Poland's AOTMiT Chief Unpacks the PLN 100K+ Doctor Contracts and Tariff Reality

The PLN 100K Question: Inside Poland's Doctor Pay Disparities

Public debate has been dominated by reports of Polish doctors earning hundreds of thousands of złoty a month through private contracts with hospitals. Yet many physicians on employment contracts earn far less. In an interview with Business Insider Poland, Daniel Rutkowski, President of the Agency for Health Technology Assessment and Tariff System (AOTMiT), laid out the real numbers.

According to agency data covering 718,000 healthcare workers, only 1% of doctors on a civil-law contract with a single hospital earned above PLN 100,000 monthly last year. However, that figure is based on individual agreements—when contracts across multiple facilities are combined, the share of doctors exceeding that threshold is estimated at between 5% and 10%. The median gross salary for a specialist doctor on a permanent employment contract is around PLN 24,000, including all duty pay and allowances.

Rutkowski stressed that the official tariff set by AOTMiT covers the entire cost of a medical service—hospital stay, diagnostics, drugs, infrastructure—not an individual physician's remuneration. How a hospital decides to pay its doctors from the revenue it receives is a matter of internal policy, contract structure and local bargaining. The agency's data shows that among specialists, over 73% of personnel costs are generated by contract-based arrangements, even though such contracts account for only 23% of staff.

The picture is further complicated by the variety of pay models: hourly rates, percentage of NFZ payment, fee per procedure or mixed forms. Only 51% of specialists are paid purely by the hour, while 34% are paid based on output. Rutkowski argued that this fragmentation, not the tariff itself, fuels the wide pay gaps.

Why a Tariff Isn't a Doctor's Paycheck—and Where It's Changing

The 73% Contract Cost Concentration

While contract doctors represent less than a quarter of the medical workforce, they absorb nearly three-quarters of total doctor personnel costs. This structural imbalance highlights how hospitals channel a disproportionate share of public funds into a minority of highly compensated contractors—often in high-demand specialties. The AOTMiT acknowledges that its current dataset cannot see the full picture, as it only captures single-hospital agreements, not multicentric earnings.

Tariffs vs Doctor Pay: The Decoupling

A persistent misconception, according to Rutkowski, is that the official tariff directly determines a doctor's take-home pay. The tariff is a cost model for the entire episode of care, factoring in nursing staff, anaesthesia, diagnostics, ward stays and medical devices—not a fee for a single physician. Each hospital director is free to structure pay as they see fit. This means two hospitals receiving the same tariff for a procedure can deliver vastly different income to the performing surgeon, depending on local contract terms and operational efficiency.

Agency's Rebalancing: Surgery Gains, Imaging Cuts

The agency has been systematically recalibrating tariffs based on standardized cost accounting data that hospitals have been obliged to submit since 2021. In 2024, general surgery tariffs rose by an average of 28%, delivering significant relief to county-level hospitals. Gynecology followed with a 21% hike in 2025, and obstetrics funding increased by over 47% from July 2025—an additional PLN 750 million annually. In contrast, CT and MRI tariffs were reduced by an average of 5.6%, expected to save the public purse PLN 167.7 million, though some specific imaging procedures received increases. The agency is currently reviewing vascular diseases, ophthalmology, cardiovascular conditions and medical-device-heavy services, with skin diseases and musculoskeletal disorders slated for 2027.

PESEL Tracking and What It Changes

A new legislative amendment will soon allow AOTMiT to use national identification numbers (PESEL) and medical practice numbers to track individual doctors' total public-system earnings across all contracts and subcontracts. Rutkowski says the goal is not to "monitor" individuals but to produce a reliable, aggregated analysis of remuneration trends. This will finally reveal the true concentration of high earners and likely put additional reputational pressure on hospitals with extreme contract payouts—especially if those contracts are poorly correlated with patient outcomes or access.

What Hospital Directors and Health System Planners Should Watch

• Contract-heavy departments face scrutiny ahead. With PESEL-based analytics imminent, hospital management should prepare to justify top-tier contract rates, particularly where compensation is linked to procedure volume rather than fixed-time commitments. The data will likely expose whether high earners are concentrated in already over-funded service lines.
• Recent tariff uplifts offer a window for restructuring. The 28% surgery increase and over 47% obstetrics boost provide financial headroom. Directors can use this to phase out purely output-based contracts in favour of mixed models that improve predictability and team cohesion.
• Imaging departments must recalibrate margins. A 5.6% average tariff cut on CT and MRI—amounting to PLN 167.7 million—will squeeze providers who have not already controlled for overcapacity or high equipment leasing costs. Planned reviews of vascular and cardiovascular services will likely cascade similar adjustments.
• Watch the 2027 tariff pipeline. AOTMiT's published plan targets skin diseases, burns and musculoskeletal care. Hospitals with concentrated exposure in these areas should start internal cost reviews now to avoid sudden revenue shortfalls.
• Negotiate contracts with cost-accounting data. The rollout of standardized cost reporting since 2021 gives medium-sized hospitals a stronger hand in bargaining with highly paid specialists. Align contract terms with the actual per-procedure cost structure the agency uses, not with outdated or estimated allocations.