The supply and distribution of physicians within health systems in Europe have remained a challenge over the years and have become significant during the COVID-19 pandemic. Austria, with 5.5 physicians/1000 people; the highest anywhere in the EU in 2023, does not seem to be impacted by shortages in general.
Nevertheless, disparities persist across specialties, sectors, and regions. As of 2023, about 3% of contracted physician jobs remained unfilled, mostly in rural settings, indicating a decentralized fee model and disparities in job attractiveness among federal states.
The primary care has been hit especially with the share of general practitioners (GPs) declining to 13% in 2024, one of the lowest in the EU (16% in 2010 Contributing factors include high workload, bureaucratic pressure, low prestige, and poor pay.
At the same time, non-contracted physicians have contributed the most to the rise in the number of physicians, increasing by 40% since 2009 to 2019, compared to a 0 increase in contracted jobs. Non-contracted physicians have control over fees, patient selection, and working hours, and in most cases, have extra earnings by way of salaried employment in the hospital.
Although waiting times are reduced, the patients incur more out-of-pocket expenses, which is a matter of concern in terms of equal access. Policymakers have proposed reforms, including the 2024-2028 healthcare plan, to introduce new contracted jobs, standardize contracts, and provide incentives to encourage medical students to work in specific areas. The issue of physician earnings and their determinants is essential for informing workforce policy.
This study examined the income of self-employed doctors in Austria using linked data from the Federal Ministry of Finance (BMF) and the Federation of Social Security Institutions (DV). Contracted physicians had agreements with all statutory health insurance (SHI) funds, and non-contracted doctors had no agreements.
Both groups were allowed to work in hospitals on a salary. The BMF data included comprehensive income streams, and the DV data contained the individual-level data of age, sex, specialty, urbanization, state, consultation volume, and permission to dispense pharmaceuticals.
The income was calculated using corresponding codes of the ÖNACE 2008, including outpatient practice, hospital activities, and other health services. The total income was determined as the amount of self-employed income and wages that were adjusted to social security and mandatory contributions. Conditional quantile regression at the median was used to assess determinants of income for contracted GPs (models GP1–GP5) and specialists (models SP1–SP6).
There was incomplete data on non-contracted physicians, which was analyzed descriptively. The regression variables were age, sex, volume of consultation, specialty, urbanization, state, and dispensing rights, with consultation and urbanization effects being tested. In 2022, the dataset comprised 3489 contracted GPs and 5330 specialists.
Median income for GPs was EUR 191,649, with mean income EUR 221,687 (EUR 212,150 self-employed, EUR 9536 wages). The median number of annual consultations was 18,407; 54 percent of them were males, 18% had dispensing privileges, and 47% based their practice in rural communities.
Specialists had a median income of EUR 210,988, a mean of EUR 276,749 (EUR 264,708 self-employed, EUR 12,041 wages), and a median of 5309 consultations; 62% were male, 52% urban-based. Non-contracted physicians had a median income of EUR 100,849, a mean of EUR 132,753, with 25% solely self-employed.
Significant GP determinants included consultation volume, age, sex, state, and dispensing rights. Additional consultation contributed to an increment of the income by EUR 11.69 per annum. Male GPs had a higher gross income of EUR 16,675 in GP2 and EUR 6763 in GP4 compared to female GPs.
Dispensing rights contributed to EUR 90,478. Consultation volume and specialty were key to specialists, with laboratory/pathology specialists receiving a lower EUR -894,225, less than the median of Gynecologists, and surgeons receiving a higher EUR 109,482. The difference between male specialists was EUR 13,413–39,222, based on the model, and Vorarlberg specialists earned EUR 64,103 more than their counterparts in Lower Austria.
Austrian GPs and specialists have median incomes of EUR 191,649 and EUR 210,988, respectively, which contrasts with EUR 100,849 for the non-contracted physicians. Since 2015, the increase in earnings has been 34-47% higher than inflation. With these large incomes, it is still difficult to recruit to work on a contract basis, which indicates that monetary rewards are not sufficient to overcome physician misallocation.
The workforce policy should therefore incorporate non-financial aspects like working conditions, autonomy, and flexibility of the career, along with the planned expansion of contracted jobs. The modernization of the collective contracts, incentives in the primary care, and disparities in the regions should be reformed to maximize the distribution of physicians and provide equal access to health care services.
Reference: Stegner C, Reiss M, Czypionka T. What determines earnings of self-employed physicians in Austria? Evidence from quantile regressions using linked tax records. Health Policy. 2026;166:105568. doi:10.1016/j.healthpol.2026.105568
