On-call duty in a county hospital: who pays and how much.

Night in a county hospital. There are a dozen or so patients on the internal medicine ward, a few people are waiting in the admissions room, and there may be no one at all on the maternity ward. But the doctor has to be there, because the rules say so — and someone pays for every hour of that presence.

Why a doctor has to be on site around the clock

A first-level hospital — the lowest level of the hospital network — must have at least two of the five basic wards (general surgery, internal medicine, obstetrics and gynaecology, neonatology, paediatrics) and a hospital emergency department (SOR) or an admissions room.¹ Not every county hospital is a first-level hospital, but these requirements show the minimum that a small hospital has to maintain.

Every ward with patients must have round-the-clock medical care on all days of the week.² The rules allow this care to be combined within wards of the same kind: internal medicine with other non-surgical wards, surgery with other surgical wards. On the maternity ward they require the constant presence of a specialist and of an anaesthetist at the same location, and intensive care may not be combined with anything.

Hospitals make use of this: one doctor is often on duty at night on several wards at once, and sometimes also covers the admissions room. The Supreme Audit Office (NIK) described, for example, a contract for on-call duty in the admissions room and on the neurology ward at the same time.³ Such duty is cheaper for the hospital, but each doctor has more patients.

Nor does every doctor have to stay in the hospital. The act also provides for standby, colloquially called phone duty: the doctor comes in when called, for example when a specialist is needed who is not on site. For an employee, an hour of standby is paid at half the base rate, and from the call onwards the time counts as on-call duty.⁴ Where the rules require constant presence — as on the maternity ward — a phone is not enough.

This gives the basic arithmetic: a year has 8,760 hours, and that is how many have to be staffed at every on-call post, regardless of how many patients there are.

How much an hour of on-call duty costs

For employees, on-call duty counts as working time and is paid under the Labour Code rules on overtime.⁵⁶ From 1 July 2026 the minimum base pay of a specialist is PLN 12,910.16 (≈ €2,930) a month,⁷ and the opt-out clause makes it possible to work more than 48 hours a week.⁸ We show the calculation of an hour at the minimum in our compilation Distribution of doctors’ pay.

One doctor may also combine both forms: be employed and do on-call duty under a contract, in the same hospital or in another one. The rules allow this and leave the choice of form to the parties. NIK noted that higher income, lower contributions and the absence of Labour Code limits lead some staff to swap employment for a contract.⁹ We describe the consequences of both forms in Contract or employment.

No authority collects or publishes contract rates. The notices of competitions in the Public Information Bulletin (BIP) of three county hospitals contain no amounts — the bidder enters the price.¹⁰ The rates that are known come from hospitals’ answers to questions and from statements by their management:

The rates disclosed by county hospitals measure different things

Doctors’ hourly rates disclosed by county hospitals: Iława PLN 131.93–270 (doctors heading wards, May 2026); Ostróda PLN 130–280 (wards and primary care, July 2026); Wadowice PLN 260 (anaesthetists, July 2026); Dzierżoniów from PLN 250 (surgery, January 2025); Mława — candidates’ demands from PLN 130 to PLN 1,700 (June 2026).

Hospital	What was given	Who and when	Source
Iława	PLN 131.93–270 per hour for doctors heading wards	the hospital’s answer, May 2026	Info Iława, 27.08.2026
Ostróda	PLN 130–280 per hour of work on wards and in primary care	the hospital’s explanation, July 2026	Interia, 28.07.2026
Wadowice	PLN 260 per hour for anaesthetists	statement by the deputy director, July 2026	TVN24, 9.07.2026
Dzierżoniów	from PLN 250 per hour in surgery	the hospital’s advertisement, January 2025	hospital website, 22.01.2025
Mława	candidates demanded from PLN 130 to PLN 1,700 per hour	statement by the director, June 2026	naTemat, 5.06.2026

Each row is about something different, so they cannot be combined into an average.^1112131415 The spread in Mława does, however, show what the market looks like: neighbouring county hospitals bid against each other for the same doctors, while paying from the same NFZ. How this bidding works, including between a public and a private hospital, is described in our text One doctor, two price lists.

