Introduction
1. Background
Cross-country comparisons of physician pay, most commonly drawn from Organisation for Economic Co-operation and Development (OECD) reports, have become focal points in healthcare policy debates. In South Korea, for example, an abrupt 77% increase in medical school quotas triggered a year-long junior doctor walkout—a dispute fueled in part by contested OECD salary figures [1]. Because South Korea has one of the lowest numbers of doctors per 1,000 people among developed countries [2], addressing the doctor shortage has been a priority for successive governments. However, many of the nation’s current healthcare challenges—such as emergency room re-transfers and a shortage of pediatricians—stem from deeper systemic issues, including an underdeveloped public healthcare system and the predominance of profit-driven hospitals. Despite this, the political response to the crisis has consistently centered on the mantra of “more doctors.” While junior doctors and medical students mainly object to the abrupt increase due to the uncertainty it creates for their futures and the potential erosion of professional discretion, some commentators and academics have cited OECD data to claim that Korean doctors earn the highest salaries among developed countries—without accounting for their heavy workload and exploitation by hospital management. Unfortunately, mass media coverage has amplified public anger by narrowly framing the crisis as doctors selfishly resisting the public good for fear of losing their already high income. This has contributed to widespread distrust of medical professionals, with numerous undesirable consequences.
Although achieving social consensus on the appropriate level of remuneration for professionals, such as physicians who provide essential public services, is important, determining what is “appropriate” is neither straightforward nor simple. Physician salaries depend on multiple factors, including variations in payment systems (e.g., fee-for-service versus bundled payments) and whether physicians work in the public or private sector. As a result, direct cross-country comparisons of physician salaries in countries with different healthcare systems introduce significant bias and can unnecessarily inflame societal conflicts.
In South Korea, a universal single-payer healthcare system is in place, with physician fees determined solely by the government. However, Korean universal healthcare does not cover a sufficient range of medical services, leading to high out-of-pocket costs and a proliferation of uncovered services [3]. With over 90% of Korean hospitals and clinics privately owned, hospitals frequently impose harsh incentive systems based on revenue generated by doctors within a fee-for-service model. Since basic fees, such as consultation charges, are the lowest among OECD countries, Korean doctors are compelled to treat as many patients as possible each day. This has resulted in the highest patient load, as seen in the highest annual number of physician visits and consultations per doctor [4]. Beyond excessive clinical workload, the physician salary data reported to the OECD may also be inaccurate due to the complexity of reimbursement systems in different countries. For example, in many countries, earnings from private-sector practice are not publicly reported.
2. Objectives
In this study, we examined data on doctor remuneration across various OECD countries, utilizing both OECD data and additional salary information from other sources. We focused on salaried specialists, as data for this group are more widely available than for others (e.g., self-employed general practitioners). We then analyzed the correlation between remuneration levels—defined as the ratio of specialist salaries to average worker salaries—and healthcare indices for each country.
Methods
1. Ethics statement
This study utilized data from publicly available databases and did not involve human participants. Institutional review board approval was waived in accordance with institutional policy for studies of this nature.
4. Data source/measurement
Data were obtained from the publicly available OECD Health Statistics. Information on doctor salaries, general wages, and other healthcare indices was collected by accessing the OECD report at https://stats.oecd.org/ (last accessed 23 December 2024) [5]. The OECD salary data used for analysis were from either 2022 or 2020.
Additionally, internet sources providing supplementary information on physician and general salaries were referenced (Suppl. 1). In instances where OECD data on doctor remuneration were unavailable for a specific country, alternative sources were used. Salary data from non-OECD sources were from the year 2024.
1) Specialist salary compared with the average worker’s salary
The OECD reports remuneration data for both self-employed and salaried doctors, further distinguishing between general practitioners and specialists. As previously mentioned, data for salaried specialists were selected for this study, as this group had the most comprehensive data coverage across domains [6]. The ratio of each country’s specialist salary to its average worker’s salary was calculated.
2) Handling missing OECD data
Non-OECD sources provided only general physician salary data, without distinction by employment type or specialty. For countries lacking OECD specialist data, general physician salary data from non-OECD sources were used, with the recognition that these figures may not directly reflect specialist salaries.
3) Association of the ratio of specialist salary to the average worker’s salary with health care indices
The healthcare indices selected for association analysis included: mortality rates from avoidable causes; mortality rates from treatable causes; the proportion of female doctors; the number of computed tomography (CT) scanners, magnetic resonance imaging (MRI) units, and positron emission tomography (PET) scanners; the percentage of the population covered by public insurance; the percentage of the population satisfied with the availability of quality healthcare; health expenditure as a share of gross domestic product; health expenditure per capita (purchasing power parity [PPP] in United States dollar [USD]); the number of doctors per 1,000 people; the number of hospital beds per 1,000 people; and the percentage of adults who rated their health as bad or very bad. The OECD-reported ratio of specialist salary to average worker’s salary was used as the representative indicator of specialist remuneration for each country.
