Doctor salary in Spain after tax — 2026
Spanish hospital doctors train through one of the most competitive residency systems in Europe, then spend a career inside a public pay scale that is notably modest by Western European standards — which is exactly why so many combine a public post with private clinic hours. Here's what every stage actually keeps after IRPF and Seguridad Social.
Take-home pay by grade — 2026
Figures for MIR years include the guardias (on-call duty shifts) that make up a substantial share of a resident's real income — base salary alone is lower. Deductions are IRPF income tax and Seguridad Social employee contributions (6.35%, capped at the annual ceiling).
| Grade | Gross Salary | Monthly Net | Effective Rate |
|---|---|---|---|
| MIR R1 (first-year resident) | €23,000 | €1,544/mo | 28.4% |
| MIR R4–R5 (senior resident) | €27,500 | €1,793/mo | 29.7% |
| FEA, early career | €42,000 | €2,573/mo | 33.1% |
| FEA, senior + exclusividad | €58,000 | €3,364/mo | 35.8% |
| Private-sector / Jefe de Servicio (example) | €95,000 | €5,110/mo | 39.2% |
FEA = Facultativo Especialista de Área, the standard grade for a board-certified hospital specialist. Figures assume the state IRPF scale; autonomous-community surcharges typically add another 2–4 percentage points effective — see note below. Source: CESM (Confederación Estatal de Sindicatos Médicos) 2026 salary survey, Estatuto Marco pay scales.
MIR, pluriempleo and exclusividad — the real doctor pay puzzle in Spain
Every Spanish doctor starts with the same gate: the MIR (Médico Interno Residente) exam, a single nationwide test that determines not just whether you get a residency place, but which specialty and hospital you can choose — ranked strictly by score. Competition for the best specialties (dermatology, plastic surgery) routinely requires a place in the top 1–2% of candidates nationally. Residency itself (4–5 years depending on specialty) pays on the modest scale shown above, propped up considerably by guardia (on-call) supplements.
Once qualified as a FEA, the defining financial decision isn't really about tax — it's about exclusividad vs pluriempleo:
- Exclusividad: committing your full working time to the public hospital (SNS) in exchange for a fixed monthly complement — typically €400–€700/month extra — in return for not taking private patients or a second job.
- Pluriempleo: keeping the public post but adding private clinic hours, insurance-company consultations (Sanitas, Adeslas, DKV) or a private practice on the side — common in specialties like traumatology, gynaecology, and ophthalmology, and often worth considerably more than the exclusividad complement, especially once established.
Public base pay in Spain trails Germany, France, and especially the UK private sector by a wide margin at FEA level — which is precisely why pluriempleo is so entrenched in Spanish medical culture rather than being a fringe practice. It's also a major driver of doctor emigration to Germany, France, and the Gulf states, similar to the pattern documented for Spanish nurses.
Regional pay gaps: SERMAS, ICS, Osakidetza, SAS
Healthcare is a devolved competence in Spain, so each autonomous community's health service sets its own complements on top of the national base salary — the gap between regions is real and persistent:
- Madrid (SERMAS) and País Vasco (Osakidetza) are consistently among the better payers, with stronger carrera profesional (seniority) supplements.
- Cataluña (ICS) has historically paid a lower base than Madrid, though supplements have narrowed the gap in recent contract rounds.
- Andalucía (SAS) runs the largest workforce with pay broadly at the national median, alongside chronic recruitment shortfalls in rural provinces that push some hospitals to offer additional incentives.
A FEA on paper-identical seniority can see a genuinely different payslip depending on which servicio de salud employs them — on top of the pluriempleo decision above.
Salary distribution — where Spanish hospital doctors sit
| Percentile | Gross Annual | Monthly Net |
|---|---|---|
| P25 (MIR resident) | ~€23,000–€27,500 | ~€1,370–€1,610/mo |
| P50 Median (FEA, early career) | ~€42,000 | ~€2,573/mo |
| P75 (FEA senior + exclusividad) | ~€58,000 | ~€3,364/mo |
| P90 (Jefe de Servicio / private practice) | ~€95,000+ | ~€4,810+/mo |
Private-practice and pluriempleo income for FEA-level doctors with an active side practice not included — some specialists roughly double their SNS income once private consultations are added. Source: CESM 2026 salary survey, Estatuto Marco.
Frequently asked questions
A first-year MIR resident on €23,000 (including typical guardia supplements) takes home around €1,544/month. A board-certified FEA on €42,000 takes home about €2,573/month. A senior FEA with the exclusividad complement on €58,000 takes home roughly €3,364/month. Doctors combining public work with private practice (pluriempleo) commonly earn considerably more.
The MIR (Médico Interno Residente) exam is a single nationwide test that ranks every aspiring specialist and determines which specialty and hospital they can choose for their 4–5 year residency. It doesn't directly set pay, but it gates entry into every specialty — and specialty choice has a large downstream effect on later pluriempleo earning potential (e.g. traumatology and ophthalmology support lucrative private work more easily than some other specialties).
Exclusividad pays a fixed monthly complement (typically €400–€700) for committing fully to the public hospital and forgoing private work. Pluriempleo — keeping the public post while adding private clinic hours or insurance-company consultations — is usually worth more once a doctor is established, particularly in specialties with strong private demand. Many doctors take exclusividad early in their FEA career for stability, then reconsider once their private-patient base could realistically exceed the complement.
A Spanish FEA (€42,000, ~€2,573/month net) earns notably less than a German Facharzt (~€4,210/month net) or a UK NHS consultant, even before accounting for cost of living. This gap is the single largest driver of Spanish doctor emigration — Germany, France and the Gulf states actively recruit Spanish-trained specialists, whose EU medical qualification is automatically recognised across the bloc.