The issues of job insecurity and lack of respect make many young doctors look for greener pastures
The charms of pursuing a career in medicine, one of the highest-paid occupations in the world, are too alluring to ignore. But they come with certain moral caveats unlike banking or lucrative positions in global multinationals where making money is only what matters. After all it’s a noble profession.
The job of saving lives should not be about the riches alone, so the argument goes. There is more: If you are a Pakistani and studied medicine here in Pakistan, you should serve your country first because your people need you. No doubt, with a low physicians per 1000 people ratio, Pakistan is always in need of doctors.
But brain drain in the medical profession, be it doctors or paramedics, continues unabated as demand for medical practitioners in the Middle East, Southeast Asia and Western countries keeps growing.
But in a globalised marketplace is patriotic homilies enough to hold back doctors from leaving Pakistan for greener pastures? If you ask a resident doctor at a government hospital, working for 36 hours straight, at times thrice a week and that too for free, the answer would be a resounding no!
When young people choose a career path they hope that after investing day and night in their five-year long studies, they will be rewarded with enough compensation to sustain a decent lifestyle. That’s the least one expects.
But in Pakistan, young doctors say such expectations are too much to ask for. "Unlike a regular Master of Business Administration (MBA), who makes around Rs40,000 once they leave school, doctors are paid Rs40,000 for six years (both in public and private hospitals), until they complete their residency," says Dr. Adeel Rahat, who is currently training at Civil Hospital Karachi for General Medicine. "Given they are lucky enough to be accepted as residents at a hospital at the first place."
"There is no increment or other benefits, in fact, trainees even do not have medical cover and it is routine for government hospitals not to pay salaries for months," he says. "There are many who agree to work as residents for free off the record, just to get done with their training under senior doctors," he adds.
So, by the time a doctor reaches the age of 30, someone who is a fast learner and lucky, he or she finally manages to unshackle themselves from the yoke of a bureaucratic juggernaut that gets hold of them at medical school and stalks them from the hospital to the medical board that finally approves their status as practitioners.
The other way is to find an opportunity aboard.
Certainly, there are many doctors working in the country who take it upon themselves to serve people. And there are many, who, after spending decades abroad, i.e., Western countries or the Middle East, return with enough cash in their pockets and serve with the sole purpose of ‘giving back’ to their country.
But young doctors say that the current infrastructure in place to train doctors in Pakistan is a nightmare. Low pay, impossible working hours, security threats, favouritism by senior doctors, all contribute to their lack of progress.
"Pakistan produces some of the best doctors in the world," says Dr. Hassan Auj, a medical officer at the University of Karachi, "but we don’t treat them as humans. In fact, many young doctors kill their high hopes and end up in mediocre positions for the rest of their lives."
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Senior doctors, however, say that one of the factors contributing to this state of affairs is lack of enough space for residency at the hospitals. "There are too many medical graduates not enough hospitals, that’s where the problem begins," says Auj.
Trainees are often treated as personal servants by senior doctors who hold their passport to freedom and glory. Finding a residency at a decent hospital involves an unspeakable amount of hassle. MBBS students invest everything in their power from personal contacts to prayers to get a break. Many wait for years. Once accepted, the real grueling begins, which can last from five to eight years. "They work like slaves. Sometimes for two days straight," says Auj.
Senior doctors argue that in specialist professions like law, chartered accountancy, and medicine students have to go through the drill in order to acquire expertise. "We all went through the same process. I know at times this does not seem pleasant, but that’s the internationally-accepted process," says Dr. Zafar Qureshi, a consultant cardiologist.
He says doctors leave the country for getting a better salary, which is their right but to argue that the training is to blame for that is wrong. "It’s simple economics. If my son gets four times the salary, say, in Saudi Arabia, I won’t stop him from leaving Pakistan."
Dr. Rahat says it is true to some extent. "But if young doctors get gradual increment in salaries over the years and the respect they deserve, that would help Pakistan retain its doctors."
He says the government should ensure that young doctors get residencies in their own medical hospitals and there should be proper employment contracts with benefits and leaves for them. "If the government can provide peace of mind and a road map to ensure our career growth, many doctors won’t leave Pakistan. Because a foreign country after all treats you like a stranger."