Doctors sit at the point on every national income scale where progressive taxation stops being theoretical. Marginal rates of 48% to 60% apply to most of a consultant's salary in western Europe, which makes the difference between systems unusually visible.
The figures below take a specialist or consultant grade salary, roughly the equivalent of a mid-career hospital consultant in each country, and apply the local 2026 rules for a single employed doctor.
The ranking
* Federal tax only; state and provincial tax reduce both figures substantially at these income levels. † Many Canadian and Australian specialists bill as self-employed practitioners or through a professional corporation, which changes the tax treatment entirely. Currency conversions use approximate mid-market rates for July 2026: 1 EUR equals 0.86 GBP, 1.16 USD, 1.60 CAD, 1.77 AUD, 1.95 NZD, 0.93 CHF, 7.46 DKK, 11.0 SEK, 11.7 NOK, 176 JPY, 1.50 SGD and 3.80 ILS.
Belgium keeps 52%, and it is not the top rate that does it
A Belgian consultant on 110,000 euros keeps just over half of it, the worst retention rate in the table. The 50% top bracket arrives at 48,320 euros, early by any standard, and the average 7% municipal surcharge applies on top of the federal tax due.
More damaging still is the absence of a social security ceiling. Belgian employee contributions run at 13.07% on every euro without limit, so a doctor pays the same contribution rate as a cleaner. Germany, by contrast, stops charging health and care contributions at 66,150 euros and pension at 90,600, which is why German retention improves as salaries rise. The Belgian structure is examined in Belgium's tax wedge.
Ireland's consultant contract is the outlier
Ireland pays hospital consultants more than any other European system on this list, following the public-only consultant contract introduced to address recruitment failures. A 220,000 euro salary is roughly double the German equivalent and roughly triple the Italian one.
The Irish tax system then takes 44.5% of it. The marginal rate above 70,044 euros is 52.1%, made up of 40% income tax, 8% USC and 4.1% PRSI, and it applies to the great majority of a consultant salary. The banding is set out in the guide to the USC.
Even after that, the Irish net figure is the fourth highest here. It is the clearest available demonstration that gross pay matters more than tax rate, a pattern that also holds in the engineering comparison.
Where the American figure needs unpacking
The $300,000 in the table is federal only. A specialist in California or New York loses a further $20,000 to $30,000 in state tax; one in Texas or Florida loses nothing, as the guide to the nine states sets out.
Two further adjustments cut in opposite directions. American specialists carry medical school debt at a scale that exists nowhere else here, frequently $200,000 or more, repaid out of net income. Against that, most also have access to retirement plans with high contribution limits, and many practise through arrangements that improve the tax position considerably.
The marginal rate is what decides extra sessions
For most consultants the practical question is not the average rate but what an additional clinic, waiting list initiative or private session is worth.
The British entry deserves attention because it is not in the published rate table. Between £100,000 and £125,140 the personal allowance withdraws at £1 for every £2 earned, producing an effective 60% band that catches almost every NHS consultant. Combined with historic pension annual allowance issues, it is the single largest reason British consultants decline additional sessions, and the mechanics are set out in the £100,000 tax trap.
What the table cannot capture
- Private practice. In Ireland, the UK, Germany, Spain and Italy, a substantial share of consultant income can come from private work taxed under different rules.
- Self-employment. Canadian and Australian specialists frequently bill rather than earn a salary, which changes deductions, pension treatment and the entire tax base.
- Training length and debt. Fifteen years of low-paid training in one country and eleven in another is a large difference in lifetime earnings that no annual figure shows.
- Indemnity. Professional indemnity costs range from negligible where the state covers it to five figures a year where it does not.
- Pension. The NHS scheme, still defined benefit, is worth a substantial percentage of salary that the take-home figure treats as a deduction.
Check a specific grade against the local rules using the UK Doctor Salary, Germany Doctor Salary and Ireland Doctor Salary medical pages, or run the figure through any Switzerland Salary Calculator.