New healthcare salary law: how medical staff pay could change from 2027

The draft law published by the Ministry of Labour on 25 May 2026 does not promise, for healthcare, merely another round of salary increases. It changes the very formula by which pay is calculated: the reference value, coefficients, category of the healthcare unit, seniority, bonuses and an unusually large amount of secondary legislation will determine how much money actually appears on the payslip in 2027. For doctors, nurses, laboratory staff, intensive care, emergency departments, ambulance services, forensic medicine and medico-social services, the real stake is twofold: staff already employed receive a safety net against a nominal decrease in income, but differences between institutions, specialties and professional generations may become wider.

On 25 May 2026, the Ministry announced the publication of the draft normative act and the implementation timetable, with the document currently under public consultation. This analysis is based on that draft version, not on a law currently in force, and its provisions may still be amended during the endorsement and adoption procedure.

The real stake for healthcare professionals

For medical staff, the draft law carries a stake that goes beyond the mere replacement of a salary grid. The text explicitly states that the salary rights that may be granted are exclusively those provided by law and that collective or individual contracts may not negotiate salaries or other salary-related rights that exceed or contradict it. In other words, hospitals and other healthcare units will not be able to create local parallel mechanisms for salary retention; the available tools remain only those provided by the law, its annexes and the subsequent regulatory acts. At the same time, the management of salary policy in public healthcare units is left to the main budget holders and the Ministry of Health, which moves an important part of the concrete effects from Parliament into healthcare administration.

There is another essential element: the draft law repeals Framework Law no. 153/2017 on the date the new law enters into force, and in the draft currently available on the Ministry of Labour website that date is 1 January 2027. This means that, for healthcare professionals, the relevant comparison is not with an abstract salary grid, but with their income in December 2026 and with the way reclassification, bonuses and the classification of the healthcare unit into a certain category will look at the beginning of 2027.

The calculation formula that will determine income in 2027

The general architecture of the law is simple in theory and very powerful in practice. The system uses 12 salary grades, with coefficients between 1.00 and 8.00, and the basic salary is established by multiplying the coefficient assigned to the position by an annual reference value. The draft expressly sets a reference value of 4,100 lei for 2027. For executive positions, seniority increments are added to this result.

*This table can be found in the draft law, Article 9 – Structure of salary grades and salary grid.

For healthcare, however, the formula does not stop there. The specific chapter in Annex II (available here on the Ministry of Labour website; a backup copy of the same document can be found here, archived in the version existing on 26 May 2026) states that the level of salary coefficients for specialised medical and healthcare support staff is established “within limits”, depending on the category of the healthcare unit, subunit and department. The maximum limit is the base coefficient increased by 10%, while the minimum limit is the base coefficient reduced by 10%. In simple terms, this means that for the same position, the gap between the lower and upper limit may reach approximately 22.2% solely as a result of the classification of the unit or department. Further on, seniority increments add, successively, 7.5%, 5%, 5%, 2.5% and 2.5%; moving from grade 0 to grade 5 increases the base by approximately 24.5%. Combined, the two mechanisms may produce a theoretical gap of approximately 52.2% between the same position placed at the lower limit, with no seniority, and the same position placed at the upper limit, with maximum seniority. For a system that declares itself concerned with equity, this is a major detail.

This is also why the healthcare section leaves so much room for Government decisions and ministerial orders. The criteria for classifying units, subunits and departments, the concrete coefficients used within these limits and the salary level for management positions are to be established by Government decision initiated by the Ministry of Health. In parallel, the framework draft states that the regulation on bonuses for working conditions must be developed within 60 days from the publication of the law. Translated for medical staff, this means that 2027 will depend not only on the letter of the law, but also on how quickly and in what direction the Ministry of Health produces the secondary regulations.

Doctors: salary protection, but not a generous regime for on-call duties

For doctors, the draft preserves an important form of protection, but it does not turn on-call duty into a spectacular source of income. The text of Annex II shows that healthcare staff with higher education who perform on-call duties outside the legal working time and normal schedule are paid at the hourly rate corresponding to their basic salary. Only on-call duties performed on weekly rest days, public holidays and other non-working days receive a rate 10% higher than the hourly rate of the basic working norm. Doctors called in from home to provide emergency medical care receive 15% of the hourly rate corresponding to their basic salary for the hours during which they are on home-call duty. This means that, in the draft, the on-call duty regime is a special one, distinct from the general logic of overtime work in the law, and remains much closer to hourly-rate payment than to a consistent system of bonuses.

The comparison with the general law in the same draft is relevant. For overtime work, the general law refers to compensation through time off and, when this is not possible, to bonuses of 75% for overtime hours and 100% for work performed on rest days or public holidays. By contrast, doctors’ on-call duties are covered by the special regime in Annex II, with payment at the basic hourly rate and only +10% on non-working days. In other words, the draft confirms that medical on-call duties are not essentially treated as ordinary classic overtime. From a professional perspective, this reduces the potential for income growth for doctors who ensure continuity through repeated on-call duties and may deepen the shortage of doctors affecting an increasing number of public healthcare units.

