No cure at home: the exodus of Pakistan’s doctors

A worrying trend in recent years has been that many young doctors are leaving Pakistan in search of work and better working circumstances overseas, or they are struggling to find jobs in the country that suit their education and specialisation. Pakistani physicians are increasingly opting to relocate to the UK, the Middle East, and even North America to pursue jobs in countries that provide them with professional progress, fair compensation, and a sense of worth. However, where this trend presents opportunities for physicians, at the same time, it creates a crisis for the healthcare sector in Pakistan, as the migration of skilled medical practitioners is leaving a gap in medical services.

Why are young doctors leaving Pakistan?

Poor working conditions and low pay in the healthcare industry are among the main reasons behind young doctors opting to leave Pakistan. Even after finishing a demanding five-year medical program and numerous home employment assignments, doctors are frequently employed in low-paying positions. “When after a five year of rigorous education, a graduate goes out to find a job, they get a low paid job with extra working hours, they are disheartened. It only encourages them them to seek better options outside Pakistan,” told Secretary General of the Pakistan Medical Association, Dr Abdul Ghafoor Shoro.

In most cases, junior physicians at public institutions frequently receive monthly compensation that is insufficient to meet their essential living expenditures. Saudi Arabia, the United Kingdom, and the United States, on the other hand, provide organised professional progression prospects and competitive wages. “After four years of study, when I went for a house job, the offer letter promised me 85,000 rupees while we only got 45,000 rupees compensation. We were asked to sign the letter, or else we wouldn't even get 45,000 rupees,” said Afsheen Ahmed, who graduated from a public dental college three years ago. She also shared that the entire system is involved in corruption, from the administration staff to the upper management.

Other than the pay disparities, many government hospitals have subpar working conditions. An overdemanding atmosphere is created by overcrowded wards, old equipment, fewer resources, and overwhelming numbers of patients. Despite putting in long hours, medical professionals are not very satisfied with their jobs. All these issues are made worse by the additional stress caused by understaffed institutions, which is why many doctors look for alternatives overseas where working conditions and hours are more controlled. “The main reasons are security, safety, better pay, and working conditions, or else why would anyone want to leave their home country,” said Dr Shoro.

The insecurity of healthcare jobs in Pakistan is another reason young doctors choose to go abroad. In many public hospitals, contract-based jobs with little to no job security are commonplace. For physicians in the early phases of their careers, the recruiting procedures are frequently unclear and unstable due to their slowness, bureaucratic nature, and political influence. Young doctors in Pakistan find it challenging to invest in their professional development and plan for the future because of this lack of stability. “I graduated five years ago from a top-notch institute, but the working conditions made me rethink my decision to join the workforce. Also, the placement criteria are absurd where a doctor from Karachi will be posted in Kashmore, but a doctor from Larkana will be posted in Karachi. This doesn’t make sense, and one should be inducted in their cities,” said Muhammad Hamza Khan, who is now practising in a private hospital.

Many physicians are compelled to choose less popular specialties or are unable to get a position in their preferred specialty. Furthermore, earning a postgraduate degree in Pakistan can be expensive and time-consuming. In contrast, nations with stronger healthcare systems have better facilities, more defined job growth pathways, and organised training programs. “I am planning to leave by the end of this year to pursue my Masters abroad. I do not plan to come back because the future is bleak here and there are no job prospects, despite the patient-doctor ratio in the country,” shared Hamza.

Young professionals, particularly doctors, who frequently face additional societal obligations, are under more financial strain as a result of Pakistan's rising cost of living. There is an underlying cultural expectation that doctors would lead stable and successful lives because they have chosen a noble and challenging career. However, this is frequently not the case in Pakistani reality. The advantages of working overseas, which offer greater pay and a better lifestyle, become more alluring when young doctors are unable to meet these expectations.

