Is Becoming a Doctor a ‘Loss Deal’ in Pakistan?


Problems of Young Doctors: There was a time when as soon as a child was born in Pakistan, the plan to make him a doctor or an engineer started. This kind of desire of the parents and their repeated mention made the children think that their success depends entirely on becoming a doctor or an engineer. And over time, this dream of parents becomes the dream of children and the answer to ‘what will I become when I grow up’ is often ‘when I grow up I will become a doctor’ or ‘I will become an engineer’. But things seem to have changed, and the dream of becoming a ‘doctor’ does not appeal to children or their parents. The protest of young doctors continues in Pakistan every day. The BBC met with young doctors working in some of the country’s government hospitals to find out what they said were “problems”.

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How much does it cost to become a doctor

The first thing these doctors talked about was how much did it cost them to become a doctor. Dr. Haider Abbas, who is stationed at PIMS Hospital in Islamabad, said that becoming a doctor costs a lot. “The cost is lower in government medical colleges but many times higher in private colleges,” he said. The monthly fee is also in lakhs and with each passing year this fee increases, not decreases. The cost of fees in government colleges is very low but books, hostels and other educational activities are expensive and a child from a poor family cannot even think that he will do MBBS.

Dr. Adil, who works at Lady Reading Hospital in Peshawar, agrees. Both doctors are graduates of government medical colleges. Dr. Adil says, “It costs the government Rs,40 to 50 lakhs to make a doctor, while the student himself has to pay Rs,4 to 5 lakhs annually for various expenses. This is for public educational institutions, but in private medical colleges, it costs between Rs,10 lakh and Rs,2 lakh per annum. On the other hand, Dr. Sukhra, who completed her education from China and is currently posted at DQ Hospital in Gujranwala, says that she spent more than Rs,5 million.

What is the salary of doctors

Dr. Sukhra lamented that “doctors graduating from private or foreign medical colleges in Pakistan are not paid during their house work.”  Dr. Haider Abbas says, “Initially, doctors from government medical colleges used to get a monthly salary of Rs,50,000 in house jobs, then when we protested, the salary was increased to. But according to Dr. Adil, the salary is very low. “As doctors, we have to compromise on the necessities of our daily lives. Living is very difficult and we can’t even think of saving or saving money.

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“If the patient dies, the blame falls on the doctor”

The second major problem is security, which doctors say puts them at risk of being attacked by patients’ families. According to these doctors, the condition of government hospitals in Pakistan is so bad that sometimes the attitude of patients and their families becomes unbearable. Dr. Haider Abbas says, “When a doctor is admitted to a hospital in Pakistan in the morning, he does not know in what condition he will return home.” There are attacks. According to him, a senior doctor has also been allegedly killed in PIMS recently.

Dr. Haider Abbas says, “Even during such incidents, protection is not provided and even after that, the police and the administration take formal action which does not lead to any final result.” “If a patient dies, the doctor is blamed, or if the hospital or the government does not provide any facilities, there is no machine or it is faulty, then the doctor is blamed,” he said. According to Dr. Sakhra, “Galum Gluch is normal, the matter goes to a standstill, the patient’s family brings weapons with them. It is not seen that there is a female doctor in front but whether it is a woman or a man, they do not see all this before the attack.

Doctors’ long working hours

At the same time, a major problem for doctors is long working hours. Dr. Sakhra says she has to work 36-hour shifts twice a week. “Hospitals do not have a system where a female doctor has an hour’s rest to rest in a room. Hostels are far away and in the current situation, going there late at night can be dangerous for a woman herself.” According to Dr. Haider Abbas, apart from duty hours, the house doctor has to stay in a certain radius and he cannot go away from the hospital so that in case of any untoward incident, he can reach the hospital.