Healthcare trade unions argue that “the new draft law reduces the difference in reward between those who sacrifice their personal and family life for these services and those who work exclusively during normal hours to a humiliating difference of only 10%”. According to a statement by the “Solidaritatea Sanitară” Federation, the draft salary law is an “attack on healthcare professionals who ensure continuity of medical services at an unprecedented level”.

“Let us be concrete about the proposed cuts:
A shift on a public holiday: from the right to a 100% bonus, remuneration drops to an hourly rate increased by only 10%.
The shift bonus: reduced to the same 10%.
The elimination of on-call bonuses, replaced by a 10% hourly rate.
Home-call duty: decreases from 40% to 15%,” the union representatives state.

There are also other details with direct impact. Doctors who do not have a contract with the healthcare unit, but work only on the on-call line, must conclude a part-time individual employment contract and benefit only from the rights related to the activity performed during on-call duty. More importantly, healthcare staff with higher education who hold management positions but are involved in on-call duties do not calculate their hourly rate based on the managerial salary, but on the basic salary of the executive position corresponding to their specialty and seniority. For heads of department, heads of laboratory or other doctors with management responsibilities, this is a clear disadvantage: managerial responsibility does not also increase the on-call duty rate.

On the other hand, the draft preserves a certain coherence for integrated university activity. Medical and pharmaceutical teaching staff carry out integrated activity, usually through the cumulation of positions with a half-time workload, while staff who have held positions such as head of department, head of laboratory or head of medical service may work under a 7-hour-per-day management contract. Those who have been integrated for more than 5 years may continue their full-time activity in the healthcare unit after the end of their employment relationship with the educational institution. This is an important provision for academic medicine, but it does not compensate for the fact that the financial regime of on-call duties is affected. Precisely the sensitive area of the current healthcare system, the place where fatigue and frustration accumulate, but also where human lives are saved.

Nurses, laboratory staff, intensive care, emergency departments and other high-risk areas

For nurses and for a large part of healthcare support staff, the most visible effect will not come from the text on on-call duties, but from the way the draft reconfigures shift work and working-condition bonuses. In units that operate without interruption, staff who work monthly in all three shifts or in two shifts under a 12-hours-on/24-hours-off system may receive, instead of the general 25% night-work bonus, a bonus of 10% of the basic salary for the hours worked in these shifts. A simple calculation is worth making here: 10% applied to all hours becomes more advantageous than 25% applied only to night hours if night hours account for less than 40% of the total. If night hours exceed 40%, the previous night-work bonus would become, mathematically, more favourable. In other words, for nurses working under some shift patterns, the new formula may be slightly advantageous; for others, it may be less favourable. The text says “may receive”, so the concrete effect will also depend on the regulation applied in each unit.

Equally important is the regime for weekend and public-holiday work for staff in healthcare, social care and medico-social units. For activity performed within the normal working schedule, in order to ensure continuity, the draft grants only an hourly rate 10% higher than the hourly rate of the basic working norm, without compensation through time off. For staff working on wards, in laboratories, imaging departments, emergency receiving units, intensive care or other continuous structures, this is a key rule: weekends and public holidays worked as part of the usual schedule are not treated as exceptional events, but as normal work with only modest additional pay.

Working-condition bonuses nevertheless remain very important and continue to strongly differentiate specialties. The draft maintains a bonus of up to 15% for neonatology, delivery rooms and medical analysis laboratories. For particularly dangerous conditions, level I reaches up to 40% and includes, among others, dialysis, palliative care, medical oncology, paediatric oncology, radiotherapy, oncological haematology, neurology, neurosurgery, infectious diseases, transfusion points and interventional endoscopy laboratories. Level II rises to up to 50% and covers leprosaria, pathology, tuberculosis, AIDS, psychiatry, forensic medicine, ambulance services, UPU-SMURD, intensive care, transplantation, burns units, prevention of healthcare-associated infections, transfusion centres, operating theatres, interventional cardiology and radiology laboratories, acute stroke units, medical genetics and, explicitly, surgical specialists. For staff exposed to radiation, the bonus reaches up to 10%, differentiated across four categories of radiological risk. For isolated or hard-to-reach localities, a bonus of up to 15% is provided.

Two strong conclusions emerge here.

First: the draft continues to reward clinical severity and professional risk, especially in intensive care, emergency medicine, surgery, radiotherapy, transfusion services, forensic medicine and interventional laboratories.

Second: under the broad umbrella of “laboratory” there are major differences. A medical analysis laboratory goes up to 15%, while pathology or interventional cardiology and radiology laboratories may reach up to 50%.

For laboratory staff, therefore, the specialty and the exact workplace will matter enormously. The text also states that the bonuses under letters a)-d) cannot be cumulated for the same person, which seriously limits the individual ceiling, even in high-intensity areas. However, the express prohibition does not also mention the radiological-risk bonus under letter e), leaving an area that will need to be clarified in the regulation.

