR data coverage has been extended slightly with the integration of military schemes and of the autonomous harbour of Bordeaux.
* Data cover GPs and "médecins généralistes à exercice particulier" (MEP). About 89% of those covered are GPs. The MEP category includes physicians with specific activities, such as acupuncturists or homoeopathists.
* Data are calculated per full-time equivalent. Physicians who have begun or finished their practice in the year or who are older than 65 years are excluded.
* Data are based on fee-for-service payments and do not include salary payments.
* Figures refer to gross income before income tax and social security contribution and exclude practice expenses and tax on professional activities. The rate of tax on professional activities is available only for the average remuneration calculated per headcount, and this tax rate is applied to the full-time equivalent remuneration.
* Data from 2005 are estimated based on the tax rate in 2004, which accounted for 35.5% of total remuneration. Between 1995 and 2004, the average rate was 35.0%.

Germany

Salaried general practitioners:
Federal Statistical Office, Structure Earnings Survey 2006. (visit http://www.destatis.de)
* Data include all salaried physicians. A breakdown between salaried general practitioners and specialists is not available.
* Average annual gross earnings and bonus payments of full-time employed physicians.
* Data do not include earnings from private liquidations.
Self-employed general practitioners:
* Rating commission (Bewertungsausschuss) and cost structure statistics of the Federal Statistical Office.
* Data are based on information of the rating commission (Bewertungsausschuss) on the average gross earnings of self-employed general practitioners for the treatment of patients insured under the Statutory Health Insurance Scheme, and an estimated average income that the self-employed general practitioners receive for the treatment of patients not insured under Statutory Health Insurance Scheme (usually insured with private Health Insurance companies). The estimation is based on the cost structure statistics of the Federal Statistical Office which provides information about the share of revenues general practitioners receive from the Statutory Health Insurance Scheme and from other sources.
* Data are average gross earnings of all self-employed general practitioners. Practice expenses are excluded.

Greece

* Data not available.

Hungary

Salaried general practitioners:
National Institute for Strategic Health Research (ESKI). www.eski.hu.
* Data cover only public employees. Up to 2004, the data refers to approx. 400 GPs employed in public service (in 2005, 270 GPs) and 6,300 GPs, who are mostly self-employed, are not included (the share of GPs employed in public service is approximately 10%, and the share of self-employed GPs is 90%).
* Data refer to practitioners employed full-time.
* Data include payments for working evenings, nights, weekends, bank holidays and overtime.
* Data include only salary paid by the employer, and do not include income derived from private practices.
* The official salary of public sector medical doctors is very low compared with earnings in other sectors of the economy, and informal payments substantially increase the income of some doctors. These payments, however, are not included.

Iceland

Salaried general practitioners:
Ministry of Finance.
* Data refer to annual income of salaried state-employed GPs who work in public health care centres. GPs working in a few health centres run by municipalities or in privately-run health centres (with an agreement with health authorities) are excluded.
* Data relate to full-time equivalent.
* Data include monthly salaries and payments for overtime, evening, night and weekend shifts and others.

Ireland

Self-employed general practitioners:
Primary Care Reimbursement Service.
* Remuneration refers to payments made to General Practitioners by the Primary Care Reimbursement Service. These GPs provide services to persons eligible under the General Medical Services (GMS) scheme. It should be noted that not all GPs participate in this scheme. Also, GPs who do participate may also have remuneration from private practice which is not included in the data.
* Payments to GPs under the GMS Scheme include:
- All fees (excluding superannuation)
- Annual leave allowance
- Rural practice allowance
- Rostering/Out-of-hours allowance.
* Study leave payments, locum, nursing and secretarial support, plus other practice support payments are not included.
* Up to 2004 the data is sourced from the General Medical Services (Payments) Board Annual Reports. From 2005, data is from the Primary Care Reimbursement Service Statistical Analysis of Claims and Payments, Health Service Executive.
* The figures for 2005 include arrears paid resulting from the implementation of a 2005 Labour Relations Commission agreement.

Italy

* Data are not available for GPs and specialists separately. The remuneration for salaried physicians is available and amounts to EUR 74 026 (USD PPP 85 483) for 2008. Data cover physician managers, veterinary and other types of physicians. Data include basic pay plus all bonuses, including the 13th month payments but do not include bonuses related to individual performance or individual working conditions, and any supplementary payment agreed at the company level.

