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Ordeal of Pakistani doctors
By Dr Amin A. Gadit

MEDICAL education and the future of doctors in Pakistan have been in the doldrums since long. There was a time when there were very few medical colleges in the country and those were in the public sector. Getting admission in a medical college was considered prestigious. First-year medical students cherished the title ‘doctor sahib” and felt pride in wearing their white coat with a stethoscope around their neck.

Things changed and the private sector established medical colleges. We now see many of them. With open merit, girls are opting more for medical studies though few take up medicine as a career. But overall deterioration in medical education and no structured career planning — unlike the situation in India — have led to doctors looking at alternative career paths.

Most of the private sector medical colleges are devoid of a full-fledged hospital to meet the minimum standards set by the Pakistan Medical and Dental Council. The public sector has large hospitals with many patients but the complaint is that teachers are not motivated and do not provide individual attention to medical students. The undergraduate years are thus full of academic stress.

After graduation, young medicos face a number of problems: internship, residency, post-graduation, marriage, income. Many girls marry and disappear from the medical horizon. Pressure continues to build up on the boys.

After internship, we have the huge problem of finding postgraduate placement. There are few training slots for the large number of medicos. Getting into a desirable training programme is a nightmare. If one is lucky, then the remuneration is below expectations. Post-graduation is a tedious process involving expenditure. Sometimes it takes years before a doctor gets his or her certification.

Settling down in practice is a big challenge. General practice is full of risks considering the law and order situation in the country — one was also distressed by the spate of ‘doctor killings’ which haunted the country earlier. In the golden days, young doctors would dream of going abroad for higher studies and were welcomed. Britain has now become a pipe dream for aspiring doctors as with its new rules and the revamping of the education system, there is practically no room for our doctors to be absorbed into its higher medical training programmes.

The United States was and is another option, though one with multiple complexities. Sitting and studying for their entry USMLE exams takes students a long time besides posing a burden in terms of expenses and being without a job while studying. Once they have passed the exams, they have to face the hurdle of obtaining visas which can be a tricky procedure, especially after 9/11; in fact doctors already in the US feel discriminated against in these times.

Australia and New Zealand are not easy options as yet for Pakistani doctors but India has a special arrangement for its medical graduates to be placed in Australia. Canada is self-sufficient in non-specialist resident doctors and looks to western-trained postgraduates for recruitment. Those doctors who go to the West without first acquiring a job suffer tremendously, with many having to take up small jobs in restaurants, railway stations, factories etc. to meet living expenses. They face an uncertain future and many undergo psychological trauma. In fact, there have been reports of how some experienced nervous breakdowns and committed suicide.

Some male doctors finally find a position but those with wives who are doctors find their spouses having to give up their career to become fulltime housewives — many feel depressed under the circumstances.

The option of working in the Middle East is a lucrative one and countries like Saudi Arabia and Oman are quite liberal when it comes to accommodating doctors from Pakistan. But these countries have a package that is different for Pakistani-trained doctors in comparison to those who qualify from elsewhere. Also, as with many other professional expatriates, Pakistani doctors find themselves at the receiving end of the Saudis’ repressive approach — their passports are kept by the employers which curbs their freedom to travel.

Moreover, in these countries doctors appointed to a particular position do not get promotions. Those doctors practising in western countries may come across prejudice and subtle discrimination but there is no outright violation of their rights.

What about those who are well-settled abroad but remain deeply attached to Pakistan emotionally? Some have tried to come back but finding it difficult to operate here professionally and at a social level have preferred to go back.

Under the current circumstances, many doors have closed for Pakistani doctors. A number of them enter into private general practice and work late hours to make ends meet. They have to move from institution to another for better salaries. The environment at many private institutions leaves much to be desired and several doctors end up labelling their jobs as ‘seth ki naukri’.

Others who are specialists and lucky enough to get government jobs are happy only for a while as with the passage of time they experience a number of problems: undesirable transfers to outlying areas, blockage of promotions, prejudices and politics.

In view of this scenario, young doctors are not finding the profession attractive. The word ‘doctor sahib’ does not attract them any longer and many are making use of their other talents by opting for careers in the media, pharmaceutical companies, business administration and the fine arts. It is about time this problem was taken seriously and a new path laid out for the coming generations of doctors whose services are badly needed by an ever-growing population that finds itself without proper medical services.

[Dr.G.AsgharMemon]

This article is most true about state of pakistani doctors. it is heartaching to see our doctors becoming prey to this quagmire.the situation is not however confined to doctors only, many of other proffesionals r suffering due to ineffective functioning of our government machinary. there are few rays of hope and dark and gloomy future. God protects us all! God saves pakistan! Ameen!

regards
dr.g.asghar