Luxembourg is facing an acute shortage of doctors, while around one third of Luxembourgish medical students do not return to work in their home country after completing their studies.
A key factor is the specialisation phase: the final four to six years of training during which theoretical knowledge is translated into practice and professional responsibilities increase significantly. It is precisely at this stage, however, that conditions in Luxembourg are often unclear and vary considerably depending on the placement, according to the Luxembourg Association of Doctors in Specialist Training (ALMEVS), the country’s junior doctors.
Around 250 young doctors are currently undergoing specialisation in Luxembourg. They work either in hospitals or in outpatient settings, for the University of Luxembourg or in private practices. What they all share, however, is the absence of a uniformly regulated professional status.
Yoon Penning, Vice-President of ALMEVS, described the situation by saying that because their status as MEVS is not clearly defined, practices, and training supervisors have considerable freedom in determining contract terms and remuneration. She added that some junior doctors work as self-employed practitioners, others as salaried employees, even when performing identical duties under very different forms of supervision.
This results in unequal working conditions, varying working hours, and significant salary disparities. Added to this are Luxembourg’s high living costs, which place particular strain on younger professionals. For many doctors, returning to Luxembourg is therefore a decision driven by personal conviction rather than attractive working conditions, according to Penning.
ALMEVS stressed that junior doctors should not be regarded as students, but as fully qualified healthcare professionals. Penning said that although they are supervised by a training supervisor, junior doctors often represent the first, and sometimes only, medical contact for patients arriving at emergency departments in the middle of the night. “Junior doctors play an extremely important role in Luxembourg’s healthcare system”, she emphasised.
Despite this responsibility, Penning argues that there is still no clear framework outlining rights and obligations. Penning said that many junior doctors lack clarity about whom to turn to in case of problems and what their entitlements and duties are, describing the current situation as overly vague.
The consequence of these variable conditions is that, even in fields where demand is high, training posts sometimes remain unfilled.
Penning pointed out that even in general practice, several training positions remained vacant last year, with more places offered than candidates who applied or passed the required examinations.
This contrasts with other countries, where competition for specialist training posts remains intense. In Luxembourg, unclear structures and high living costs may be contributing factors.
Negotiations with the Ministry of Health and Social Security have been ongoing since March last year regarding a unified agreement for junior doctors. Discussions focus, among other issues, on working hours, on-call duties, and overtime, which can reach 40, 60, or even over 100 hours per week depending on the department.
Penning noted that overtime and on-call payments vary widely between hospitals. She added that equal access to training opportunities is another key demand, as some junior doctors receive funding to attend conferences while others receive none.
Salary remains a central point of contention. ALMEVS is calling for pay to be aligned with the civil service’s A1 career scale. The A1 career scale refers to the highest category in Luxembourg’s civil service pay system, typically reserved for roles requiring a university master’s degree or equivalent qualification.
Penning justified their demand in stark terms: “We have all completed between four and six years of university education. That corresponds to an A1 career level. But we are paid well below that. Luxembourg is an expensive country, this is not sustainable.”
According to ALMEVS, an adjustment of the legal framework and the introduction of a new charter for doctors in training could provide at least a partial solution. The objective is greater transparency, improved working conditions, and enhanced attractiveness for the next generation of doctors. Penning concluded that without structural reforms, Luxembourg risks losing further ground in the international competition to attract young medical professionals.
