Dr Farman is a graduate of King Edward Medical University (KEMU), the most prestigious medical school in the Punjab, and passed the Fellow of College of Physicians and Surgeons (FCPS) Part I exam this year.
Despite his CV, he has been unable to find a postgraduate position in order to undertake the four years of training required for the FCPS Part II qualification. The final date of induction is July 31.
There are dozens of doctors like Dr Farman who have passed the FCPS I exam but have not been inducted as postgraduate trainees, as a shift in induction criteria has limited the number of seats available.
In Punjab, there are a total of 3,909 paid postgraduate trainee positions, each of which is occupied for four years. That means some 977 graduates can be inducted each year from the whole province to paid seats.
Around 1,000 doctors have just passed the FCPS I exams in Lahore alone, according to the results recently announced by the College of Physicians and Surgeons of Pakistan (CPSP). According to the Health Department, every year 3,200 students become doctors after passing the MBBS exams. They can sit the FCPS Part I exams right away.
“There should be 12,800 postgraduate seats in the Punjab so all the doctors can do specialisations,” said Dr Shabbir Chaudhry of the Young Doctors Association (YDA).
Dr Chaudhry said that according to CPSP criteria, a professor serving as an FCPS supervisor can train 12 postgraduates and an associate professor or assistant professor can train eight. “In a unit of four supervisors, there should be 36 postgraduate seats. But in major hospitals, there are just 15 seats per unit,” Dr Chaudhry said.
Dr Salman Kazmi of the YDA said that as per the CPSP, there should be one postgraduate seat for every 2.5 beds. That meant that Mayo Hospital should have 880 seats for its 2,200 beds, but it had only 382. “There is a growing frustration among doctors who have passed the FCPS I but are not getting inducted for specialisation,” he said.
Previously, at least some of the shortfall was covered up through ‘honorary’ postgraduate seats, meaning the trainees were not paid. But the Health Department issued a notification on March 9 stating that the number of honorary positions could be no more than five per cent of paid postgraduate seats.
“This has made things ever harder for doctors,” said Dr Kazmi. “This means that there will be just 13 honorary postgraduate seats in Jinnah Hospital, on top of the 260 paid seats. Allama Iqbal Medical College [of which Jinnah Hospital is the attached teaching hospital] admits some 325 students every year, so there aren’t enough seats even for their graduates.”
Another cause of the shortage is that of the 3,909 paid seats, the Health Department temporarily converted 291 seats into seats for medical officers to accommodate doctors hired during the YDA strike in the Punjab last year. “The seats were converted for the financial year 2012-2013 but they have not been reverted yet. There is already a shortage of postgraduate slots and these seats have added to it,” said Dr Kamran, another doctor who has passed FCPS I and is yet to find a postgraduate position.
Dr Kazmi said that the chief minister should act fast as there was an acute shortage of specialist doctors in the Punjab. “Of the 54,647 registered medical practitioners in the Punjab, only 14,843 are specialists,” he said.
“New hospitals set up by the government are not working properly due to a lack of trained specialists. Surgeries are not being done at Shahdara Hospital because no general surgeon is available. More than 1,000 specialist seats at district headquarters and tehsil headquarters hospitals and 70 per cent of teaching posts at new medical colleges are vacant,” he added.
A CPSP spokesman concurred that there was a shortage of specialists in the country. “We need specialists in every discipline. In no faculty is the doctor-patients ratio up to World Health Organisation standards. We have few doctors in specialties like emergency medicine, endocrinology and anaesthesia,” he said
The spokesman suggested improving hospitals outside of Lahore. “The CPSP may consider accrediting DHQ hospitals if the facilities are upgraded. This would help reduce the burden in Lahore and specialists could be trained in far-off areas. We are also considering accrediting private medical colleges if they improve their facilities,” he said.
Health Secretary Hassan Iqbal said that the department was working on improving facilities at hospitals so they could open postgraduate positions and on building new hospitals. “Things cannot be fixed overnight but we are working on it,” he said. He added that a summary had been sent to the chief minister to revert the 291 medical officer seats to postgraduate positions.
Published in The Express Tribune, July 28th, 2013.