What this adds up to for a single hospital can be seen where the data have been disclosed. In Iława the average monthly invoice of a contract doctor from January to May 2026 was PLN 37,558.33 (≈ €8,530), and 14 doctors invoiced more than PLN 50,000 (≈ €11,300) a month.¹¹ The hospital in Wadowice paid 89 contract doctors a total of about PLN 43 million (≈ €9.76 million) in 2025. The three highest annual amounts exceeded PLN 1.2 million (≈ €272,000), and the highest went to an anaesthetist.¹³ Each of these amounts is a payment from one hospital, not the doctor’s whole income.

How much a day and a year cost

The cost of one on-call post is the rate times 8,760 hours.

This is an estimate: one post, without cover, the whole day at one rate. A hospital with two wards and an admissions room has several such posts. If it staffed four of them at PLN 200 per hour, on-call duty alone would cost about PLN 7 million (≈ €1.59 million) a year. For comparison: the average county hospital’s revenue from the NFZ in 2025 was about PLN 131 million (≈ €29.7 million) (our calculation from data of the Association of Polish Counties, ZPP: PLN 27.16 billion (≈ €6.16 billion) across 207 hospitals), although the spread between small and large hospitals is wide.

For an employee, an hour of on-call duty at the statutory minimum is cheaper, but after on-call duty the doctor must have at least 11 hours of rest, granted immediately after it ends.¹⁶ The hospital therefore needs more doctors than posts — someone to take over the day after the night. This is one of the reasons why hospitals turn to contracts: in the 12 hospitals it audited, NIK found that on average 47% of staff were on civil-law contracts, and that their cost averaged 26% of operating costs.³

In the financial reports of the 207 county hospitals for 2025, salaries account for 40.73% of costs, and external medical services — where doctors’ contracts are booked, among other things, but also, for example, tests commissioned from outside — for 25.30%.¹⁷

Who pays: from the contribution to the county budget

1. 01.

   NFZ. On average 93.8% of county hospitals’ revenue comes from contracts with the NFZ. The lump sum depends on the points for services reported in the previous period, their price and a quality coefficient. Staffing hours are not in the formula: a ward with few patients reports few points, although its on-call duty costs the same.

2. 02.

   The hospital. When the lump sum does not cover costs, the hospital makes a loss and first covers it itself. With a loss of more than 1% of revenue, it must prepare a recovery programme.

3. 03.

   The county. The county “may cover” the hospital’s loss — it does not have to. After 2020, rural counties spent PLN 26–36 million a year on this. In Lubliniec, for example, the county council gave PLN 700,000 (≈ €159,000) towards the loss for 2025, which amounted to PLN 14.7 million (≈ €3.34 million).

4. 04.

   Creditors. The rest becomes debt. 125 of the 207 county hospitals had overdue liabilities, totalling almost PLN 1.48 billion (≈ €336 million), and interest cost them PLN 344.04 million (≈ €78.1 million). When an independent public facility is liquidated, the county takes over its debts.

The rules of the lump sum are set by the Act on publicly funded healthcare services and a regulation of the minister of health,¹⁸¹⁹ while covering the loss and taking over debts are governed by the Act on medical activity.²⁰ The financial data come from reports of the Association of Polish Counties¹⁷²¹ and from a county council resolution.²² How the lump sum works is described in our text How the NFZ pays hospitals.

Instead of covering the loss, some counties lend hospitals money. In April 2026 the Radom County Council lent the hospitals in Iłża and Pionki PLN 4.93 million (≈ €1.12 million) for their liabilities for 2025; according to the head of the county (starosta), the county had already given the two hospitals more than PLN 32 million (≈ €7.26 million) in total.²³ In Jasło the county lent the hospital PLN 6 million (≈ €1.36 million) interest-free for 10 years.²⁴ A loan does not reduce the loss — it shifts repayment to the following years, which the hospital starts with the same lump sum and the same on-call duty.

