KARACHI:
The Pakistan Medical Association requested the Supreme Court on Wednesday to revisit a decision that created an “open merit” system for medical college admissions. As a result of this policy, the country has been churning out far more female doctors than male doctors, but as 75% of the women abandon work after graduating, the healthcare system is suffering.
In 1991, the Supreme Court abolished the 60:40 ratio for male and female students in medical college admissions. “We had hailed the decision in 1991, but [in hindsight] it seems that it has backfired,” said Dr Mirza Ali Azhar at a press conference on Wednesday.
Today, there are not enough doctors to staff rural health centres and basic health units, which are small clinics that are supposed to fill the gap in the countryside where hospitals do not exist. Balochistan, Gilgit-Baltistan and other conflict zones in the country are also short of medical professionals.
The doctors took great pains to clarify that they were not against women attaining a medical education. They merely want for the human resource situation to be calibrated so that staff is deputed where needed instead of there being chronic shortages.
Dr Azhar added that when he started his medical education in 1973, there were 80 girls and more than a hundred boys in his class. “All the men are still working,” even though less boys were admitted than girls.
According to Dr Idrees Adhi, young men are not attracted to the medical profession anymore as women have traditionally outperformed them in academics.
They are also worried about financial uncertainty as government healthcare jobs do not have the safety net of salary and promotion rules. “When they graduate, they [feel that they] are far behind their colleagues who choose commerce or any other field,” he added.
It is no secret that male doctors were moving aboard for better job prospects. “The Middle East and other countries do not need to spend money to produce their own doctors,” said Dr Qazi Wasiq, “as they are getting them from our country.”
He also alleged that private medical colleges in Pakistan were only worried about making a profit instead of ensuring adequate healthcare delivery. “It has become a status symbol for parents to enroll their daughters at private medical colleges, as it makes it easier for them to find a future spouse,” he said. These young women graduate but are then reluctant to work in rural areas. They don’t even like doing night duty, remarked Dr Qaiser Sajjad.
Separate medical colleges for boys
The PMA demanded that the Supreme Court form a committee to work on recommendations to revise the policy.
They suggested that 10 medical colleges should be reserved for boys as there are six medical colleges that are exclusively reserved for girls. They asked the government to improve the service structure for doctors, so that more male students would choose the medical profession and also decide to work inside the country.
“It took us twenty years to see the results of the decision that was taken in 1991, and it will take at least half that time to turn it around to fix the problem. Therefore, the government should wake up right now to address the issue,” said Dr Mirza.
Published in The Express Tribune, August 23rd, 2012.
COMMENTS (56)
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Mandatory rural service for few years after provision of security & administrative cover to Doctors can make things comfortable.
However, for obvious reasons, the feudal culture has to be limited to their own households beforehand.
Thereafter, even if a female Doctor retires to her married life, she's not wasting, as she will still contribute to our country or humanity, being in a family, though not paid for her professional advices.
People, it does not matter if they serve or not; at least they are getting educated for the good. I used to talk about this with my wife as well early on but then I realized that a MBBS qualified girl getting married would raise her kids to contribute towards our society more than a girl who just did FSc. No offence to anyone but education does not hurt. Girls are there on pure merit and you do not want to disturb the balance created by merit. Might not realise it today because its about our future generation, but changing parameters in the society and trying to mould it has serious repercussions for a much longer term; problems that would take themselves a couple more generations to get solved at the very least.
However, signing a bond for serving at least 5 or 7 years in the country should be necessary and a NOC shall not be issued if someone is moving abroad to take up a job before that. Also include 2-3 years of that in rural areas. All this is only possible if there is a proper service structure and facilities such as housing and transport provided to doctors especially in remote areas. You can not just post a female doctor from Lahore to a village near Multan without giving her housing and transport facilities.
The solution to the Human Resource problems is that we need more hospital, more medical schools and more types of jobs. Even those girls who got married might serve in a less interactive job.
I personally think the doctors should sign a bond with the Govt. and Department of Interior & Immigration to serve their country for atleast a period of 5 years after their MBBS degree, and seriously I couldn't agree more with the PMA stance on this matter.
This is Such a funny post...I'm sure the writer's significant other is a doctor
101 % true !! i mean they just take our seats ... get the degree and get married without even serving the nation for one day ... there shud b a rule that one has to provide service of atleast 2 years !!
See that also means temperin with merit
Well AKU has an unwritten 50-50 quota for men and women. Other medical schools should follow.