The staff of public health directorates should not be overlooked either. The draft provides that they may benefit from the same working-condition bonuses if they work under the same conditions as the staff who already receive them in healthcare units. For preventive medicine, public health and certain laboratory or epidemiological intervention activities, this is one of the few openings that may matter for recruitment and retention. In the same register, doctors employed in social services or social care units are referred to the salary level applicable in non-clinical healthcare units, which strengthens their connection with the healthcare system proper.

Where do risks of inequity and conflict arise? Criticism of the draft

The greatest tension in the draft is not found in the list of bonuses, but in their ceiling. At general level, the sum of bonuses, allowances, premiums and awards may not exceed 20% of the sum of basic salaries, per main budget holder and by funding source, except for the elements expressly excluded. For healthcare, this means that bonuses “of up to 40%” or “of up to 50%” are not synonymous with guaranteed money in employees’ pockets. They remain maximum legal ceilings, not automatic rights. In hospitals with many departments eligible for high bonuses, the 20% ceiling may force management to distribute less than the wording of the annex would allow, especially since the concrete level of the 40% and 50% bonuses is established by the unit’s management, in consultation with the trade unions, but “within the staff expenditure approved in the budget”. Healthcare receives potentially significant rights, but also a strong budgetary brake.

It is true that the draft excludes some relevant elements from the ceiling: the night-work bonus, the overtime bonus, the 10% bonus for work in three shifts or 12/24 shifts, the bonus for isolated localities and the performance award.

What does the Minister of Labour say?

Interim Minister of Labour Dragoș Pîslaru says the new salary law will introduce a new structure of basic salaries and bonuses, but with the application of the principle of income protection: if the new calculation would lead to a lower amount, the difference will be granted as an individual compensatory right.

According to him, “no Romanian will lose a single leu” through the application of the law, while salaries are expected to increase for 56% of public-sector employees, with the others remaining at their current level.

“People will have a new classification based on a new basic salary and a new structure of bonuses, which are limited to 20%. The calculation is made — let’s say you currently have 12,100 lei in payment and, under the recalculated figures, you arrive at 11,000. You will have a difference of 1,100 lei, which is considered compensation. So, there is the salary resulting from the application of the new law plus compensation considered an individual right, not a collective one, of 1,100 lei. That is where you happened to be in 2027 when the law was applied (…) No Romanian will lose a single leu as a result of this law. The principle of income protection is the fundamental principle of the political agreement between the parties and the one guiding our work at the Ministry of Labour, in the drafting and support team for this project. Therefore, Romanians should know that any statement creating panic that their salaries could be negatively affected is untrue. What is very true is that for 56% of public-sector employees, salaries will increase, and for the others they will remain in payment exactly as they are,” interim Minister of Labour Dragoș Pîslaru said on Monday.

What 2027 may look like, cautiously assessed

In the draft law analysed by Medic24 in the version available at the time this analysis was written, 2027 begins with two certainties: the reference value is set at 4,100 lei, and the salaries of staff already in the system, remaining in the same position and under the same conditions, should not decrease nominally below the December 2026 level, thanks to the transitional salary difference. This leads to the first cautious prediction: for most professionals already employed in healthcare, 2027 is more likely to begin with nominal stability than with reductions. But nominal stability does not automatically mean a real gain.

The second cautious prediction made by the authors of this analysis is less comfortable. The draft states that the reference value is set annually so that the increase in personnel expenditure does not exceed the nominal GDP growth rate, and if the GDP forecast worsens during the year, the reference value is not changed. In other words, the law does not build in an automatic intra-year indexation to inflation. For doctors, nurses and laboratory staff whose nominal income remains almost unchanged, the effect is simple: purchasing power decreases exactly by the inflation rate, whatever that may be. Anyone entering 2027 without a promotion, without a favourable reclassification of the unit, without a new bonus or without moving into a new seniority grade will feel inflation as a real cut, even if there is no nominal cut.

Those with a real chance of staying above inflation are more likely to be the groups working in areas with high and predictable bonuses or those who benefit from a favourable change in the category of the unit. Moving into a new seniority grade may bring 7.5% or 5% in the early stages of seniority, which can better protect real income; towards the end of a career, the 2.5% steps are far less capable of offsetting price increases. In parallel, a higher classification of the unit or department may change the salary much more strongly than a seniority grade. This means that, in 2027, not everyone in healthcare will experience the same salary reality: high-risk areas and well-classified units may remain relatively protected, while segments with low bonuses and no professional advancement may enter a year of real stagnation.

In a scenario of political instability and economic pressure, the first stress points will most likely be precisely those left to the discretion of the budget and subsequent regulatory acts: the effective percentage granted from the “up to” bonuses, the classification of units within coefficient limits, the pace at which Government decisions and Ministry of Health orders are issued, and managers’ willingness to promote staff covered by the protection of the transitional difference.

In its current form, the draft does not bring a uniform and clear increase for all medical professions, but rather a combination of protection for those already in the system, selective reward for high-risk specialties and a wide margin of administrative variation. And for 2027, the key question for healthcare professionals will not only be “what is the coefficient of the position?”, but also “in which unit do you work, in which position do you remain, what bonus do you receive and how much of the legal maximum can actually be paid?”.

Material produced by:

Valentina Popescu

Dragoș Șerban