New Zealand
Pros
As an Emergency Department Registrar in New Zealand, the foundational salary stands at approximately $120,000. However, additional earnings ranging from $1,000 to $5,000 bi-weekly after tax are contingent upon undertaking extra shifts. Moreover, the hospital covers the reimbursement of all registration, college, and examination fees. Additionally, the opportunity exists to claim expenses related to textbooks. The remuneration package includes complimentary meals at the hospital canteen and free parking facilities.
Netherlands
The foundational salary for a Postgraduate Year 1 (PGY1) position is approximately €60,000, with automatic annual adjustments based on inflation plus an additional 2% for each year of service. It is noteworthy that, in this context, there is no provision for locum work. While additional compensation is provided for overtime or work conducted outside regular office hours, the option to work extra hours for additional remuneration is not available. Presently, my engagement in a PhD program has resulted in a reduction of €10,000 in my salary.
Compensation depends on the Clinical Academic Officer (CAO). In many District General Hospitals (DGHs), the initial monthly salary is approximately €4,200. However, to compute the annual salary, it is necessary to multiply this figure by approximately 14, as there is a double salary payout in June and December, constituting a holiday bonus. Additionally, a slight supplement is provided for evening and night shifts, resulting in an approximate annual salary of €60,000.
For roles in less popular specialties such as public health or psychiatry, individuals in their first postgraduate year (PGY1) have the potential to earn close to €5,000 per month.
Job opportunities for foreigners
Securing a training position is exceptionally challenging for non-Dutch graduates due to the self-sufficiency in producing an ample number of graduates domestically. Moreover, Dutch specialist salaries rank among the highest globally, contributing to the infrequency of professionals leaving the country. Unless one intends to pursue roles such as General Practitioner (GP), psychiatrist, or insurance/occupational physician, the requisites for obtaining a position typically include an outstanding curriculum vitae (CV), almost invariably featuring a Doctor of Philosophy (PhD) qualification.
Denmark
In Denmark, I am currently in my second year of clinical oncology training, a program spanning six years. My monthly remuneration stands at approximately £5,200, complemented by an additional £800 contributed to my retirement fund by my employer. The variation in monthly earnings is contingent on the number of shifts I undertake, averaging around three to four 17-hour night shifts per month. According to legal stipulations, my workweek totals an average of 37 hours. Despite a slightly higher tax rate, my take-home pay is 60% of the gross salary. Notably, I am exempt from tuition fees.
While the workload is demanding and the staffing levels are insufficient, I find my daily routine comparatively manageable when contrasted with the challenges outlined in your narratives. Upon specialization, my prospective work schedule will exclude night shifts, and the base pay is anticipated to increase to approximately £7,000. Furthermore, there is potential for substantial salary augmentation through seniority and added responsibilities. Additionally, engaging in ambulatory locums, remunerated at approximately £150 per hour, is a viable option after regular working hours due to the scarcity of oncologists.
Opportunities for foreigners
If my recollection serves me correctly, Danish is considered one of the most challenging languages to learn, alongside Finnish and some other less common languages. Denmark has faced a persistent shortage of doctors for several years, particularly in less popular specialties and more remote areas, although major cities tend to be adequately staffed.
Consequently, there is a notable presence of expatriates who have successfully acquired proficiency in Danish relatively quickly. While I cannot confirm the current status, the government has historically initiated programs in remote regions offering comprehensive support. These programs encompassed language learning assistance, housing facilitation, and assistance with educational matters for expatriates, particularly for roles in psychiatry or as General Practitioners (GPs).
The condition for participation usually involved a willingness to relocate to more remote areas, defined in Denmark as being a maximum of 1.5 hours away from one of the major cities. The specifics of these programs may have evolved over time. From my understanding and personal experience, acquiring proficiency in the language and obtaining certifications typically necessitates a few years.
France
Currently working in France, where the conditions, while acknowledging their relative scale, are challenging (though not as dire as in other regions).
In France, there are no foundation years, and medical studies span six years, followed immediately by what is equivalent to the Core Training (CT) phase in the UK. My specialization is in psychiatry, a discipline that lasts 4-5 years in France, with one remaining year officially designated as “docteur junior” since the 2018 reform. Despite the increased responsibilities during this phase, there is no corresponding increase in pay.
During the initial year, the net monthly pay was approximately £1300. Night shifts, spanning 14 hours from 6:30 pm to 8:30 am, are remunerated at about £114. A 24-hour shift on Sundays and public holidays amounts to a little more than double that figure. In psychiatry, the frequency of shifts varies, ranging from 1 to 4 per month, in addition to mandatory rotation on Saturday mornings, which unfortunately goes unpaid due to a legal loophole. Overtime is not compensated since there is no established framework for tracking it. The current net monthly pay is around £1600, with higher compensation for shifts as this phase involves increased autonomy.
Locum work
After completing five semesters, junior doctors become eligible for locum work, which is well-compensated. However, this entails complete autonomy and self-sufficiency, requiring a high level of confidence in one’s abilities.
While the taxation is lower compared to the UK and the cost of living is somewhat reduced, the workload is demanding. In psychiatry, the average workweek is around 48 hours, counting shifts, but it tends to lean towards 55 hours, especially in inpatient settings. In other specialties, the working hours can be significantly higher, and unfortunately, the field witnessed a concerning frequency of suicides in 2021.
One significant concern is the comprehensive role expected of doctors in France, coupled with the absence of structured case management. Additionally, the reliance on psychoanalysis and the lag in availability of therapy, cultural awareness, and inclusivity pose considerable challenges.
Taxes
In summary, the remuneration is suboptimal compared to the UK, despite lower taxes. The love for psychiatry persists, but the approach to the discipline in France, in my opinion, lags behind the standards observed in the UK.
An additional worry is the lack of robust supervision and the absence of annual assessments in France. It is possible to complete residency without undergoing scrutiny or assessment of hard skills through means such as Multiple-Choice Questions (MCQs) or assignments.
How much do consultants (psychiatry or other specialties) make in France?
The compensation structure depends on whether one is engaged in hospital work or private practice (wherein practitioners work independently, and patients’ expenses are fully covered by national insurance). A consultant concluding their career can anticipate a monthly income of approximately 6000 euros. Various options are available, with Quebec posing certain challenges, while Switzerland presents more feasible prospects.
Ireland
In the realm of hospital practice in Ireland, the annual income amounts to €300,000. This comprises a public salary of €180,000, with the remainder derived from private practice seamlessly integrated into a 40-hour workweek. The contractual provisions include six weeks of annual holidays, seven days designated for study leave, and an on-call commitment of 1 in 10.
Radiology in Ireland
In the context of radiology practice in Ireland, the large university hospitals manage coverage with their trainees, minimizing disruptions to their consultants during night shifts. Conversely, consultants in smaller hospitals, each equipped with comprehensive Remote Information System/Picture Archiving and Communication System (RIS/PACS) workstations at home featuring excellent voice recognition capabilities, handle coverage. Notably, Ireland’s national integrated RIS/PACS system ranks among the largest globally, allowing for remote coverage from different geographical locations within the country. Compensation is augmented for on-call duties, with subsequent time off the following day. The national RIS/PACS infrastructure also facilitates lucrative locum opportunities, enabling remote reporting after regular hours. While challenges persist within the national health service, particularly for radiologists, the situation is not as dire as it may be portrayed.
It is noteworthy that there exists a substantial expatriate British population in Ireland, with a higher ratio compared to Irish individuals residing in the United Kingdom. Despite the favorable conditions and a starting salary of approximately €130,000, the migration of British radiologists to Ireland remains surprisingly limited.
