The Dentist Pay Gap in Europe: Policy Perspectives

Does the EU Need to Intervene in Regulating Dentist Pay Scales?
The Unequal Landscape of Dentist Pay in Europe
Dentistry is a vital component of healthcare, yet dentists across the European Union (EU) experience striking disparities in pay and working conditions. While practitioners in countries like Germany, Denmark, and the Netherlands often enjoy high earnings and strong labor protections, their colleagues in Eastern and Southern Europe frequently face lower wages, fewer benefits, and unstable working arrangements.

For example, according to reports from the Council of European Dentists (CED), average annual incomes for dentists in Western Europe can exceed €100,000, while those in Eastern Europe often earn less than a third of that figure. These disparities raise pressing questions: should the EU intervene to harmonize pay scales, or should this remain the domain of national governments and professional bodies?

Why Dentist Pay Matters Beyond Salaries
Workforce Retention and Migration

• Intra-EU migration of dentists is well-documented. Dentists from lower-paying countries often move westward in search of better pay and working conditions.
  
  
• Countries like Romania, Bulgaria, and Poland report significant losses of dental professionals, contributing to workforce shortages and unequal access to care.
  
  
• Conversely, countries such as Germany and the UK (pre-Brexit) have benefited from this mobility but now face ethical questions about reliance on foreign-trained professionals.
  

Patient Access to Care

• Unequal dentist pay contributes indirectly to access disparities. Regions with poor remuneration struggle to retain professionals, leading to rural shortages and overburdened urban centers.
  
  
• EU patients are supposed to enjoy equitable access to healthcare under European treaties, yet oral health is one of the areas with the greatest inequalities.
  

Professional Well-being and Burnout

• Pay scales directly affect job satisfaction and stress levels.
  
  
• Dentists in underpaid regions often work longer hours, sometimes in multiple jobs, leading to higher burnout and reduced quality of care.
  

Current Regulation: National vs. EU Competence
Healthcare—including dentistry—remains primarily the responsibility of national governments. Pay scales are typically negotiated through:

• National health systems (for public dentists).
  
  
• Private markets (for self-employed practitioners).
  
  
• Collective bargaining (in some countries with strong unions or professional bodies).
  

The EU’s role in health policy is largely supportive, focused on:

• Free movement of health professionals.
  
  
• Cross-border healthcare rights.
  
  
• Ensuring safe training and professional qualifications (Directive 2005/36/EC).
  

So far, the EU has not intervened directly in setting healthcare pay scales—and certainly not in dentistry.

Arguments for EU Intervention
1. Reducing Intra-EU Inequity
Dentists performing similar work under comparable qualifications face dramatic income differences. EU-wide frameworks could help level the playing field, supporting professional equality across borders.

2. Tackling Migration and Retention
Harmonizing pay (or at least setting minimum benchmarks) might reduce the “brain drain” from Eastern to Western Europe, stabilizing local dental services.

3. Safeguarding Patient Access
EU intervention could indirectly improve patient access to care in underserved regions, aligning with EU goals of health equity.

4. Precedent in Other Sectors
The EU already sets directives on working time, health and safety, and minimum wages in certain industries. Dentistry could fall under similar regulation if justified by public health needs.

Arguments Against EU Intervention
1. Subsidiarity Principle
Healthcare regulation is a national competence. Direct EU involvement in dentist pay would likely face strong political opposition.

2. Market Realities
Dentist pay reflects local economies, patient demand, and insurance structures. A German dentist earns more partly because treatment fees are higher and insurance reimbursement is robust. EU regulation cannot override these structural differences.

3. Risk of Distortion
Setting EU-wide pay scales could discourage private practice innovation or create tensions between public and private sectors.

4. Legal and Practical Challenges
There is no legal precedent for the EU directly regulating pay scales in healthcare professions. Doing so would require significant treaty changes or member state consensus.

Middle-Ground Solutions: EU Influence Without Direct Pay Control
Even if the EU cannot (or should not) directly set dentist salaries, it could take indirect measures to narrow disparities and improve conditions:

Benchmarking and Transparency

• EU agencies could publish annual reports on dentist pay, adjusted for purchasing power parity.
  
  
• Transparency could pressure national governments to address extreme disparities.
  

Support for Under-Resourced Regions

• EU funds could support dental workforce retention programs in countries facing migration crises.
  
  
• Subsidies for rural practices or incentives for young dentists could improve local stability.
  

Harmonizing Reimbursement Policies

• The EU could encourage more consistent dental insurance and reimbursement schemes across member states.
  
  
• This would standardize patient fees and indirectly stabilize dentists' incomes.
  

Professional Mobility Safeguards

• While free movement is a cornerstone of the EU, safeguards could ensure that mass migration does not destabilize national systems.
  
  
• For example, temporary service agreements or “return programs” for emigrant dentists could be encouraged.
  

Case Studies in Pay Disparities
Germany

• Dentists often rank among the highest paid in Europe.
  
  
• Strong insurance reimbursement and high patient demand support a stable income.
  

United Kingdom (Pre-Brexit Reference)

• NHS dentists faced pay stagnation despite long working hours, fueling dissatisfaction.
  
  
• Many turned to private practice to supplement income.
  

Romania and Bulgaria

• Young dentists frequently migrate westward within a few years of graduation.
  
  
• Local health systems struggle to replace losses, especially in rural regions.
  

Scandinavia

• Denmark and Sweden balance relatively high pay with strong welfare protections.
  
  
• However, tight regulation limits the number of dental graduates, controlling workforce supply.
  

Ethical and Policy Considerations

• Equity vs. Sovereignty: Should an EU dentist in Poland earn closer to a counterpart in France? Or do local economies dictate fair wages?
  
  
• Public vs. Private: Regulating pay in a largely private profession (dentistry) would challenge EU competence.
  
  
• Patient-Centered Outcomes: Ultimately, the debate is not about dentist salaries alone—it is about whether pay disparities undermine patient access and care equity.
  

The Way Forward

• EU intervention in dentist pay scales is unlikely in the near term, given legal and political barriers.
  
  
• However, indirect EU involvement through data transparency, workforce incentives, and insurance harmonization could reduce disparities.
  
  
• National governments and dental associations must remain proactive, but the EU can play a supportive, coordinating role to prevent widening inequalities.
  

For now, the debate remains open: does the EU need to intervene in regulating dentist pay scales, or should it focus on facilitating fair conditions indirectly?