There are calls when the long duty hours are over. On the other hand, Ali Raza, vice-president of the Pakistan Medical Commission (PMC), says that the PMC has recently proposed to regulate the working hours of doctors, but according to him, Depending on what field the doctor is working in. For example, there will be more duty hours for surgery and similarly in some other fields it is necessary to complete the prescribed duty hours which may be more.

Increasing the ratio of doctors to patients

Another complaint of these doctors is that the ratio of doctors to patients in Pakistan’s government hospitals has now widened. The population multiplied, but hospitals were not built, and the number of doctors did not increase significantly. It may be recalled that according to official statistics, the number of doctors in Pakistan is more than 222,000 while the number of dentists is more than 23,000. The total number of registered nurses in the country is only 145,000 and the total population of Pakistan is over 200 million. According to international standards, a population of 1,000 requires two doctors, one dentist and eight nurses. According to this list, Pakistan is currently far behind.

Dr. Sukhra, referring to the shortage of doctors and other medical staff and the number of patients, said that his hospital receives more than 4,000 patients a day in the OPD and more than 2,000 patients in the trauma wards. Five doctors see 500 patients, it is not the doctor’s fault or the patient’s, there is an urgent need to increase the number of doctors in government hospitals. The situation is somewhat similar in Islamabad. Dr.Haider Abbas, who is currently stationed at PIMS, the largest hospital in the federal capital, says: There are five doctors.

Talking about this, PMC vice president Ali Raza says that the reason for the shortage of doctors is to say goodbye to the profession after completing the education of women. It should be noted that the rate of female students in medical colleges of Pakistan is about 70% but the rate of female doctors in practicing doctors is only 23%. According to Ali Raza, the reason for this difference is social behavior. Many women say goodbye to their careers after marriage for a number of reasons, but doctors say that one of the reasons is the strict working hours. Ali Raza told the BBC that “steps are now being taken to bring these women back into practice.”

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‘Doctors themselves become psychiatric patients as they overcome difficulties and obstacles’

Dr. Adil says that the present government is ‘anti-doctors’ which is changing its policies but nothing is being done to improve the infrastructure. According to the Pakistan Bureau of Statistics, by the end of the fiscal year 2018, there are 1279 government hospitals and 5671 dispensaries across the country, while Pakistan has an average of one bed for every 1580 patients. Doctors say that in the current situation, it is not possible for them to advance in their field. According to Dr. Adil, “the amount required for qualification abroad cannot be met with the salary received in Pakistan.”

Similarly, Dr. Sakhra says that a doctor can make progress if he wants to, but there is no such facility in the system. However, Dr. Haider Abbasi says that due to the large number of patients, doctors must have the opportunity to gain good experience and increase the skills for their field. But the burden is too great. He says there should be scholarships and opportunities for qualified doctors to take advanced courses in other countries. Speaking on the ongoing protests by young doctors, Dr. Adil said, “We protest for the betterment of the system and for the betterment of both the medical staff and the patients.” The system is broken and the government is not ready to listen.

According to him, now that doctors are being brought on contract, if my job is not secure then how can I perform my services with full competence. Speaking on the occasion, Dr. Haider Abbas also criticized the government’s decision to allow doctors to work on contract basis instead of permanent employment in government hospitals. According to Dr. Adil, we doctors had high hopes for the current government. Recently, a large number of doctors returned, but seeing the situation here, some went abroad while others turned to private hospitals because of government policies. And the measures are creating more problems for us.

He says the difficulties and obstacles have increased to such an extent that “doctors themselves become psychiatric patients as they cross them.” It is not recorded but we start taking anti-depressant medication ourselves. Our problems and the frustrations they create do not matter to the government or the management of the hospitals.

Is becoming a doctor in Pakistan now a losing proposition

After hearing these issues, the question that comes to mind is whether becoming a doctor in Pakistan is a losing proposition? Dr. Haider says, “If you have a passion for service and you have no other responsibilities, then this (becoming a doctor) is not a loss-making deal, but in the circumstances and frustration, it is a loss-making deal.”