The average net salary in Macedonia's public healthcare institutions is 50,039 denars across all institutions (around 813 euros). Base net salary, before allowances: 37,660 denars (around 612 euros). The figures are for December 2025, drawn from an analysis of 18,872 employees across 12 institution types.

The number might look reasonable. But hidden inside it is the story of how the system actually works. In institutions that run 24 hours a day, additional allowances (for on-call duty, night shifts, weekends, holidays) exceed 40%. The University Clinic for State Cardiac Surgery - 40.66%. Štip Clinical Hospital - 37.83%. The University Institute for Radiology - 37.67%. Which means: the base salary of a surgeon is absurdly low, and the money arrives via additional shifts.

The flip side: in preventive institutions and outpatient clinics, additional allowances are below 15%. There the salary is closer to the base - and for many, barely enough to live on.

Now the second story. 1,822 healthcare workers have filed lawsuits against public healthcare institutions. The claim: around 134.6 million denars (or 2.18 million euros) in unpaid allowances - for overtime, night shifts, weekends, public holidays, anniversaries. 62 of 108 public healthcare institutions have active legal disputes. Largest single suit - Bitola Clinical Hospital, with 16.8 million denars. Most plaintiffs - General Hospital Kumanovo, with 317.

What does this tell us? That the system pays base salaries that aren't enough, then compensates with overtime, and then frequently doesn't pay the allowances. It's a model that depends on doctors' willingness to put up with it - and when hundreds of them run out of patience, the state asks "why are they working abroad?"

Director Sašo Klekovski: "A larger share of the disputes comes from non-compliance with the Labour Relations Act and collective agreements." Translation: the institutions don't honour their own contracts. That isn't an error - it's the system.

Doctors' salaries in Macedonia are structured so that every surgeon, doctor, nurse must be physically exhausted by overtime in order to earn "enough." That doesn't work for patients who wait in queues, doesn't work for doctors who become doctors-without-evenings within ten years, and doesn't work for a state when 1,822 of its own employees have to sue their own healthcare institutions.