6. Study size
Sample size estimation was not performed, as the analysis included all available target data.
7. Statistical methods
Linear regression analyses were used to examine associations. Simple linear regressions assessed the relationships between the ratio of specialist salary to average worker salary and the selected healthcare indices. Multiple linear regression was then performed for all variables that reached statistical significance in the simple regression analyses. Final regression models were constructed using significant variables, with model reliability verified via residual analysis. Multi-collinearity was assessed by calculating variance inflation factors.
Results
1. Specialist salary in each country
Table 1 presents the average specialist salary (in USD, based on both exchange rates and PPP in USD) for each OECD member country, as reported in the OECD dataset. Among the 38 member countries, 7 (Australia, Austria, Canada, Colombia, Japan, Switzerland, and the US) did not provide salary data. Only 4 countries (France, Germany, Israel, and Korea) explicitly reported full salary data, while for most countries, income from private practice was either not explicitly included or not specified. Among non-OECD sources, doctors’ salaries were generally the highest on the Economic Research Institute (ERI) site (Suppl. 2) [7–13]. In most cases, the 2024 ERI doctor salary data were higher than the 2020–2022 OECD specialist salary data, although OECD salaries exceeded ERI figures in 8 countries. This difference was most pronounced in South Korea, where the OECD data were 1.6 times higher than ERI data (Suppl. 3). The average ratio of OECD to ERI salary data across countries was 0.81 (standard deviation, 0.3).
2. Specialist salary compared with average worker’s salary in each country
Specialist salaries were next compared with the average worker’s salary for OECD member countries, using US PPP values from the OECD report. As shown in Table 1, full data were available for France, Germany, Israel, and Korea. On average, specialist salaries were 2.59 times higher than the average worker’s salary (standard deviation, 0.89) (Figure 1). The specialist-to-average worker salary ratios were 2.05, 2.59, 3.10, and 3.64 for France, Germany, Israel, and Korea, respectively. Chile, Turkey, and Luxembourg had the highest salary ratios, each exceeding 4, whereas Greece, Latvia, Lithuania, Norway, Poland, Portugal, and Sweden all had salary ratios below 2.
For the 7 countries where specialist salary data were unavailable in the OECD report, the salary ratio was calculated using data from ERI, World Salary (for Austria), or Indeed (for Canada). In these 7 countries, the doctor-to-average worker’s salary ratio was higher than in those countries with available OECD data, with an average ratio of 6.19 (see Suppl. 4). Among the 9 countries where both OECD and ERI salary data were available for doctors and average workers, the ERI-based salary ratio was consistently higher than the OECD-reported ratio (mean, 3.81±0.61 vs. 2.39±0.41) (Suppl. 5).
3. Health care indices associated with doctor salary/average worker’s salary ratio
To ensure a sufficient sample size, non-OECD data were included in the analysis for countries lacking OECD specialist salary data. In simple linear regression analysis, the proportion of female doctors, the percentage of the population covered by public insurance, and the number of doctors per population were each significantly and negatively associated with the doctor-to-average worker’s salary ratio (Table 2). In contrast, the number of CT, MRI, and PET scanners, as well as health expenditure per capita, showed a significant positive association with the salary ratio. In multiple linear regression analysis, the number of CT, MRI, and PET scanners remained positively and significantly associated with the salary ratio, while the percentage of the population covered by public insurance remained negatively and significantly associated. Variance inflation factors for these variables were both 1.02, indicating no evidence of collinearity.
Due to potential inaccuracies introduced by combining OECD and non-OECD data sources, an additional analysis was performed excluding countries where specialist salary data were unavailable in the OECD report (Suppl. 6). In this subset, the proportion of female doctors, the percentage of the population covered by public insurance, and the number of doctors per population remained significantly and negatively associated with the specialist-to-average worker’s salary ratio in simple linear regression analysis. None of the variables showed a significant positive association in this restricted analysis. These 3 variables continued to show significant associations with the salary ratio after multiple linear regression.
Discussion
1. Key results
This study examined doctor remuneration in OECD member countries using both the OECD report and additional online data sources. Specialist remuneration levels, defined as the ratio of specialist salary to the average worker’s salary, were calculated and correlated with various healthcare indices. The results showed that, on average, specialist salaries were 2.59 times higher than the average worker’s salary in those countries that provided salary data to the OECD.
