Forms of employment of a doctor in Poland: either a civil contract or an employment one?

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Forms of employment of a doctor in Poland: either a civil contract or an employment one?

The Polish medical community is actively discussing the forms of employment of doctors. The fact is that the working conditions in case of a civil contract differ from those of employment one. Let’s dive into when one or the other contract is signed with a doctor, and how do the two types of contract differ?

Civil contract (umowa cywilnoprawna).

The doctors are entered in two types of civil law contracts in Poland: a contract of agency (umowa zlecenia) and a contract on the provision of medical services (umowa o świadczenie usług medycznych), otherwise called a medical contract.

Civil contracts are signed with doctors who have opened a private medical practice, and this is nothing more than an individual enterprise established by a doctor. Their criteria are defined by the Law on Medical Activity.

The types of private medical practice are:

• private medical practice – allows a doctor to organize his/her therapeutic practice or work in a medical institution under a civil law contract, or provide your services at the place of treatment;
• private monodisciplinary medical practice allows you to establish a doctor’s office;
• private medical practice only on call;
• private practice of a practitioner only on call;
• private medical practice only in a medical institution on the basis of a civil contract with a medical institution;
• private monodisciplinary medical practice only in a medical institution on the basis of a civil contract with a medical institution.

When working under a civil contract, the last two types of private practice are used. Such contracts may be signed with several medical institutions, but not with an institution the doctor already works for under an employment contract.

To start a private medical practice, you shall take the following steps:

1. To make an entry in the register of economic activities in the city or district administration. To submit the relevant application, you only need an identity card.
2. To submit an electronic application for making an entry in the register of persons engaged in medical activities through the portal http://rpwdl.csioz.gov.pl/
3. To obtain a REGON number – a statistical identification number. The application shall be submitted to the provincial statistical office within 14 days after the registration of the activity.
4. To report to ZUS. Within 7 days of starting a business, you shall register for social and health insurance at the appropriate ZUS branch.
5. To make a notice to the tax office, business activity data shall be completed within 30 days of registration.
6. To open accounts department. The tax ledger of income and expenses starts from the date of commencement of business activities. In addition, it is necessary to maintain a register of fixed assets and intangible assets, as well as a register of equipment.
7. To make a company stamp.
8. To open a bank account.

Pros and cons of private practice.

Flexibility is considered one of the advantages of private practice, including in terms of working hours. However, if a doctor works under a civil contract in a health care institution, the hospital shall try to impose its own conditions on the doctor, and the only way of the doctor’s freedom is his/her decision – to accept them or not.

Another advantage is being a boss for yourself, but only in case of independent private medical practice. In case of working under a civil contract with a medical institution, this freedom and independence are quite seemed, including due to fines, often prescribed in the contract.

The rates of tax contributions to ZUS under a civil contract are higher than under an employment contract. Still, income tax is paid at a flat rate of 19% regardless of the size of the profit, which affects the financial attractiveness of private practice. In addition, in case of his/her own office, the doctor sets the prices for services himself/herself. Moreover, some expenses, like buying a car or fuel for commuting to work, may be included in the cost of running a business.

Hourly restrictions for medical staff do not apply to doctors working under a civil contract. For them, working more hours and therefore earn higher wages is often taken as advantage. However, this form of employment is linked to the lack of other rights such as annual leave, maternity leave, parental leave and study leave. Simply put, a doctor only earns money by working.

When it comes to issues of civil liability for damage caused by a doctor it is shared between the doctor and a legal entity when the service is provided in a medical institution, – joint liability. Therefore, civil liability insurance is required for individual practice.

Employment Contract (umowa o prace)

This is an agreement between a doctor and a health care institution, according to which the doctor undertakes to perform certain work under the guidance of the employer, at the place and time specified by the employer. As a result of the employment contract, both parties acquire the rights and obligations specified in the labour code.

As stated in the Law on Medical Activity, the basic daytime work of a health care worker is 7 hours 35 minutes, with a maximum of 48 hours weekly. Overtime work is paid a bonus of 45-65% of wages.

A doctor may agree to an increase in working hours beyond 48 hours per week. Still, this must be voluntary and written consent. In addition, a doctor has the right to take patients in another institution under a civil contract.

An employment contract also gives the employee the right to annual paid leave, as well as maternity leave, childcare. It is also important that in case of unintentional harm the employer is one who is liable.

Resume

Both forms of employment have their own pros and cons. An employment contract guarantees stability, protection according to the labour code and social benefits, vacation, sick leave, etc., while running a business and a civil contract gives higher earnings and a flat tax. However, the employer in this case does not pay neither vacation nor a sick leave to a doctor.

More often, medical institutions are interested to sign civil contracts with doctors despite free choice of the form of employment, as a doctor is responsible for civil liability and obliged to pay social contributions and taxes in this case.