When there is no one to take the duty

Money is one side. The other is people: a ward without a full on-call rota cannot admit patients. The hospital in Skarżysko-Kamienna suspended its paediatric ward from 1 April 2025, giving as the reason “a lack of doctors needed to staff the on-call duty” (our translation).²⁵ In Zakopane the obstetrics, gynaecology and neonatal ward is suspended until 31 October 2026, and the hospital is announcing competitions for doctors for regular ward work and on-call duty.²⁶ In Lesko a ward where 74 births took place in 2025 was suspended because of a lack of doctors and a renovation, and at the director’s request the NFZ terminated the contract at the end of the year.²⁷

Does every county need a full hospital

Since the cost of on-call duty does not depend on the number of patients, it is highest in the hospitals that have the fewest. In Wadowice the maternity ward was suspended from February 2026: there were 566 births in 2025, against about 1,000 in 2020, and the ward made a loss of PLN 12 million (≈ €2.72 million).²⁸

One direction of reform is concentration: fewer wards, grouped in larger hospitals. In 2023 NIK named “too many county hospitals” (our translation) as one of the causes of their problems.⁹ Since 2025 the NFZ may, at a hospital’s request, remove a ward from the network if this serves the consolidation of services in a given area, and in its place conclude a contract, for example for planned treatment.²⁹

There are also arguments against. A closed ward means a longer journey for the patient, and in childbirth minutes count: at the beginning of October 2026 in Warsaw a woman sent home from hospital gave birth, by her own account, about 20 minutes later. The hospital says that the patient herself wanted to go home.³⁰ Some county hospitals have recently invested in buildings and equipment. The hospital in Pionki opened new pavilions in 2023 — construction and renovation cost PLN 86 million (≈ €19.5 million) and equipment another PLN 15 million (≈ €3.4 million), about 40% of it from a government fund. Its surgical ward is to close at the end of 2026,³¹ and the county is lending both of its hospitals money for current liabilities.²³

The same hours in two places

Nobody adds up the hours that one doctor works in several places. Sometimes the same hours are billed twice. NIK described a hospital that paid two doctors PLN 16,300 (≈ €3,700) for hours shown at the same time in two places.³ In the county hospital in Braniewo one doctor billed 11,577 hours in 2024, although a leap year has 8,784 — according to the new management, the same hours were counted under several headings at once. This is an allegation, not an established fact: no one has been charged.³²³³ We describe this case in more detail in our text on multiple jobs and parallel contracts.

NIK also found on-call shifts lasting 73 hours without a break, and in another audit as many as 124 hours.⁹³ In that second audit, price was in most cases the only criterion for choosing bids, contracts were concluded even though requirements were not met, because there were not enough doctors for on-call duty, and in 9 of the 12 hospitals a total of PLN 10.3 million (≈ €2.34 million) was paid above the maximum value of the contracts.³ The amounts themselves can be seen only when a hospital answers a question. In the monitoring run by Watchdog Poland (Sieć Obywatelska Watchdog Polska), 212 first-level hospitals received a request for doctors’ pay. 73 refused, and 26 sent legible lists. In a typical one, the middle entry is about PLN 154,000 (≈ €35,000) a year, and 18 entries exceed PLN 1 million (≈ €227,000) — each of them a payment from one hospital.³⁴

Data · check for yourselfDoctors’ pay monitoringWhich hospital disclosed its doctors’ pay, which refused and which did not reply. Facilities can be filtered by hospital network level. In Polish.Open the monitoring

What the PLN 240 hourly limit will change

The pay limits act, which the Sejm passed on 22 October 2026, provides that the gross hourly rate for services financed by the NFZ may not exceed 1/20 of the minimum wage, i.e. PLN 240.30 (≈ €55) in 2026.³⁵³⁶ The limit also covers contracts, and the text does not exclude on-call duty from it. It is now before the Senate.³⁷ We follow its stages in Pay limits for Polish health professionals.

