Taiwan’s healthcare workers have been holding protests for the last few months to highlight their excessive work hours while being underpaid. I will  compare Taiwan with other advanced countries to look at how overworked and underpaid Taiwan’s doctors and nurses are.
 

Taiwan’s Doctors and Nurses Are Overworked and Underpaid

Among the advanced countries, Taiwan’s doctors earn relatively low salaries. The average salary of Taiwan’s doctors is among the bottom 10 lowest salaries among the advanced countries.

Data source: Taiwan, other countries. Note (1): The average salaries for doctors in other countries are obtained from averaging the average salaries of general practitioners and specialists. Note (2): The definition of advanced countries used in this article is based on the International Monetary Fund’s definition.

It is worse for Taiwan’s nurses – they earn one of the lowest average salaries among the advanced countries.

Data source: Taiwan, other countries. Note: The salaries for Latvia and Lithuania are excluded because there isn’t more recent data.

Over the longer term, the average salary of Taiwan’s doctors has remained among the lowest over the past decade.

The average salary of Taiwan’s nurses has also remained low and stagnant over the last decade even as countries like the Czech Republic, Estonia and Slovakia have caught up or even surpassed Taiwan.

Taiwan’s doctors and nurses are being overworked, like all of Taiwan’s workers.

Taiwan’s workers work one of the longest hours among the advanced countries and in the world (see red bar in chart below). Similarly, Taiwan’s health and social service workers also work one of the longest work hours (see maroon bar).

Data source: Taiwan, other countries. Note: The breakdown of the number of work hours worked in the health and social service sector in other countries is not available for comparison.

Adjusted for the number of hours worked, Taiwan’s doctors earn even lower salaries. Taiwan drops below Spain and Italy, and Slovenia’s doctor salary overtakes Taiwan when comparing the average doctor salary per hour worked.

Again, it is even worse for nurses. In terms of the average salary per hour worked, Taiwan’s nurses earn one of the lowest, or even the lowest salary among the advanced countries.

Taiwan’s doctors and nurses are being badly underpaid for the number of work hours they are putting in.

Note: The salaries for Latvia and Lithuania are excluded because there isn’t more recent data.

Taiwan’s doctors and nurses see many patients because Taiwan has one of the highest numbers of doctor consultations per capita, with each person making an average 15.7 consultations a year.

Data source: Taiwan, other countries

As a result, Taiwan’s doctors have one of the most consultations among the advanced countries – each doctor has an average of 5,397 consultations a year.

Data source: Other countries. Note: Taiwan’s data is estimated by dividing the total number of consultations (305,650,289) by the total number of doctors (56,638).

In other words, each doctor in Taiwan has an average of 22 consultations a day. Doctors in the Nordic countries and Switzerland only have an average of two to four consultations a day, while doctors in most other advanced countries have only seven to eight consultations a day.

Taiwan’s doctors have three times the number of consultations as doctors in other advanced countries.

Note: The number of doctor consultations is obtained by dividing by the number of days worked. The number of days worked is derived by dividing the total number of hours worked in a year by eight hours.

When comparing the average doctor salary per consultation, Taiwan’s doctors are even worse off – they earn one of the lowest salaries among the advanced countries for each patient they see.

Among the advanced countries, Taiwan’s nurses also have to see one of the most patients per nurse.

Note: The data for Norway, Ireland, the Netherlands, Sweden, Switzerland, Finland, England, Belgium and Spain covers the period from 2009 to 2010 and is obtained from a study published in 2014. The data for Greece and Germany covers the period from 2009 to 2010 and is obtained from a study published in 2012. The data for the other countries is from 2012 and is obtained from a study published in 2013. Taiwan’s data for the day shift, night shift and graveyard shift (maroon bars) is obtained from a survey conducted by the Taiwan Nursing and Medical Industries Union.

On a per patient basis, Taiwan’s nurses therefore also earn one of the lowest, if not, the lowest salary among the advanced countries.

With the long work hours and number of patients they have to see, and coupled with their low pay, Taiwan’s doctors and nurses are being severely overworked and underpaid.

Note: This data is obtained by dividing the average daily salary for nurses by the nurse-to-patient ratio. The salary data used corresponds to the year from which the nurse-to-patient ratio is obtained, or the data from the closest year available.

