Spain's Galicia pays nearly €1,000 per 24-hour rural shift

Galicia pays nearly €1,000 for a 24-hour shift at a PAC

The Xunta de Galicia (regional government) has decided to increase the rate for medical on-call shifts to nearly €1,000 per 24-hour turn at Primary Care Points (PACs). The reason is not sudden generosity: it is the inability to fill vacancies in rural and depopulated areas. In addition to the nearly €1,000 per shift, there is an extra monthly payment of €1,610 for being available seven days a month. The measure, reported by Faro de Vigo, has sparked a debate that goes far beyond doctors' salaries.

The first misunderstanding to clear up concerns the figure. The €1,000 is the ceiling, not the norm. Some argue that the average shift at a PAC is around €400 gross, or about €240 net, which puts the hourly rate at roughly €16-18. Shifts on December 25 and January 1 do reach that near-thousand-euro range. The range cited by some professionals involved in the discussion goes from €540 for a 17-hour shift to €820 for 24-hour ones, and €1,650 for special holidays. They insist the average is much more modest than the headline suggests.

Why does the Xunta pay nearly €1,000 per shift at a PAC?

Because they cannot find anyone willing to work them. The most repeated diagnosis is demographic: aging rural areas with no young people, where doctors leave at the first opportunity. It is not a money problem; it is a lifestyle problem. Almost nobody wants to live in a village 45 minutes away from an urban center with services, especially a professional who can choose their destination.

The administration's response is that of a company needing to fill a position: raise the price. The Xunta offers posts through competitive selection with better working conditions, in addition to the financial incentive. The lingering question is whether this is enough when the issue is not salary, but isolation.

Calculating the real cost: How much remains of €1,000 gross?

This is where the breakdown many skip begins. From those nearly €1,000, one must deduct social security contributions and income tax (IRPF). Since these payments are added to the regular payroll, they are taxed at the doctor's highest marginal rate, not the average rate. The complete calculation, item by item, leaves the net amount per shift well below what the headline suggests. Some estimate it does not even reach €500 for 24 hours, which equates to three days of work for a standard employee.

The comparison made from the other side focuses on the hourly rate. A mechanic in Spain charges around €40 per hour; a plumber, about €30. A doctor on call, based on the calculation of €400 gross for 24 hours, works out to €16-18 per hour after a minimum of ten years of training. This argument does not settle the debate, but it orders it.

Comparative grievance with other civil servants

Part of the conversation does not dispute the price, but the privilege. Civil servants already have lifetime job security; they do not also need to get rich through on-call shifts. Those who want to make big money should open a private clinic and accept the incompatibility rules. This is the stance most often repeated when discussing public healthcare spending.

Opposing this is the argument that Spanish healthcare spending is relatively low precisely because professionals are paid less in exchange for stability. The abuse of temporary contracts allowed filling gaps without consolidating positions, paying more in return. Now the Xunta is doing what any company would do: paying more and improving conditions where nobody wants to go.

The solution nobody wants to put on the table

A proposal appears again and again: forcing doctors to cover rural posts for a set number of years after completing their residency (MIR). The argument mirrors that of military pilots: if we train you with public funds, you owe a service. The objection is obvious: turning a liberal profession into mandatory service carries a political cost no government wants to bear.

The alternative proposed is the opposite: opening more places in medical schools. The problem, it is argued, is not a lack of doctors, but that governments do not hire them. There are calls for applications that remain unfilled. And while thousands of Spanish students are left out of medicine, professionals are imported from other countries. The bottleneck lies in the supply of positions, not demand.

Night shifts: What doesn't show up on the paycheck

The conversation drifts toward the actual conditions of on-call duty. Sleeping in the same work clothes, in beds like those of patients, with the pager going off at any hour. Sharing a room with someone else whose pager might go off, or who snores. Eating cold food if caught working. Bunk beds crammed together for six, without air conditioning, with machine noise and cockroaches roaming. Some recall sleeping next to the morgue and noticing the smell when a fridge broke down.

The response from the other side is that this is drama. That until you see what you earn for the shift, then you forget it. That firefighters spend their shifts at home with their families. That doctors are privileged and complain all day. The debate over salary turns into a debate over merit, vocation, and privilege, which is where it always ends.

The elephant in the room: Municipal structure

Some point out that the underlying problem is not health-related, but territorial. Spain's municipal structure is obsolete: too many municipalities, too many villages, a subsistence farming model that no longer exists. It is time to close municipalities and regroup populations in tertiary cities, or at least in villages 15 or 20 minutes from an urban center with jobs and services.

The German or French model is cited as a reference: small villages but within a stone's throw of a proper city. In Galicia, many are 45 minutes away. That is the problem no increase in shift pay solves. You can pay a doctor more to go to a village, but you cannot pay to move that village from where it is.

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With these differentials, migration of doctors to rural areas should be massive. It remains marginal. The Xunta's pay rise buys time, not solutions. If the problem is that nobody wants to live in certain places, the price of the shift is only the symptom.