Most specialist doctors do not work in hospital as employees but under a contract (kontrakt).12 This single difference decides whether it is possible at all to establish how much public money goes to one person — which is why it ties together the other mechanisms described on this site.
73%
of specialists work under civil-law contracts — a B2B contract or a contract of mandate (73.16% to be exact)
Two forms of employment, two levels of transparency
Employment (etat) means an employment contract: the base salary cannot fall below a threshold set by an act, working time has limits, and the employee is entitled to paid leave and sick pay. A contract is a civil-law contract: the doctor issues an invoice as a business or is paid under a contract of mandate. The rate is agreed by the parties and nobody publishes it.
| Employment (employment contract) | Contract (civil-law contract) | |
|---|---|---|
| Legal basis | Labour Code | Civil Code: self-employment (B2B), or a contract of mandate or a contract for a specific work |
| Pay | At least the statutory minimum — for a specialist PLN 12,910.16 from 1 July 2026 | The amount in the contract |
| What is public | The statutory minimum, known to the zloty | Neither the rate nor the total amount |
| Working time | 48 hours a week; with an opt-out clause up to about 78 hours | No Labour Code limits — work in several facilities can be added up |
| Protection | Paid leave, sick pay, protection against dismissal | None — as for any business |
The share of contracts comes from AOTMiT data reported by the daily Rzeczpospolita.1 We show the statutory minimum pay for doctors in the pay distribution, and for other medical professions in Medical staff.
Legal and often advantageous
A contract in itself is not an abuse. The doctor gains flexibility and a higher rate, the hospital — freedom in drawing up the rota. We do not judge the form of employment. We describe its side effect: public money disappears from view.
Salaried pay follows a public tariff and appears on the payroll. A contract is business revenue settled by invoices. Nobody collects these amounts in one place, and the same doctor may hold contracts with several facilities at once. As long as payments from public funds are not added up for each person, the total remains unknown.
Three reasons why the contract wins
73% is neither a fashion nor a coincidence. Three mechanisms push towards the contract, and none of them stems from bad faith on the part of the doctor.
- 01.
Tax and contributions. A doctor running a business can pay a flat-rate tax (ryczałt) of 14% of revenue on medical services. The health contribution then depends on revenue thresholds and in the highest one — above PLN 300,000 a year — amounts in 2026 to PLN 1,495.04 a month, and does not rise further. An employee pays income tax on the 12%/32% scale, and the health contribution is 9% of income. With revenue of around PLN 1.6 million, the health contribution under the flat-rate tax is roughly eight times lower than on the same amount earned as an employee.
- 02.
Hours. The Labour Code limit of 48 hours a week does not apply to a contract, so it is legal to work in many facilities with no upper limit. This is the engine of holding multiple jobs.
- 03.
The hospital’s interest. With a contract, the hospital pays no employer contributions and no paid leave or sick pay, and it can draw up the rota more freely. When doctors are scarce, it often does not offer employment at all.
The calculation of the burdens comes from Money.pl,3 and the comparison of both forms in a hospital from Wsparcie dla Szpitala.4 How work in several facilities adds up in practice is described in our text on holding multiple jobs.
Six types of contract
The contract is not a single model. Prof. Urszula Demkow, a doctor and former deputy minister of health, distinguishes at least six, each linking payment to the work done in a different way. Her argument: the pathology is not the form of the agreement itself but the lack of transparency — pay detached from the time, cost and outcome of treatment.
| What the hospital pays for | Where problems arise | |
|---|---|---|
| Hourly | A rate for every hour worked | The most transparent, but rewards time, not outcome |
| Per on-call shift | An amount for a 12-, 16- or 24-hour on-call shift | A high rate regardless of workload; one person collects too many shifts |
| Monthly lump sum | A fixed amount for a range of duties | Without a precise range of duties it becomes a high payment that cannot be accounted for |
| Per procedure | An amount per operation, test report or consultation | Rewards the number of procedures, including beyond need |
| Percentage of revenue | A share of the value of the service settled with the National Health Fund (NFZ) | The riskiest: the doctor takes a percentage, while the theatre, anaesthetist, nurses and complications are paid for by the hospital, which may lose money on the operation |
| Share of profit | A share of the result after costs | More rational, but in profitable fields — invasive cardiology, orthopaedics, neurosurgery — it creates pay chimneys |
Most often the models are mixed: an hourly rate plus on-call shifts, procedures, a lump sum for availability and a management allowance. When several mechanisms overlap, without close scrutiny it is hard to say what exactly the hospital is paying for — and this is where a pay chimney most easily arises. That is why the solution is not a ban on contracts but transparency: the total payments to each person, records of working time and public reference points for rates.
The typology was published by Klub Jagielloński, a Polish think tank, under the CC BY 4.0 licence.5
How much more — and why it cannot be seen
25,595PLN/month
median pay of a specialist under a contract; as an employee — PLN 23,666
316thousand PLN/month
the highest contract in the compilation of regional hospitals; the highest salaried pay — about PLN 101,000
At the median the difference is moderate — a contract pays about 8% more. It grows, however, towards the top of the scale, and at the very top it is several-fold. And it is precisely contract amounts that nobody publishes: salaried pay is visible to the zloty, while a contract is business revenue outside the payroll register.
A rare insight into full annual income comes from the asset declarations of doctors who are local councillors. Of the 182 declarations checked for 2024–2025, 165 show the doctor’s own practice and 11 only employment and contracts. For 2025, the median income from the practice alone was about PLN 500,000 (≈ €113,000) (104 declarations), and the median total income from work — about PLN 633,000 (≈ €144,000) (113). We have compiled the distribution and links to the declarations in our analysis Doctors who are councillors.
Notes 5laws, data and statements we relied on
-
Rzeczpospolita, “Wypłaty lekarzy na kontraktach większe niż 100 tys. zł tylko w 1 proc. przypadków” (“Payments to contract doctors above PLN 100,000 in only 1% of cases”, in Polish) — AOTMiT data on doctors’ forms of employment. ↩ ↩2
-
HireDoc, “Raport z rynku pracy lekarzy” (“Report on the job market for doctors”, in Polish), Q3 2025 — share of employment offers. ↩
-
Money.pl, “Lekarze na ryczałcie — wysokie dochody i niskie obciążenia” (“Doctors on the flat-rate tax: high income and low burdens”, in Polish) (opinion piece by M. Samborska). ↩
-
Wsparcie dla Szpitala, “Praca na kontrakt czy etat w szpitalu w 2026 r.” (“Working in a hospital on a contract or as an employee in 2026”, in Polish) ↩
-
Klub Jagielloński, “Kontrakty maskują braki kadrowe. Co znajduje się na umowach lekarzy w Polsce” (“Contracts mask staff shortages. What is in doctors’ contracts in Poland”, in Polish), 13.07.2026 (Prof. Urszula Demkow, CC BY 4.0). ↩