Doctor take-home pay in Spain after tax, 2026
Few residency systems in Europe are harder to get into than Spain's, and what waits on the other side is a public pay scale that looks thin next to the rest of Western Europe. That mismatch explains why so many doctors run private clinic hours alongside a hospital post. Below is what each stage keeps once IRPF and Seguridad Social have been settled.
What each grade nets in 2026
For the MIR years the guardias are included, since on-call shifts account for a large slice of what a resident actually earns and the base salary alone sits lower. Coming off: IRPF and the employee Seguridad Social contribution of 6.35%, subject to 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 stands for Facultativo Especialista de Área, the standard grade held by a board-certified hospital specialist. The figures apply the state IRPF scale, and regional surcharges normally add another 2 to 4 effective percentage points, as the note below explains. Source: the CESM 2026 salary survey and the Estatuto Marco pay scales.
MIR, pluriempleo, exclusividad: how Spanish doctors really get paid
One gate stands in front of every Spanish doctor: the MIR examination, a single national test deciding not merely whether you get a residency but which specialty and which hospital, allocated strictly by score. Reaching dermatology or plastic surgery routinely demands a place in the top 1% or 2% nationally. Residency then runs four or five years depending on specialty, paid on the modest scale above and held up considerably by guardia 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.
At FEA level, public base pay falls a long way behind Germany, France and above all the British private sector, which is exactly why pluriempleo is embedded in Spanish medical culture rather than being unusual. It also drives steady emigration toward Germany, France and the Gulf states, following the same pattern documented among Spanish nurses.
Regional differences between SERMAS, ICS, Osakidetza and SAS
Health policy sits with the autonomous communities, and each regional service adds its own complements on top of the national base. The resulting gaps are neither small nor temporary:
- 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.
Where Spanish hospital doctors fall on the pay range
| 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 are excluded here, and some specialists running an active side practice roughly double what the SNS pays them once private consultations are counted. Source: the CESM 2026 salary survey and the Estatuto Marco.
Frequently asked questions
A first-year MIR resident on €23,000, counting the usual guardia supplements, keeps around €1,544 a month. A board-certified FEA on €42,000 keeps about €2,573, and a senior FEA drawing the exclusividad complement on €58,000 roughly €3,364. Anyone combining a public post with private practice normally earns considerably more than any of these.
One national examination ranks every aspiring specialist in Spain and decides which specialty and which hospital they may choose for a residency lasting four or five years. The MIR sets no salary directly, yet it controls entry to every specialty, and that choice shapes later private earnings heavily. Traumatology and ophthalmology, for instance, carry lucrative private work far more readily than several other fields.
Committing fully to the public hospital and giving up private work earns a fixed monthly complement, normally €400 to €700. Keeping the public post while adding private clinic hours or insurance-company consultations usually pays better once a doctor is established, particularly in specialties where private demand runs strong. A common pattern is to take exclusividad early in an FEA career for the stability, then revisit the decision once a private patient base could realistically outgrow the complement.
On €42,000, keeping roughly €2,573 a month, a Spanish FEA earns markedly less than a German Facharzt on about €4,210 or an NHS consultant in Britain, and that is before living costs enter the comparison. No other factor drives Spanish medical emigration as hard. Germany, France and the Gulf states recruit Spanish-trained specialists in earnest, helped by an EU qualification that every member state recognises automatically.