Let me clarify to all the esteemed readers that we, the medical students, have aleady signed an affidavit stating we have work in a rural unit for 'x' no. of years or otherwise we face a penalty that does go into millions. Problem is, there's no enforcement of this particular deal and almost every medical student gets away with it. So 60:40 quota indeed is the best option they've got. However, I've witnessed many female doctors genuinely struggle to keep up, make both the family and professional life work simultaneously and face an enormous amount of scolding and abusing from their 'saas' and husbands and finally after many tantrums, leave their profession because they couldn't take the psychological pressure anymore. So this notion of 'doing MBBS to hunt for a husband' is disgraceful to women like us who are indeed studying Medicine for the love of it.
Disallow the male doctors to move abroad and you will feel the difference. Make sure they serve in the country for at least 5 years and in a rural area at least 2 out of those 5 years.
Do not interfere with the flow of society and education otherwise it provides disastrous results as proven by history in Pak and around the globe.
also i find it deeply disturbing that 80-20 in favor of female ratios in medical schools "disturb" people but similar ratios in favor of males in engineering schools are not a cause for concern. Misogyny anyone?
I agree that many female medical students only go to Med Schools to find a good rishta. However the PMA is ignoring an important aspect of the situation: Does the Pakistani healthcare system have enough employment opportunities for ALL of the doctors graduating each year?
Also the problem with BHUs and RHCs is not just the absence of doctors but also the lack of resources. A doctor cannot perform magic. He (or she) needs the proper equipment and staff. Even if we had a doctor in an empty room in each BHU and RHC of Pakistan, it wouldn't do much good to the society.
A lot of girls just come to get degrees so that they get good "rishtas" and trust me, I'm in a med school myself and that is how I know
@Naseer: why cant we make the environment conducive so that they can work? Isnt that a better way?!
This problem could be solved by making it mandatory for each female/male doctor to serve within the country (province or cities could be selected by lotory type method) for at least 3-yrs (married or not). It's further suggested that minimum 2-yrs military mandatory service for each/every Intermediate (FA or FSC graduates).
Suggestion open for debate: make it mandatory to work for 5 years after graduation otherwise the person's medical license should stand cancelled. and this license should be reviewed after every 5 years for an evidence of active practice, and if a doctor fails to conform to the criteria, his/her license should not be renewed.
Good move by PMA, I am a 4th year student in a public sector medical college of karachi.there are 220 girls and 80 boys in our classthat tells the whole story. I personally thinks most of the female students are here to find some good rishta for themselves.i also want to add that working condition in government hospitals are soo bad there is no arrangement of security so females and even male doctors are afraid of working in a government hospitals.
I do not understand all this propaganda. My wife is a graduate of King Edward (first div in all professional examinations), passed FCPS part 1 and IMM in first attempt, but she could not find a job for three years in government sector. Only this time around when government recruited a lot of doctor during strike she was able to find a job. Female doctors want to do the job, but Government does not have any jobs. Do you know that this year for 486 posts of WMOs more than 2000 female doctors applied. Obviously those who applied wanted to do the jobs but Government doesn't have jobs.
Hell, why would I want a doctor for a wife??? How much time do doctors spend at home?
@Dr. X:
If women have a problem in working after graduating from medical school. They shouldn't go to medical school. Period.
I think seats should be adjusted for a fair male-female ratio. A separate medical college is alone going to take 10 years to develop by then you could have easily produced a 1000 or so male docs.
@Al-Chemisto: (Not saying it a sexist way. ) Because she knows what genitals are, as opposed to a non doctor wife who sadly doesn't even know her own biology, just like any other woman in our misogynist society.
@ Hassan Bin Ajmal .. If you don't want to work in Pakistan then I hope you are not subsidized by my tax money
My mechanical engineering class at UET had almost 120 boys and only 6 girls. All the boys who as teenagers chose engineering over medical say that was the best decision of their lives. We were making good money in industry when our counterparts in medical schools were still sitting in class rooms. Improve the salaries and benefits for young doctors and you will automatically get the attention of more boys. Setting quotas is a step in backwards direction
I am a 2nd year medical student and I am sure that today not even MALE doctors want to work in Pakistan. Look at the condition and situation of our country. Corruption, insecurity, terrorism, injustice and what not? Changing the law for merit seats won't make any difference. First of all make this country a better and safer place. Provide us justice, security, opportunities and basic rights for both men and women. Govt. priority should be education and health. We love this country and we really want to serve it.
good move...Now a days girls are going in profession only to get a big fish.....More boys should b allowed to enroll in Medical Institutes.......
Setting Quotas will be sexist. Instead they should set a mandatory serving time of around 5 years for each graduate. Or they can also set a fine of 10lacks if anyone wants to quit.
