Low wages and brain drain: an alert from Peru.

David McCoy and colleagues, and the related Comment, show the diversity of factors related to low wages of sub-Saharan health professionals. In Peru, physicians' salaries have decreased to a quarter of 1976 salary levels, from S/.7974 to S/.1919 in 2004, adjusted for 2001 Peruvian nuevos soles. Physicians end up having two or more jobs to secure a decent income.

A survey of 202 interns from Universidad Nacional Mayor de San Marcos in Lima, between September and December, 2007, showed that 106 (53%) had a salary expectation of more than S/.8000 (US$2600). Yet an average doctor's salary in Lima is S/.1930 ($670). 77 (38%) of those interviewed were considering migrating to a developed country to practise medicine. Factors associated with the desire to migrate were increased income expectation, having first-degree relatives in the profession, and having presented a research project at a medical students' congress.

These results are worrying. First, economic expectations of graduates are way below what the Peruvian market can offer them. Second, more than a third of students plan to migrate to a developed country, which is a serious concern if we consider that they were trained at Peru's largest public medical school. Additionally, the fact that having physician relatives was associated with an emigration perspective suggests either that those students are aware of better professional development opportunities abroad, or that there is a current dissatisfaction with medical practice in Peru.

We share McCoy and colleagues' view that government policies to improve medical salaries are needed. Considering that Peru is the country with the lowest public expenditure on health in the Latin-American region, these policies are nothing but urgent.