The education and training system for medical studies in the Punjab is outdated. Not much effort has been made to improve it or to rectify the numerous flaws in it. One of the major flaws that need to be addressed is the examination system. Currently this consists of two parts: a written exam and an oral viva. I have been in the field for nine years. First, I was a student for five years; since then I have been working as a doctor at Shaikh Zayed Hospital in Lahore. I have known several students who did exceptionally well in their written examinations and received very high marks but were failed by the internal examiner in the viva due to some personal grudge. There has never been an inquiry as to how a student receiving 80 percent marks in the written part of the examination failed the viva. A student who passes the written examination but fails the viva has to take both parts of the examination afresh. This is just one of the many problems medical students face.

My hospital experience consists of the last two years of medical college and four years as a doctor. Working as a doctor, one’s life mostly depends mostly on one’s seniors. So far, I’ve been lucky to work with helpful and supportive seniors who try to make the working environment as comfortable as possible and facilitate the doctors working under them as much as they can. However, I have seen others work under professors who make working conditions hard - sometimes unbearable.

All doctors overwork. Some are required to spend a whole week a month at the hospital. It’s said to be a part of the training process and it is presumed that it helps learning. It might but it also leads to some of the patients not receiving the care they deserve. As a result we frequently hear doctors telling their patients “Time’s up for today. Please reschedule for another day.” This is mostly a result of being overworked.

In addition to their long working hours, most doctors in Pakistan are underpaid. The average monthly pay of a post-graduate resident working in a hospital is around Rs 90,000, if the person is fortunate enough to be training at a government hospital. Many private hospitals don’t pay their residents; others pay between Rs 30,000 and Rs 60,000. A doctor has to study for five years at a medical college while first degrees in most other fields require four years. Doctors are also required to undergo a year of house job with long duty hours. It is unfair, therefore, to be paid no more than Rs 90,000 a month with an annual increment of just about Rs 2,000 so that their salary comes to around Rs 98,000 after four years. This is the main reason most of the medical students graduating from Pakistan are inclined to take international examinations and head to the United Kingdom or the United States to pursue careers there.

The MTI act may very well put all healthcare workers at the mercy of politicians and bureaucrats, who will choose –rather than properly appoint– a board of governors.

Another issue faced by doctors working in a government hospital is security. There have been many instances of attendants assaulting doctors on account of their patients not receiving the expected care. Once, while I was working as a house officer in medicine, my team and I had to perform CPR on a brain dead patient for more than 30 minutes just to appease the attendants. The problem is more severe for female doctors working evening and night shifts when there is minimal security at the hospital. There have been occasions when doctors on duty at night have had to lock themselves in some room after a patient expired. Recently there has been some improvement with regard to security people assaulting healthcare workers have been punished. However it still remains an issue for doctors working at government hospitals.

For some time, now the government has been trying to introduce a new law called the Punjab Medical Teaching Institutions Reforms Act. The law has been opposed by all healthcare workers (doctors, nurses and paramedics); even guards, sweepers and gardeners working at hospitals have opposed it. The main reason for this is the belief that the Act will take away job security and put all healthcare workers at the mercy of politicians and bureaucrats, who will choose a board of governors to oversee a hospital and have the power to appoint personnel.

The employees also fear that their jobs will no longer be pensionable and that most of them will have no source of income after the age of 60. The protesters have been accused of being work shirkers but most of the doctors are working more than 80 hours a week, with some shifts lasting longer than 24 hours, some in wards where up to three patients share a bed for lack of resources.

The MTI Act will also make healthcare expensive for most of the population.

On the other hand it is hoped that the MTI Act will enable the teaching hospitals to work independently and administrative issues would be solved internally instead of being referred to the government. If the distribution of healthcare cards is widespread and fair more patients might afford the needed health care services. This is not the case as of now.

Healthcare needs to become a priority of the government. Specialised healthcare professionals should be appointed to run the system.

The writer is a post graduate trainee in FCPS (radiology) at Shaikh Zayed Hospital