Emergency doctors want to travel alongside anaesthetists in medical emergency aid service (SAMU) vehicles. However, anaesthetists argue this would compromise the quality of the service.
An unofficial reason cited by insiders appears to be financial, with anaesthetists reportedly reluctant to expand SAMU operations due to potential loss of income. Indeed, on-call shifts at the SAMU are very lucrative, as research conducted by RTL has found.
A few weeks ago, the organisation and operation of Luxembourg’s medical emergency aid service (SAMU) made headlines following the circulation of an internal reference document. The document is now being revised after emergency doctors requested permission to accompany SAMU teams. Until now, only doctors and nurses specialising in anaesthesia and resuscitation have been authorised to take part in SAMU deployments. However, this is set to change at the request of emergency doctors, who are already allowed to accompany SAMU teams abroad.
Anaesthetists remain highly sceptical of the proposed change. In an interview with RTL, Dr Philippe Welter, president of the Cercle des Anesthésistes, said the anaesthetist–nurse partnership “works better than a marriage”. He argued that altering this structure would undermine the quality of care provided by the medical emergency aid service (SAMU). Dr Welter also noted that there is currently no shortage of anaesthetists, meaning there is no reason to open SAMU roles to other types of doctors.
Emergency doctors, however, do not share this view. They argue that SAMU work is part of their job, and that their training has evolved in recent years to include the necessary qualifications to participate. Similar arrangements are already in place abroad. Due to restrictions placed on emergency doctors in Luxembourg, many are reportedly reluctant to work in the country, they said.
What is clear, however, is that many doctors are eager to work for the SAMU, and the reason may be financial. SAMU on-call shifts are known to be well compensated, though the exact earnings are not easy to determine.
According to the Grand Ducal Fire and Rescue Corps (CGDIS), an anaesthetist earns €121.24 per hour while on call. In addition to this base rate, all interventions and medical procedures are billed separately.
The rates for these procedures are detailed in the National Health Fund’s (CNS) nomenclature of medical procedures, a 133-page document that outlines the applicable fees. RTL has summarised the relevant information in the table below for clarity.
As this table shows, doctors earn a substantial amount per call-out: around €200, plus additional fees for individual procedures or supplements, for example, if the emergency is further away or if doctors have to travel by air. Medical transport is billed at €300. This table does not include night hours, Sunday hours, or public holidays.
Remuneration for being on call depends on the duration, the number of interventions performed, and the time and days worked.
Let’s take the example of a 12-hour shift: this would equal to €1,454.88 just for being available.
According to RTL information, a doctor performs an average of between three and five procedures during such an on-call shift. Based on four procedures, this amounts to approximately €800 extra. For a 12-hour on-call shift with four procedures, a doctor therefore earns around €2,250. This does not include additional medical procedures, supplements, or medical transport.
For hours worked at night, on Sundays, and on public holidays, procedures are billed at double the rate, which can bring the remuneration to more than €5,000 for these shifts.
As for the average amount earned by a doctor on an emergency medical service shift, the CNS did not wish to disclose this information to us.
This information was not easy to obtain either. However, as the head of the SAMU base in Kirchberg, Dr Philippe Welter, explained that it is the various base managers who decide how to allocate shifts and who can work at what times. There are no guidelines from the CGDIS on this matter. According to Dr Welter, at the Kirchberg SAMU, the average hourly cost over the year is around €200.
Dr Welter told RTL that the Kirchberg SAMU has a fair system for allocating both shifts and remuneration: “There are 13 anesthetists working at the SAMU, and it is organised via a schedule, a duty roster. The system is fair: everyone works the same number of shifts as their colleagues. In other words, we all do more or less the same number of on-call hours. This includes a fair distribution of nights, weekends, and public holidays, which we share among ourselves.”
However, this way of working is not imposed by the CGDIS. Each base manager can therefore decide on their own accord how to organise their teams.
Dr Philippe Welter continues: “At each base, they organise themselves according to what is possible and people’s preferences.”
Is it then possible that some doctors benefit more than others from lucrative SAMU on-call shifts? According to Dr Welter, it is a possibility, but he clarified that he knows that base managers make sure that everyone is treated fairly.
According to information from RTL, this attractive remuneration attracts many freelance doctors from abroad. Dr. Welter confirmed this information but took a critical view of this phenomenon: “I can confirm that there are quite a lot of freelancers. In fact, there are more and more. But I can’t be happy about that, it’s not my goal. We already said this in 2018, during the merger with the CGDIS: calling on foreigners to help is fine, but the main burden must remain on the country’s hospital doctors, because we want at least 50% of the work to be done in hospitals, precisely in order to retain the skills and know-how we need on a daily basis.”
According to emergency doctors who spoke to RTL, the generous remuneration is the main reason anaesthetists do not want to open SAMU work to them. From their perspective, there is no other plausible explanation.
When asked about this, Dr Philippe Welter responded cautiously. He said he understood why people might think so and acknowledged that anaesthetists currently earn around €200 gross per hour on SAMU duty, regardless of whether the shift takes place during the day, at night, at weekends, or on public holidays. He also pointed out that emergency doctors have seen their own fee structure increase significantly over recent years, which in his view means no one is taking money away from anyone else. As he put it, anaesthetists neither lose nor gain anything financially from emergency doctors joining SAMU rotations.
Key questions remain open: how exactly are taxpayers’ money used within the SAMU, and how is remuneration organised inside a service of this kind? RTL’s research shows that such financial information is difficult to obtain. The CNS has also not yet responded to questions about the annual budget allocated to the SAMU.
A vote on the adjusted reference framework for the service is expected to take place at the CGDIS board meeting in early 2026.