@Vigilant: There are plenty of examples which can counter your logic How much do u know about the countless lives we save? We save lives every second even in a crappy working environment.
There are real problems in the health care system. Why dont you ask your government to do something about it? There are approx 30,000 beds for above 81 million people in Punjab and much less number of doctors. Why do patients demand beds from doctors when we are not the ones who are responsible for providing beds? There is Non availability of Life saving medicines and equipment. We dont have a working MRI and CT scans in the largest hospitals of Pakistan.The only working thing in your hospital is your doctor. With so much patient load and long exhausting duty hours, its very hard to give the best treatment to everyone. Some do treat their patients badly for no reason. But the whole community is not responsible for their individual actions.
Why dont we apply the so-called "2-years-mandatory-work-principle" to other professions as well. Force engineers to work for 2 years in wapda..Force journalists to work for PTV for 2 years.
It is indeed a nice step, please implement this for better health care in future
Its every ones choice to work after studies you cant restrict any one because of an industry Indeed it is a very nice step.. @Farrukh Malik:
Instead of discouraging brilliant females and establishing quota, the government should get a written bond of 25 Laks from all doctors studying on government expense to spend at least 10 years in government sector before moving abroad.
Doctors here in UK have to spend the rest of life paying back the loan that they had taken out for a medical degree, whilst in Pakistan government pays everything getting nothing but strikes in return.
As a medical student, I couldn't agree more. Ideally, all medical graduates - or at least those who study on government-funded seats - should be given a provisional temporary degree upon graduation and must complete a few years serving in rural / underprivileged areas before getting a permanent MBBS degree.
However, seeing the way things are right now (for better or for worse), I think bringing back the 60:40 ratio - at least in government medical colleges - will be a quicker, more effective solution for our healthcare system in the meantime, since our government hospital have working conditions that make it very difficult for females to work there especially during emergency / night shifts.
Govt must develop a policy like if she/he is not interested in medical practice after getting four years of MBBS degree where govt pays subsidy of almost 3 Million.. He/She must pay back double of this amount to the govt..... Or 20 years medical service must necessary after getting this degree....
Good decision! I think the ratio of 60:40 would help!
And soon we will start banning all females from work, since they are all bound to get married some day.
Im a male doc who graduated five years back and now pursuing my post grad degree in Karachi. I'd just like to share a few of my observations over here:
Firstly, the idea of an all male medical college or even reserving a major quota for males would not solve any problems rather may even aggravate the situation. Not many people might be knowing this but there are several male doctors in the market already who are extremely underpaid and being exploited by the private hospitals to work on meagre salaries ,simply because they know they can have a replacement without much difficulty, particularly in the major cities.
Secondly, its true that there is scarcity of proper health services and doctors in the rural and underdeveloped cities and districts, a major reason for that being the Govt hasnt developed medical centers and hospitals or any incentives for medical staff working there in these areas and most of the native doctors belonging to these areas even do not want to work there and and migrate to the major urban areas.
Thirdly, there is an unchecked churning out of medical graduates in thousands by the mushrooming of medical colleges without much concern over quality control by PMDC.Most of the half baked doctors may even end up being a bane rather than a boon. As medical education throughout the world is under strict stringent check unlike Pakistan, where you basically need to have the correct amount of money to get in and come out of the college without much problem.
Lastly, the process of migrating abroad for the young doctors is getting more and more difficult by the day and spilling in more grads into the local job market without any proper planning is only going to worsen the growing frustration among the young doctors.
So before trying to implement or enforce anything, the PMDC must look into the ground realities and try to curb the corruption within itself and view the problem realistically.
Looking at the current situation of healthcare professionals in Pakistan, the "male-female" ratio should be the least of the govt's worries. Why don't they work towards giving the graduating doctors more security, both physical & financial and see the results then, instead of reverting back to last century. It's not like Pakistan's moving forward in alot of sectors anyways.
@Al-Chemisto: when u visit government hospitals or private clinics who have only one motive to extract money as much as they can......then u will have consider two options either "doctor in the family" or "family doctor" and better is "doctor in the family"
@Dr. X: i have been to government hospitals & i know that how much polite and humble doctors are and how much they care about patients. Once a heart patient died at hospital because my relative who was doctor in-charge was sleeping. You & we the system......stop whining....& try to deliver your best
I am surprised to read the comments supporting the move by PMA to curtail the basic right of women to education in our society. Instead, the PMA should ask the government to establish more medical colleges.