Taiwan’s Cost of Living Hikes Beyond The Amount They Earn

Next, we compare the salaries of Taiwan’s doctors and nurses with the cost of living to see how poorly they are paid.

Compared with advanced countries with a similar GDP per capita and cost of living as Taiwan, we can see in the chart below, that doctors in most other countries are paid salaries commensurate with their countries’ cost of living – they largely fall along the trendline.

However, Taiwan falls further below the trendline than other countries, signifying that for their skillset, Taiwan’s doctors are not paid salaries commensurate with Taiwan's cost of living.

Italy and Greece are still recovering from the 2008 economic crisis, and their salaries have yet to recover fully. Estonia’s salary also falls below the trendline due to Estonia seeing the highest inflation in the last two years among European countries, and salaries have yet to catch up. Unlike these countries facing crises, Taiwan’s salaries are low because they have been artificially suppressed for the last two to three decades.

Germany has a similar cost of living as Taiwan but their doctors are paid salaries three times higher than Taiwan’s doctors.

To be on par with other countries, Taiwan’s doctors should be paid an average salary about 40% to 50% more than what they currently earn, or about NT$275,000.

Data source: Cost of living

Compared with the cost of living, Taiwan’s nurses are even more underpaid – Taiwan falls furthest away from the trendline than other countries.

Taiwan’s nurses should earn double their current salaries today, or close to what the nurses in Germany, Spain and Slovenia are earning, given their similar cost of living as Taiwan. The average monthly salaries of Germany’s, Spain’s and Slovenia’s nurses are NT$138,861, NT$117,169 and NT$103,794 respectively.

To be on par with other countries, Taiwan’s nurses should be paid about NT$110,000 a month, instead of the average of NT$57,917 a month (this figure is already inclusive of bonus and overtime pay).

 


When comparing the average doctor salary per consultation, Taiwan’s doctors are even more underpaid.

Per consultation, Taiwan’s doctors are being paid only NT$347, but they should be paid about NT$2,000 per consultation to be on par with other countries, or 5.5 times higher. Based on the number of patients they are seeing and Taiwan’s cost of living, Taiwan’s doctors should be earning an average salary of over NT$1 million a month, instead of an average of only NT$191,833 a month.

The same trend can be seen when comparing with average doctor salary per hour worked, as well as with the average doctor salary per hour worked and per consultation.

Clearly, Taiwan’s doctors and nurses are severely overworked for the salaries they are being paid, and the number of patients they are seeing.

To compound the problem for Taiwan’s nurses, the salary difference between Taiwan’s nurses and doctors is one of the largest among the advanced countries.

Taiwan’s nurses earn an average salary of only 30% that of doctors. The reason for this is because Taiwan’s nurses are far more underpaid than doctors for the cost of living in Taiwan.

In other countries where there are also large salary differences between nurses and doctors, like in Germany, Switzerland, Ireland, Canada and Luxembourg, both the salaries of doctors and nurses are already among the highest in the world and much more adequate for their cost of living than Taiwan.

In fact, in Luxembourg, both doctors and nurses earn much higher salaries than the trend for their country’s cost of living (as we saw above). In Germany, Ireland and Canada, while nurses earn a quarter to a third of the salaries of doctors, nurses are actually paid adequately for the cost of living in their countries. The large salary gap exists because their doctors are paid higher than the trend among the advanced countries.

In Taiwan’s situation, both doctors and nurses are paid lower than the trend for Taiwan’s cost of living, while nurses are paid much lower than the trend.

Taiwan Is Hiring Too Few Doctors and Nurses

An important reason why Taiwan’s doctors and nurses are being overworked is because there are too few doctors and nurses in Taiwan.

Among the advanced countries, Taiwan has the fewest doctors per 1,000 people.

And while most other advanced countries are increasing the number of doctors per 1,000 people at a faster pace, Taiwan is instead growing its number of doctors more slowly.  

Taiwan also has one of the lowest numbers of nurses and midwives per 1,000 people among the advanced countries.

Data source: Taiwan, other countries

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TNL Editor: Kim Chan (@thenewslensintl)

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