EDITOR—The political transition in formerly communist countries has affected not only the health of their populations but also their healthcare systems.1 Healthcare reform introduced in Poland in 1999 influenced the organisation of health care, but the working environment of Poland's doctors has not improved. Since Poland's accession to the European Union, many doctors have left the country to look for jobs in west European countries, particularly the United Kingdom and Scandinavia (almost 500 Polish doctors registered in the UK in 2004, 30 times as many as in the previous year).

Why do so many doctors decide to leave their native country after democracy has been won?

Firstly, salaries are low, especially in hospitals—much lower than the average salary in public institutions (in a public hospital, doctors typically earn about €300 (£206; $362) per month after tax). This is not enough to live on, so doctors (particularly young ones) cannot be fully independent and have to seek financial support from their families. Many cope with this problem by being employed in several places, and some work in the pharmaceutical industry (doctors working as sales representatives are probably rather unusual in other countries).

Secondly, the residency system is poorly developed, so after graduating many doctors are denied the possibility of specialisation. Sometimes the only way to specialise in the chosen area is to emigrate from Poland. But not only financial reasons matter. The standard of living and the working conditions seem better in west European countries. Doctors can stick to just one job, which means shorter working time and fewer patients. In west European countries, access to new technologies of diagnosing and treating patients is much better. The variety of opportunities to develop professionally is also important, for clinicians as well as scientists.