@Shazia Majeed
It’s disgusting the way public’s tax money is being wasted on providing subsidised medical education to male students who don’t work in Pakistan after. Why is tax money being wasted like this? the vast majority of male medical students waste our education, they don’t work as doctors here. It’s high time the govt. stopped wasting the people’s money on men who just want the label of doctor in order to get a rich.
See, this can work both ways.
Its Lupus !
There should be a mandatory working period after graduation for medical students.They take advantage of cheaper education due to subsidies from govt. based on public money and then they don't work after marriage.There must be penalties on medical students who don't work,why are they misusing subsidised medical education to find richer rishtas when they should be working as doctors.Medical graduates who don't work must face stiff fines and/or jail time for wasting the people's hard earned money which govt. has taken in the form of taxes on everything.Stop wasting our tax money.
It's disgusting the way public's tax money is being wasted on providing subsidised medical education to female students who don't work after getting married.Why is tax money being wasted like this? the vast majority of female medical students waste their education,they don't work as doctors.It's high time the govt. stopped wasting the people's money on women who just want the label of lady doctor in order to get a richer husband.
Agreed that it is not the problem but only a small part of it. But it is true that mothers prefer and look for doctor bahus for their "chaand se" baitay, even though they have no intentions of letting them work afterwards. Pregnancies and kids have also put a full stop on the careers of many female doctors I know.
It's all about incentives, perks and facilities that draw people regardless of gender. Facilities like better pay, security, daycare, promotions etc. Take for example the cases of these two hospitals: Shaikh Zayed Hospital has a daycare/nursery for children of the female professionals. However, administration at a certain state of the art, modern and international level hospital has rejected repeated requests from female staff members related to daycare facilities. Their reason is that "then you will be spending most of your time there instead of working." (they have a better pay scale though, especially for consultants). So it the root cause cannot be pinpointed on a single male-female ratio. Doctors-beating-government and other concerned authorities should take other factors into account as well.
In India there is a mandatory rural service stint that needs to be completed after house surgency without which the individual is not allowed to practice medicine (my brother is a doc in the US but he completed his rural service back home before leaving for his MD there). Of course, I completely agree with Dr. X that the enabling conditions need to be present and you can't blame women for not wanting to work in unsuitable conditions. However, sex-segregated institutions is archaic as it gets - once they graduate, will these doctors also only be allowed to see patients of their own genders?
@Al-Chemisto: Many factors...First, To brag about her profession in-front of relatives!! Plus the ones who get popular in Gynae Obs earn so much(approx 5000-10,000 Rs per baby!!.....some even like 30,000Rs)... and Pakistani fertility rate is so high! =P Also, some men think that lady doctors are mentally very mature and intelligent.
@Farrukh Malik: Doctors are supposed to work for a year before they get their PMDC registration otherwise they cant work in Pakistan
most of my cousins have gone to hte best places in Karachi and eventhough all of them went on to practice, they said most of their female friends didnt. They only went to Med schools so that they can marry a good mate rather than actually practice medicine. Im never for putting quotas but maybe a more rigorous process can be applied to only accept candidates who are interested in working after getting their degree. Some combination of interview/recommendations/etc can be used to weed out non-serious people.
The system needs to be revamped. It is not just a male-female students issue.
Seriously these rishta hunting women really make me sick. After establishing this, I would like to say that keep the merit open and give them a safe place to work. Why would a woman work at night when there is no security in the hospital? BTW even Male Doctors are worried about their safety in the Hospitals.
The problem is not merit. It is about the working environment and mentality which prevents women from working in a profession which require a lot of sacrifice. What makes a student choose engineering over medicine? He knows that the outcome of the profession is nothing. He knows that he cant cram the sub-branch of a branch of Freaking Artery which supplies the worthless small part of an organ in the body(confusing right?!). He knows that its useless to remember the 3 names of the same disease( and then getting failed cz he forgot about the 4th). Here you see patients giving death threats to the doctors after their patient expires from natural causes.Patients abusing doctors. And doctors being beaten in hospitals Your hospitals aren't safe. We spend so much less on Health. Even lesser than Education. Dont expect miracles out of this system.
As a female doctor I actually support this move. The situation is exactly as mentioned above!
A very good and much needed step indeed . What is the point of becoming a doctor when you are not going to practice ? Or female students should sign an agreement to serve compulsory for particular period after education completion . And yes i am female and my sister is a practicing doctor who believes in serving people rather then sitting at home with degree !
Instead of going back to 80's a better option is to make sure all the graduates (on public money) of both genders should serve for 'X' number of years before they could discontinue or change professions. If not then they should cough up the money that spent on them.
Why every one wants a doctor wife?