The president of the National Association of County Hospital Employers (OZPSP) says that “probably nobody will work in an emergency department for PLN 240 an hour”, and at the same time that the limit will become a floor for doctors who earn less today (our translation).³⁸ How many doctors are above this amount and how many below it, nobody has shown — including the explanatory memorandum to the bill.³⁵

What is not known

It is not known how much county hospitals pay in total for on-call duty, what the distribution of rates is, or how many hours one person works in all hospitals combined. These figures are not in any public register. Until they are, the dispute over whether PLN 240 an hour is too little or too much cannot be settled with data.

Some of these questions would be answered by the total pay of each person from all facilities with an NFZ contract, published every quarter under a permanent identifier instead of a name. Duplicated hours and amounts from several hospitals would then be visible in a single row.

Our demandPublic amounts, protected namesWe call on the state to publish, every quarter, the total pay of each person working in facilities with a National Health Fund (NFZ) contract — summed across all their workplaces, under a permanent identifier instead of a name.Our demand

Notes 38laws, data and statements we relied on

1. Act on publicly funded healthcare services, Article 95l(4)(1) and Article 95m(3) and (6) (in Polish; consolidated text Dz.U. 2025 item 1461) — the profiles of a first-level hospital, the requirement of at least two of them and of a contract for a hospital emergency department (SOR) or an admissions room. ↩

2. Regulation of the Minister of Health on guaranteed hospital treatment services, § 5(1) and Annex 3, part I, items 2–3, 9, 14, 26, 36, 37 (in Polish; consolidated text Dz.U. 2023 item 870, as amended) — round-the-clock medical care on all days of the week and the rules for combining it; an exception for planned hospitalisation on days off was added by an amending regulation (in Polish; Dz.U. 2026 item 840). ↩

3. Supreme Audit Office (NIK), “Zlecanie usług medycznych przez szpitale publiczne” (“Outsourcing of medical services by public hospitals”, in Polish), P/22/046, 29.03.2023 — 12 hospitals, including county hospitals: a contract for on-call duty in the admissions room and on the neurology ward, duplicated hours of two doctors (PLN 16,300 overpaid), 134 on-call shifts longer than 40 hours, the longest 124 hours. ↩ ↩² ↩³ ↩⁴ ↩⁵

4. Act on medical activity, Article 98 (in Polish; consolidated text Dz.U. 2026 item 156) — for an hour of standby, 50% of the hourly rate of base pay; a call-in to the hospital is settled as medical on-call duty. ↩

5. Act on medical activity, Article 95 (in Polish; consolidated text Dz.U. 2026 item 156) — medical on-call duty means performing professional activities outside normal working hours and counts as working time; for its pay, Article 151¹ § 1–3 of the Labour Code applies accordingly (para. 5). ↩

6. Labour Code, Article 151¹ (in Polish; consolidated text Dz.U. 2026 item 1245) — a supplement of 100% of pay for overtime at night, on Sundays and on public holidays, 50% on other days. ↩

7. Act of 8 June 2017 on the method of setting the minimum base pay of certain employees of healthcare providers, Article 3a and the annex (in Polish; consolidated text Dz.U. 2022 item 2139) — coefficient 1.45 for a specialist doctor; base amount: announcement of the President of Statistics Poland (GUS) of 9.02.2026 (in Polish; M.P. 2026 item 192), average pay in 2025 PLN 8,903.56. ↩

8. Act on medical activity, Article 96 (in Polish; consolidated text Dz.U. 2026 item 156) — work beyond an average of 48 hours a week after written consent; repeal from 1.01.2028: Article 3(2) and Article 12(3) of the Act of 5 July 2018 (in Polish; Dz.U. 2018 item 1532). ↩

9. Supreme Audit Office (NIK), “Funkcjonowanie szpitali powiatowych” (“The functioning of county hospitals”, in Polish), P/22/048, 2023 — 22 hospitals, 2020–2022: replacement of employment with contracts, on-call shifts of up to 73 hours without a break in three hospitals, “too many county hospitals” among the causes of problems. ↩ ↩² ↩³