Challenges in securing jobs

Lack of employment opportunities in the healthcare industry is one of the main problems faced by Pakistan's young doctors. Approximately 15,000 new doctors are produced annually by Pakistan's medical colleges, but the number of public sector employment openings has not kept up. To accommodate this flood of recent graduates, the public and private sectors have not made enough investments in developing hospital infrastructure or healthcare services. As a result, despite the population’s obvious need for healthcare experts, many young doctors are either unemployed or compelled to work in jobs unrelated to their field. “If there are 15,000 graduates every year from all over the country, the number of jobs hardly matches the number of graduating doctors. The government, on the other hand, cannot accommodate them due to finances and budget restraints, and that is where the loophole widens,” explained the secretary general of the PMA.

Healthcare recruiting practices in Pakistan are sometimes tainted by political interference, which results in hiring decisions that are not always made based on merit, for young physicians who have put in a lot of effort into earning their credentials, nepotism or favouritism frequently results in missed career prospects. Even the most talented doctors look for jobs overseas because they believe their qualifications and abilities will be more respected there due to the perceived unfairness of the recruiting process.

To advance in their careers, recently graduated physicians need direction and hands-on training, but Pakistan's healthcare system frequently lacks the means to offer these services. “After getting out of medical school, we are on our own and have to navigate through either asking for counseling from seniors or relatives. There are very few teachers who mentor you and guide you to take a better option,” said Ahmed, who is assisting one of her teachers at a private clinic. She also said that in public hospitals, most hiring is done through political involvement, and people with certain ways of speaking are given priority. Many young doctors feel alone and unsupported in the absence of formal programs or sufficient mentorship, which influences prompts them to look for better prospects for professional growth overseas.

With a national health spending that is much lower than that of many other nations, Pakistan’s healthcare system continues to be underfunded. Young doctors have fewer career options as a result of underfunding, which is the reason behind fewer hospitals and fewer medical resources. The few hospitals that do exist are frequently overcrowded, poorly furnished, and run by a small group of physicians and nurses. Even if there are jobs available, they are frequently in difficult settings where it is hard for doctors to deliver high-quality patient care due to a lack of infrastructure and resources.

Doctor shortages in Pakistan’s healthcare

Pakistan may see a significant shortage of trained medical personnel in the upcoming years if the current migration of young doctors continues. The consequences of this scarcity will be extensive, ranging from public health outcomes to patient care.

The patient-to-doctor ratio will rise in Pakistan as the number of active physicians declines. Pakistan’s public hospitals are already congested, and this problem could get worse if there are not enough doctors. Reduced time for each patient leads to hurried consultations, a higher risk of misdiagnosis, and generally worse care. “We are not talking about a decade later, but in the next two or three years, the shortage will be obvious. Doctors have been leaving the country right, left, and centre for the last few years,” said Dr. Shoro.

Patients may find it more challenging to get care for complicated medical conditions due to a shortage of specialised physicians. Specialists in disciplines like neurology and oncology are already in limited supply in Pakistan. Patients may not be able to get timely, specialised care in Pakistan if young doctors keep leaving, particularly in rural areas where access to healthcare is already scarce.

The strain on the remaining healthcare professionals will rise as fewer young doctors join the system. Increased workloads may be expected of senior physicians and other healthcare personnel, which could lead to a decline in job satisfaction and a rise in patient care errors. “Senior physicians will leave the field after a while, and then there will be a gap to be filled. Among the various reasons is the ratio of male and female students. Every year around 70-80% female candidates get enrolled in medical schools, and if the number is to be believed almost half of them don’t practise at all,” lamented the secretary general. He also added that male students do not apply for medical schools much, which is why the gap is widening year by year.

A lack of physicians may result in missed diagnosis, treatment delays, and generally poorer healthcare quality, all of which only increase public health problems. The country runs the risk of experiencing a shortage in the years to come if significant reforms and investments are not made in the healthcare industry. The current tendency may have long-term effects that negatively impact Pakistan’s public health and standard of living if it is not addressed.