Between countries there are large differences in the remuneration of medical specialists. We compared the remuneration levels in 2010 in six countries: Belgium, Denmark, England, France, Germany and the Netherlands. We used OECD figures for the remuneration levels, but corrected them extensively for differences in measurement between countries. English doctors earned most in 2010, French doctors earned least. For the six countries under study the number of doctors per capita is most consistent with the differences in income. Surprisingly, the payment scheme (salaried or fee-for-service) does not seem to account for differences between countries, although within countries fee-for-service specialists earn more than their salaried counterparts. Differences in the role of the GP, differences in workload, composition of the workforce and education could not account for differences in remuneration between these six countries. As our conclusions are based on only six countries more research involving a larger number of countries is needed to confirm these findings.