10. Notices reviewed: Wodzisław Śląski County Hospital, competition for on-call duty and regular work in the admissions room (in Polish), 2025–2026 (criterion: price 100%); Kętrzyn County Hospital and Mazurskie Centrum Zdrowia in Węgorzewo (in Polish), as at 21.10.2026. ↩

11. Info Iława, “Ile zarabiają lekarze w Szpitalu Powiatowym w Iławie? Placówka podała dane” (“How much do doctors earn at Iława County Hospital? The facility has released the data”, in Polish), 27.08.2026 — the hospital’s answer to a resident’s question; in some cases a management allowance is added to the rate. ↩ ↩²

12. Interia, “Lekarz zarobił 1600 zł za godzinę. Powiatowy szpital z milionowymi długami” (“A doctor earned PLN 1,600 an hour. A county hospital with debts in the millions”, in Polish), 28.07.2026 — the summary given to a county councillor and the hospital’s explanation. ↩ ↩²

13. TVN24, “Wadowice: zarobki lekarzy w szpitalu” (“Wadowice: doctors’ earnings at the hospital”, in Polish), 9.07.2026. ↩ ↩²

14. Dzierżoniów County Hospital (NZOZ), “Zatrudnimy lekarzy na oddział chirurgiczny” (“We will hire doctors for the surgical ward”, in Polish), 22.01.2025. ↩

15. naTemat, “Od 130 zł do 1700 zł za godzinę dyżuru. Polskie szpitale toczą walkę o lekarzy” (“From PLN 130 to PLN 1,700 per hour of on-call duty. Polish hospitals fight for doctors”, in Polish), 5.06.2026 — statement by the director of the hospital in Mława. ↩

16. Act on medical activity, Article 97 (in Polish; consolidated text Dz.U. 2026 item 156) — at least 11 hours of uninterrupted rest per day, after on-call duty granted immediately after it ends. ↩

17. Association of Polish Counties (ZPP), “Szpitale powiatowe w kryzysie — analiza sytuacji finansowej w 2025 roku” (“County hospitals in crisis — an analysis of the financial situation in 2025”, PDF, in Polish), report no. 26, April 2026 — MZ-03 reports of 207 hospitals (163 SPZOZ and 44 companies): cost structure, the NFZ share of revenue, results, liabilities and financial costs. ↩ ↩²

18. Act on publicly funded healthcare services, Article 136c (in Polish; consolidated text Dz.U. 2025 item 1461) — the hospital network lump sum depends on the funds in the NFZ plan and on the number, type and prices of services reported in the previous period. ↩

19. Regulation of the Minister of Health on the method of setting the lump sum of the basic hospital healthcare security system (the hospital network), § 3(1) (in Polish; consolidated text Dz.U. 2025 item 878, amended Dz.U. 2026 item 105) — the lump sum is the product of the number of points, the price of a point and the quality coefficient. ↩

20. Act on medical activity, Articles 59 and 61 (in Polish; consolidated text Dz.U. 2026 item 156) — the net loss is covered by the facility itself, and the founding body “may” cover it; a recovery programme where the loss exceeds 1% of revenue; after liquidation, liabilities pass to, among others, the local government unit. ↩

21. Association of Polish Counties (ZPP), “Nakłady JST na ochronę zdrowia” (“Local government spending on healthcare”, PDF, in Polish), report no. 27, May 2026 — counties’ spending on covering hospitals’ negative results (§ 416) according to RB-28S reports. ↩

22. Lubliniecka.pl, “Finansowa kroplówka dla lublinieckiego szpitala kosztem inwestycji” (“A financial drip for the Lubliniec hospital at the expense of investment”, in Polish), 24.08.2026. ↩

23. TwójRadom, “Blisko 5 mln zł wsparcia dla szpitali w Iłży i Pionkach” (“Nearly PLN 5 million in support for the hospitals in Iłża and Pionki”, in Polish), 28.04.2026 — long-term loans passed by the county council and a statement by the starosta. ↩ ↩²