Japan

* Existing data is not in line with the OECD definition. Data is available for all physicians together. It is not possible to separate remuneration for GPs and specialists since the professional category of GPs does not exist in Japan.
* Based on the OECD calculation using monthly wage and additional payment data from Basic Survey on Wage Structure 2006 (Ministry of Health, Labour and Welfare), the remuneration of salaried physicians is JPY 11 011 900 (USD PPP 88 474) for 2006. Data refer to regular employees who work for private establishments with 10 or more regular employees and exclude part-time employees. Data include wages paid to employees for the survey month of June, based on paying conditions and calculating methods specified in advance in the labour contract, labour agreement, and/or working rules of establishments. Data also include additional payments such as bonus and term-end allowance and other payments paid in the previous year (in principle, a year from January to December). They include temporary payments not based upon agreements or rules settled in  advance, regular payments made less frequently than every three months and a back pay under a new labour agreement. Data refer to gross remuneration before tax.

Korea

* Data not available.

Luxembourg

Salaried general practitioners:
Social Security General Inspection.
* Data refer to gross income before tax, net of practice expenses per salaried GP.
* Data do not include physicians in training.
* Figures exclude foreign physicians who do not pay social security contribution in Luxembourg and physicians who practice mainly outside of the country.
* Figures do not include physicians whose annual income is less than the minimum social salary (annual average) of EUR 16 596 in 2003, 16 946.6 in 2004, 17 711.2 in 2005 and 18078.6 in 2006. Hence, those physicians who begin or stop their practices in the year are not included.

Self-employed general practitioners:
Social Security General Inspection.
* Data refer to gross income before tax, net of practice expenses per self-employed GP.
* Data do not include physicians in training.
* Figures exclude foreign physicians who do not pay social security contribution in Luxembourg and physicians who practice mainly outside of the country.
* Figures do not include physicians whose annual income is less the than minimum social salary (annual average) of EUR 16 596 in 2003, 16 940.6 in 2004, 17 711.2 in 2005 and 18078.6 in 2006. Hence, those physicians who begin or stop their practices in the year are not included.

Mexico

Salaried general practitioners:
Ministry of Health (MOH) and Instituto Mexicano del Seguro Social   (IMSS) “Authorized tabulator of medical personnel”.
* The average wage of general practitioners is based on information from MOH and IMSS. MOH data includes GPs in normative functions and GPs classified as level A, B and C. Data from IMSS refers to the gross income of the most represented levels.
* Data refer to average gross annual income and exclude payments for overtime, evening, weekend shift and holidays.
* Figures refer to salary in the public sector.
* Data for 2007 are estimated.
* Data are not calculated per full-time equivalent.
* 2007 data are based on the wage increase stipulated by law. Wages include benefits and advantages according to the law. Payments for overtime, incomes from private practices or informal payments received are not included. Data represent the average wage of GPs in the following public institutions: Ministry of health (SSA), Social Security Mexican Institution (IMSS), and Social Institute of Security and Services of the Workers of the State (ISSSTE).

Netherlands

Self-employed general practitioners:
Ministry of Health, Welfare and Sport.
* Figures apply to about 90% of all practising GPs (as of 1 January 2003: self-employed GPs: 7 385; total number of GPs: 8 107 (head count); in 2006: self-employed GPs: 7 583; total number of GPs: 8 408) (Source: Netherlands Institute for Health Services Research ).
* Data refer to full-time equivalent, based on a norm practice (2 350 patients). Figures include compensation for evening, night and weekend shifts for GPs working in acute care.
* Data exclude practice expenses.

New Zealand

Salaried general practitioners:
* Data not available. GPs with the exception of the West Coast District Health Board are not salaried in New Zealand.
Self-employed general practitioners:
* Data not available. Existing data are not in line with the OECD definition: data from New Zealand Business Benchmarking Survey 2005, conducted by Waikato Management School, University of Waikato, are not very comprehensive since data are supplied voluntarily by business accountants and comprises median rather than average remunerations.   

Norway

Salaried general practitioners:
* Data are not available exclusively for salaried GPs. Data for salaried GPs are compiled together in the remuneration of salaried specialists.  
 
Poland

Salaried general practitioners:
* Existing data are not in line with the OECD definition. The structure of earning by occupation survey, conducted from 2001, in units with ten or more employees, collects salaried annual income/earnings for ISCO’88 group 222 – health professionals. The group includes medical doctors, dentists, veterinarians, pharmacists and health professionals (except for nursing) not elsewhere classified together and it is not possible to separate the remuneration for GPs and specialists.

Portugal

Salaried general practitioners:
* Data not available exclusively for salaried GPs. Data for salaried GPs compiled together in the remuneration of salaried specialists.