2. Interpretation/comparison with previous studies
Our findings highlight the considerable challenges of using OECD data to compare doctor remuneration across countries. First, 7 countries did not provide any doctor salary data to the OECD. Second, OECD remuneration data were often incomplete or inaccurate, as many countries failed to submit full salary information. A previous study comparing specialist remuneration across 6 European countries (Belgium, Denmark, England, France, Germany, and the Netherlands)—which have similar gross domestic products and healthcare systems—found that OECD data were not based on a consistent application of income definitions, making direct comparisons unreliable unless data were significantly modified at the national level [14]. In the case of South Korea, specialist salary data are likely among the most accurately reported due to the country’s single-track, government-controlled healthcare system and universal health coverage. Since healthcare premiums in Korea are strictly tied to income levels, specialist salaries can be more precisely estimated based on the amount of healthcare premiums paid. Although non-OECD sources report doctor salaries for all physicians rather than just specialists, these data were generally higher than the OECD values in most countries, suggesting that the OECD salary data may be substantially underestimated.
Determining the amount and method of doctor remuneration is complex. Physician salaries are influenced by a range of factors, including specialty, experience, educational and training costs, type of employment, as well as external factors such as location (rural vs. urban), payment model, and the strength of the public healthcare system. Doctors must be compensated at levels that ensure their financial security and allow them to make patient care decisions without undue financial pressures [15]. However, compensation models also influence medical ethics, especially in capitalist systems where the fiduciary responsibility to act in the patient’s best interest may be compromised. While salary-based payment is associated with fewer procedures per patient and a greater focus on preventive care, thus helping to reduce healthcare overutilization, low base salaries and profit-driven bonus structures can still incentivize inappropriate increases in healthcare expenditure [16–18]. High doctor salaries become problematic when they significantly drive up healthcare costs without ensuring improved quality of care. In this respect, South Korea’s healthcare system has demonstrated notable strengths: it has the lowest rate of treatable (preventable) deaths, minimal disparity in doctor distribution between rural and urban areas, and the shortest waiting times among OECD countries.
The recent conflict involving trainee doctors and medical students in South Korea stems from the longstanding, overly simplistic view that the nation’s healthcare problems are caused solely by a doctor shortage. Against this backdrop, President Yoon Suk Yeol made an unexpected and unprecedented national announcement, effectively imposing martial law targeting trainee doctors [19,20]. This episode illustrates how far politicians may go to undermine both democracy and the healthcare system in pursuit of political objectives in an increasingly polarized world.
The Korean government has consistently failed to address the underlying problem: the lack of a robust public healthcare system, which has led to over 90% of hospitals being privately owned. Inadequate financing of essential services, such as consultations and basic operations, has pushed hospitals toward expensive, high-tech care, while the government’s unwavering belief in the “more doctors” solution has led to deep distrust among medical professionals. Young doctors, in particular, recognized that expanding doctor numbers without systemic reform would threaten not only their future earnings but also their professional integrity, as they would be increasingly subject to the priorities of profit-driven hospitals. Public frustration over widening socioeconomic inequality has amplified the perception that South Korean doctors were acting immorally, with their opposition framed as a selfish effort to protect their financial interests by restricting the physician supply (Suppl. 7). This argument was further amplified by some Korean scholars and government officials who misused OECD doctor remuneration data without acknowledging its limitations [21]. The more doctors were vilified as public enemies, the more politicians fixated on the issue of increasing doctor numbers, often without regard for educational quality or the need for system reform, because it served their image as champions of justice fighting a privileged group.
3. Limitations
First, reliance on OECD data for statistical analysis without detailed adjustments may have resulted in erroneous findings. Nevertheless, our primary aim was to highlight the issues with OECD doctor remuneration data and the difficulties of cross-country comparisons based on these figures. Second, we focused only on specialist salaries, which generally reflect doctors employed by hospitals. Thus, using specialist remuneration, rather than that of all doctors, to examine associations with healthcare indices may not provide a comprehensive picture of the relationship between doctor pay and healthcare outcomes. Third, websites that report doctor salaries depend on self-reported data, which may be even less reliable than OECD data derived from government sources. Still, the general trend of higher remuneration levels from such sites, compared with OECD data, was consistent, with notable exceptions—South Korea among them. Since Korea does not allow a private healthcare track, its reported remuneration data may be more accurate or even somewhat overestimated compared with other countries, where private sector income is excluded from official statistics.
4. Conclusion
Our findings indicate that OECD specialist salary data may not accurately reflect actual physician salaries in many member countries. Nevertheless, the misuse of such data by governments to advance political agendas can lead to significant distrust and have costly consequences. The OECD should require member countries to report salary data according to standardized definitions, as the publication of inaccurate data can result in far-reaching and potentially catastrophic outcomes.
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