24. Jaslo4u.pl, “Szpital nad przepaścią. Powiat daje 6 milionów” (“Hospital on the brink. The county gives 6 million”, in Polish), 21.04.2026. ↩

25. Radio Kielce, “Skarżyska pediatria zawieszona” (“Skarżysko’s paediatric ward suspended”, in Polish), 31.03.2025. ↩

26. Zakopane County Hospital, “Czasowe zawieszenie oddziału położniczo-ginekologiczno-noworodkowego” (“Temporary suspension of the obstetrics, gynaecology and neonatal ward”, in Polish), 1.10.2026 (updated 14.10.2026), and notices of competitions on the hospital’s website of 12 and 21.10.2026. ↩

27. NFZ, “Informacja dotycząca statusu oddziału ginekologiczno-położniczego w Lesku” (“Information on the status of the gynaecology and obstetrics ward in Lesko”, in Polish), 21.03.2026. ↩

28. TVN24, “Od lutego bez porodówki w Wadowicach” (“No maternity ward in Wadowice from February”, in Polish), 16.01.2026 — the number of births and the ward’s loss according to the management. ↩

29. Act on publicly funded healthcare services, Article 159a(4) and (5) (in Polish; consolidated text Dz.U. 2025 item 1461) — removal of a profile from the hospital network contract to consolidate services, and a replacement contract; the provisions were added by the Act of 5 August 2025 (in Polish; Dz.U. 2025 item 1211), in force from 17.09.2025. ↩

30. Zero.pl, “Odesłana ze szpitala, urodziła w łazience. Oświadczenie placówki a fakty” (“Sent home from hospital, she gave birth in the bathroom. The facility’s statement and the facts”, in Polish), 18.10.2026 — the patient’s account and the hospital’s statement; the course of events is disputed. ↩

31. Krytyka Polityczna, “Szpitale w stanie krytycznym” (“Hospitals in a critical condition”, in Polish), 18.09.2026 — the cost of the new pavilions and the renovation, of equipment, the share of the Government Local Investment Fund, the decision to close surgery on 31.12.2026. ↩

32. Interia, “Braniewo — doby rozliczone na 72 godziny w szpitalu powiatowym” (“Braniewo — days billed as 72 hours in a county hospital”, in Polish) — the same hours billed under several headings at once, according to the hospital’s new management. ↩

33. Dziennik Elbląski, “Zarobki lekarza sięgnęły prawie 1,8 mln zł” (“A doctor’s earnings reached almost PLN 1.8 million”, in Polish), 9.07.2026 — 11,577 hours in 2024, invoices for PLN 1,772,879.50, change of management, termination of the contract, no charges. ↩

34. Watchdog Poland (Sieć Obywatelska Watchdog Polska), monitoring “Ile zarabiają lekarze?” (“How much do doctors earn?”, in Polish) — hospitals’ replies for 2025; network level, reading of the lists and medians: Monitoring Watchdog (our compilation, in Polish). An entry on a list is a settlement in one facility, not always one person. ↩

35. Government bill amending the Act on publicly funded healthcare services and certain other acts, Sejm print no. 3157 (in Polish) — proposed Article 132ab(1) and (6), explanatory memorandum and summary of comments from the consultations; legislative progress (in Polish), as at 21.10.2026. ↩ ↩²

36. Regulation of the Council of Ministers of 11 September 2025 on the amount of the minimum wage and the minimum hourly rate in 2026, § 1 (in Polish; Dz.U. 2025 item 1242) — PLN 4,806; 1/20 of this amount is PLN 240.30. ↩

37. Sejm of the Republic of Poland, 67th sitting, 22.10.2026 — vote no. 149 (in Polish) on the bill on pay limits for medical staff as a whole: 229 in favour, 144 against, 67 abstentions. ↩

38. Rzeczpospolita, “Prezes związku szpitali: nikt nie będzie pracował na SOR za 240 zł/h” (“Head of the hospitals’ association: nobody will work in an emergency department for PLN 240/h”, in Polish), 6.10.2026 — interview with the president of OZPSP (the position of one party to the dispute). ↩