Slovak Republic

Salaried general practitioners:
Ministry of Health. Quarter Report on Employees in Health Service in the SR and on their Wage Sources in Health Service in the Slovak Republic, M(MZ SR) 2-04.
* Data refer to physicians working in state/public health care establishments and do not include physicians in private and non-profit organisations.
* Data are not available exclusively for GPs and data for salaried specialists are compiled together.
* Data refer to average annual income of physicians who receive most of their income through a salaried arrangement.
* Data refer to income before tax and include social contributions, gratuities, bonuses, ex-gratia payments, and thirteen month payments.
* Data do not include severance payments, lodging, transport, cost-of-living, family allowances, social security contributions, maternity leave, and sickness pays.

Spain

* Data not available.

Sweden

Salaried general practitioners:
Swedish Medical Association and the Federation of the county councils.
* Data cover GPs employed by the county councils.
* Data are calculated per full-time equivalent.
* The figure does not include payments for being on call and overtime payments.

Switzerland

Self-employed general practitioners:
Hasler, N. (2006) “Revenus des médecins indépendants de Suisse en 2002 (réévaluation) et 2003 (nouveau)”, Bulletin des médecins suisses (BMS) 2006 n°39, Fédération des médecins suisses, Berne.
Hasler, N. (2006) “Revenus des médecins indépendants de Suisse en 2001 et 2002”, BMS 2006; 87 n°3, Fédération des médecins suisses, Berne.
Hasler, N. (2008) “Revenus des médecins indépendants de Suisse en 2003 (réévaluation) et 2004 (nouveau)”, BMS 2008; 89 n°6, Fédération des médecins suisses, Bern.
Hasler, N. and M. Reichert (2009) “Revenus des médecins indépendants de Suisse en 2004 (réévaluation) et 2005 (nouveau)”, BMS 2009; 90 n°11, Fédération des médecins suisses, Bern.
See http://www.saez.ch/f/set_archiv.html.
* Data are for both salaried and self-employed GPs but since most GPs are self-employed in Switzerland, data are classified as self-employed GPs.
* Figures relate to gross income subject to the contribution for “old age and survivors insurance” (AVS Assurance vieillesse et survivants), which is the 1st pillar of the Swiss social security system. Data exclude deduction for voluntary payments to the 2nd and the 3rd pillars of the social security system, of which the legal ceiling is set at about CHF 30 000.
* Physicians over 65 years old are excluded.  
* Data refer to head-count.

Turkey

* Data not available.

United Kingdom

Self-employed general practitioners:
* Data from the NHS Information Centre’s annual GP earnings survey.
* There was no enquiry in 1996, due to the change to self assessment of tax liability. Income tax for the self-employed changed from assessment on prior year earnings to current year earnings. Estimates of earnings and expenses were therefore taken together in 1995 and 1996.
* The Inland Revenue changed the treatment of capital allowances in calculating tax liability for 1996 as part of the move from tax assessment based on prior year earnings to current year earnings. Figures relating to years between 1995/96 and 1997 have been adjusted to put them on a comparable basis with previous years.
* Figures from 1998 onwards are not adjusted in respect of the changed treatment of capital allowances in calculating tax liability in 1996. Therefore they are not on a comparable basis with previous years.
* Figures for 1971 to 2001 are based on General Medical Services (GMS) GPs. Personal Medical Services (PMS) GPs were included in the EEQ (annual enquiry) for the first time in 2002, therefore figures relating to GPMS (both GMS and PMS GPs) are only available from 2002 onwards.
* From 2003 onwards, EEQ results are at UK level. Prior to this, they were published at GB level.
* Figures tie in with Financial year rather than calendar year.
* Data includes full-time and part-time GPs.
* Data excludes expenses.
* Data includes overtime, bonuses and other payments and represents profit after expenses have been taken account of.

United States

Salaried general practitioners:
U.S. Remuneration Estimates for General Practitioners
Source: Salaried and Self-employed. 2001 Patient Care Physician Survey. American Medical Association.
Coverage: This survey was a nationally represented survey of physician practice characteristics.
* The data shown here is the annual mean physician income, after expenses and before taxes for general/ family practice specialties.
Deviation from definition: Data matches OECD definition. Data is for both full-time and part-time physicians.
Deviation from calculation method: Calculation method matches OECD definition.
* No breaks in time series.
Self-employed general practitioners:
Source: U.S. Remuneration Estimates for General Practitioners, 2001-Patient Care Physician Survey. American Medical Association.
Coverage: This survey was a nationally represented survey of physician practice characteristics.
Deviation from the definition: The data shown here is the annual mean physician income, after expenses and before taxes for general/ family practice specialties.
Deviation from the calculation method: Calculation method matches OECD definition.
* No breaks in time series.

                                             
Source OECD HEALTH DATA 2009, November 09Last update: 09/29/2009