The Curious Case of Missing Doctors

By Madiha Mohammed Najib

Every year in Pakistan, thousands of students graduate from medical schools with a majority being females. Out of these, only 23% of the female medical graduates go on to register as physicians, according to PMDC statistics. This very popular statistic is oft quoted when we want to address the issue of the dearth of doctors in the country. With an abysmal doctor-patient ratio it is easy to squarely blame one gender for the lack of doctors in our society.

This thought and statistic became the basis of my discussion with my mother-in-law who is a practicing gynecologist. We were discussing how unfortunate it is that we lose such great talent to the clutches of our socio-cultural norms. She did however, called me out on my naivety and said that I need to think beyond the hyped “Doctor Bahu” phenomenon and delve deeper into the systemic issues that have resulted in a lack of doctors in Pakistan.

The Alleged Problem

In case you are living under a rock and have not heard of this trend of ‘Doctor Bahu’, allow me to elaborate. Girls have consistently out-performed boys when it comes to pre-medical board exams and this has historically enabled girls to secure more merit seats in medical colleges. However, what is seen is that the number of girls who officially join the healthcare industry is significantly lower compared to those who joined medical school.

Anecdotal evidence suggests that women leave the industry post marriage because either they are not allowed to work or they have no desire to continue working in the medical field because their aim of securing a decent ‘rishta’ has been fulfilled. To a mind that is unaware of the constraints and idiosyncrasies of our society, this claim would be nothing short of outrageous. However, I am confident that you in your circle have come across at least one female doctor who gave up her profession to stay home and make ‘gol rotis’. ‘Doctor Bahus’ are the epitome of irony, where a woman is desired for her profession, a profession that is requires consistent effort and hard work, only so that she can give it all up to be a trophy whose work is limited to the household.

We have been fed this ‘Doctor Bahu’ narrative for long enough that we have started to believe that this is the root cause of the lack of doctors in our society. But is this truly the case or are we being blinded-sided? If that is indeed the case, then intervention requires changes in mindset and push-back from girls themselves which is a long drawn out process. But what if ‘Doctor Bahu’ is more hype than reality, then what are the causes of this reduced number of healthcare providers in the country?

 

A Deeper Look

 

A recent report highlighted that we are over-estimating ‘Doctor Bahu’ syndrome and that there are many other underlying factors that contribute to the less doctors becoming registered with the PMA (previously PMDC). The following are some factors that were highlighted by the report:

  • Medicine is seen as a respectable career choice for girls therefore, many girls who may or may not be interested in the medicine are forced by family, especially fathers to chose medicine because doing ‘office jobs’ with men is considered unacceptable. Thus, many girls are forced into the field for the prestige that comes with being a medical professional. Thus, once they have the degree there is little to no motivation to continue practicing medicine.
  • Medical degrees are considered to be a safety net for girls just in case their marriage does not work out and she needs to secure herself financially. Thus, the profession is a back-up if need be rather than a priority and a card that must be played during crisis.
  • The report highlighted that the women felt torn between their responsibilities as a wife and mother and their career. Women’s understanding of their motherly duties which are rooted in cultural and religious norms were a factor that prevented them from fully taking up a full time position. Furthermore, women felt that their husbands and in laws were a barrier that prevented them from fully committing to their career because the onus of taking care of the household lies on them. Women emphasized that they do not have the required support to pursue their career.
  • Women specifically highlighted that there were no day cares for working mothers and therefore it becomes difficult for women to manage their motherly responsibilities along with their professional ones.
  • Long working hours, lack of facilities, unstructured programs and terrible working conditions were also cited as reasons that both men and women chose not to pursue the medical profession in Pakistan. Doctors are not institutionally provided with the support that they require to do their job well. They are not even paid well or at times at all, as the recent doctor strike has shown us. Furthermore, they are forced to work in environments in which their life is constantly under threat because attendants of patients often get very violent.

 

What About the Men?

This study also spoke to men to see why their participation in the medical force was dropping and they sighted the following reasons:

  • As breadwinners of their households the salary a medical professional receives upon graduation is almost half of that of their compatriots of other professions thereby making medicine the least lucrative career choice.
  • Limited quality post-graduate programs in country was another factor that deterred men from staying in country and pursuing medicine.
  • Trainee doctors feel that the opportunities for growth and mastery that are available abroad for doctors are severely lacking in Pakistan therefore, it makes sense to go for further training out of the country.

The above given reasons highlight that though the ‘Doctor Bahu’ syndrome may have weight, but there are underlying other factors at play when it comes to the lack of doctors in our country.

 

What Next?

I have realized that we as a society love to look for problems however, once the problem has been identified we either brush it under the carpet or we chose to ignore it because let’s be honest, it is more fun to crib about things rather than being solution oriented.

So what can be done? We know that doctors there are numerous doctors who pursue medicine but chose not to practice in the country for a multitude of reasons. A large part of the issue is that the education of many doctors, many of those who go to government colleges, is funded through the national exchequer. This puts a strain on our already meagre resources. In my opinion, the solution is two pronged. One that focuses on the industry itself and the other a social drive that focuses on changing the mindsets of the population.

The government recently had tried to instate a 50-50 quota for selection of male and female doctors (this quota was later revoked)to address the issue at hand. This approach was akin to putting a Band-Aid on a gun shot wound. The following are some policy measures that can be taken by the government:

 

  • There needs to be a revision in the salaries of graduate doctors. Low salaries are a big deterrent for many who wish to enter the medical field. Many feel it is not worth waiting for years before they can earn enough money to support their family.
  • The working environment needs structure and improvement; we all have run into overworked-underpaid doctors who despite wanting to a great job are unable to do so.
  • Develop more world-class hospitals that provide international level training.
  • Provide basic facilities for female doctors like day-cares and other facilities that will encourage and support women to stay in the work force.
  • Once these have been provided the government can then as a policy measure introduce a bond for those who have studied on public funding to serve within the country. Furthermore, their degrees may only be released upon completing their service.

We as a society are unsupportive of our doctors, especially females. The irony lies in the fact that those who demand female doctors as their primary healthcare physician are the ones who prevent women from actualizing their potential in the field.

A change in this trend requires consistent effort because mindsets do not change overnight.  This continuous effort must be made consciously and sub-consciously at all levels and at all times. The following are a few suggestions that come to mind to tackle this challenge:

  • Educational drives at the high school level with teachers, parents and students highlighting the challenges and rewards of the medical profession.
  • De-stigmatize other professions and highlight the importance of the work of those professions thereby reducing the number of female candidates forced to join medical colleges because other professions are considered disgraceful for girls
  • Support from family members when women are asked to give-up their medical profession after marriage.
  • Not marrying someone who has a career, medical or otherwise, when you want them to sit at home and not work.

What I am suggesting is not unique but requires us keep up the dialogue so that changes are made both at the policy level and at the socio-cultural level. I do believe one thing is certain, if we can fix structural the problems in the industry, the change in mind-set will follow. Till then we as women and professionals must do our part to create awareness and push the needle.

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