Doctor drain
The number of doctors fleeing Pakistan to find jobs abroad is a cause of growing concern for the medical field in the country. It points to a lack of opportunities and accommodation of graduates within the healthcare system
Muhammad Hamza Khan is a young house officer at Jinnah Postgraduate Medical College (JPMC) in Karachi. He recently completed his MBBS degree from Dow University Ojha campus on an international seat. Graduating from the world of learning medicine to the world of practicing medicine in the same city was a rude awakening for the youth.
“When a doctor gets into the system after completing education and starts their house job, that is when they realise what options they have here,” Khan said.
Established in 1845, Dow University of Health Sciences is a public medical university that has ranked among the top institutes in the country. Medical colleges in Pakistan have expanded considerably in recent years. In 2019, there were roughly 114 medical colleges, both public and private. This equates to around 16,000 medical graduates per year.
In Sindh, around 2,500 seats are allocated in public sector universities while around 1,800 seats are allocated in the private sector from a total of 29 universities. So where do the rest of those 16,000 doctors go?
Khan, for one, has a sponsor from Germany and is preparing for his language test.
Greener pastures
The main factor behind applying abroad for jobs is the lack of lucrative employment for medical graduates in Pakistan. Although the field of medical sciences has always been considered better than other fields, in terms of merit and education, in our society, the country’s job market has little to offer medical students once they step out of university. “When someone who studies at an international seat has spent almost 1.25 crore to 1.5 crore for their five-year fees, in the current dollar rate, do you think they will settle for 40,000 rupees a month?” Khan points out.
After she graduated from Dow Medical College, Arbish Azeem* started looking for job opportunities. However, she failed to find anything that was worth her degree and achievements. “I was getting jobs for 20,000 rupees at that time after spending so much on my education,” Azeem said.
“The first shock one will get after completing their education is that you do not get paid for house job. While the government does pay the hospitals, the hospitals in turn try to not disburse that amount to the young doctors. Some institutes even make you sign an affidavit saying that you are getting a salary while the doctors are hardly getting anything,” said Azeem, who now works for a private hospital. Now most doctors protest against this corrupt practice which has ensured that they receive at least half of the salary which is released on their names.
Graduates also do not know who to turn to in order to register their grievances, be they about nominal salaries or other difficulty in securing a job. The associations which are made for young doctors have been hijacked by consultants and resident officers who are also busy minting the money which is released for house officers. “Amid all this, the only options doctors have is to try and get licensing and move away from here to find better opportunities to work and live abroad,” Khan explained.
“It was not like doctors weren’t leaving the country due to such reasons, even in the 1960s and 1970s,” said the general secretary of the Pakistan Medical Association, Mirza Ali Azhar. “A majority left the country to pursue higher degrees and training. Some of them came back to Pakistan but many of them didn’t. The only issue nowadays is the number of graduates has increased while job opportunities in the public sector have not.”
The situation has not improved since Azeem graduated almost 10 years ago. Competition has only increased, but at least now young doctors are voicing their concerns about pay and corruption.
Where the problem lies
The problem is in the system where more doctors are graduating but there is no proper channel for them to be trained well and accommodated in the system. “The simple thing is that doctors graduating and getting trained from Aga Khan University Hospital (AKUH) are getting so many opportunities while studying from a similar syllabus doctor from Civil Hospital have to struggle to make their way,” told the PMA general secretary.
He also added that pay disparity and corruption on a huge level where so many people are involved and still working within the system for years is questionable. “Just imagine where the morale of a young doctor will stand when they are being asked to bribe for what they have the right, just because institutes know that doctors are helpless and need training, they exploit their situation by making money out of their misery, which is why doctors decide to leave because the same scenario they face while going for jobs,” he shared.
“Students have to bribe hospitals to get slots for training just because the training should be done within a specific time limit. The students are helpless, they have to go for it,” Khan confirms.
As far as the government jobs are concerned which are inducted via the Sindh Public Service Commission, those are not advertised regularly, and the number of seats also varies between 300-700 sometimes but even in that if one clears the exam and interview, they are posted in deserted and rural areas of Sindh. “Doctors from Karachi are a different case. They never go to rural areas such as Shahdadkot, Kashmore, or Shikarpur. Even the ones commissioned from the rural parts of the province try to get themselves transferred to Karachi seeing the prospects of a big city having opportunities, and support for the family in terms of education, healthcare, and other facilities, in all of this when they struggle for transfer many don’t get their desired postings so they leave the job and opt for a private option if they get better,” Azhar explained.
Women in the work field
Sindh, like other parts of Pakistan, has a gender imbalance in the medical field when it comes to the workforce. Despite a growing number of women pursuing medical education, female doctors are severely underrepresented. A reduced participation rate results in the dearth of female healthcare workers offering services to the community. According to a study conducted by Gallup Pakistan and PRIDE, as many as 35% of female medical doctors in Pakistan are unemployed,
Traditional social standards frequently discourage women from pursuing medical occupations, hence reducing the pool of female doctors. “When I was getting admission to MBBS, my family’s first concern was how I would manage the night shifts. They said I should pursue engineering, where I could be home before sunset or have a better routine. They were telling all this to someone who has secured 92 per cent in intermediate. I was in the top 50 in MDCAT the year I appeared,” said Azeem. “It is not just about what I was getting in monetary terms but the system in the country is discouraging. It creates such situations where doctors think that leaving this country is a better option than finding a job here,” Azeem shared.
Although the grass looks greener on the other side, getting accepted into a hospital abroad is no less grueling than looking for work at home. The obligation to meet licensing and credentialing regulations is perhaps the biggest barrier for doctors desiring to work abroad. Each country has a medical licensing authority, and doctors are frequently subjected to rigorous evaluation and testing to demonstrate their competence. This procedure can be time-consuming and costly, as doctors may be required to retake exams or undergo extra training. “Each country has its own way of licensing and testing a doctor before they call them or before you can go and practice there, and it's not a piece of cake. It is also very costly. Just clearing such licensing takes three to four lengthy steps. The majority of medical graduates in Pakistan focus on USMLE which is done for the United States, then Ireland, Germany, United Kingdom, and others, but each country has a rigorous procedure to follow,” explained Khan.
*Names have been changed to protect identity