Back to Pakistan

New rules mean many international medical graduates from Pakistan in training in the UK will have to return home. Amin Muhammad Gadit finds out what they can expect

Recent changes in the UK visa rules for doctors have created havoc among many aspiring international medical graduates (IMGs), who are now faced with a serious dilemma regarding their postgraduate career path. Many of these doctors come from developing countries and are going to suffer because competition is now tough for getting into training rotational posts. They are left with almost no choice but to go back to their country of origin or seek alternative employment elsewhere. Many of these doctors are from Pakistan.

The medical system

Currently Pakistan produces a large number of doctors, through the many private medical schools throughout the country. Karachi, Pakistan's largest and most densely populated city, has nine medical schools-three in the public sector and six in the private sector. These produce about 1400 new medical graduates every year. But the College of Physicians and Surgeons of Pakistan, based in Karachi and the only certifying body for all specialties recognises postgraduate training at only some of these institutions, including four specialised postgraduate medical bodies for rotational training leading to higher postgraduate qualifications.

Warrick Pages/Panos
Waiting for her doctor to return

These slots account for only about half of the doctors produced each year. And many of these recognised institutions do not provide adequate and up to the mark training. However, private medical schools charge exorbitant fees, grossly in contrast with individual earnings, and hence a huge sum is invested by the parents of these prospective medical graduates.

Foreign qualifications and training are still regarded highly compared with local training and qualifications, which is why many new doctors aspire to go abroad for higher training. At one stage the United States was the most popular place, but after 9/11, visa restrictions and a perceived discriminatory attitude made the United Kingdom the favourite option. A large number of doctors went to the UK, passed PLAB (Professional and Linguistic Assessment Board) and, while waiting for a placement, took on jobs in restaurants, factories, shopping centres, and kiosks to make ends meet.

General conditions

Corruption, insecurity, violence, robbery by gangs, and kidnapping are rampant in Pakistan. Doctors are kidnapped for ransom, target killing, and other atrocities. Jobs are poorly paid and training slots are few. And if you are fortunate enough to get a placement, the remuneration is low, and individual doctors undergo enormous stress while trying to continue to the end of the postgraduate path.

Many of these doctors leave postgraduate training and either go into general practice or to positions in Middle Eastern countries, where wages are low. Although some doctors attain the FCPS, which is the fellowship of the local college, they cannot get a foothold in gainful employment because job opportunities are limited. The other university related qualifications, such as medical doctor, which on paper are equal to FCPS, are generally discouraged.

New UK visa policy and Pakistani doctors

A huge number of doctors are affected by the new UK policy, and find themselves in the dark. About 20% of these have tried Australia and New Zealand but only one doctor has been successful in getting a placement in an area of high need in Australia. Fifteen doctors have so far returned to Pakistan and about 350 are planning to do so.

Doctors who never left

Many doctors who stayed in Pakistan are of the opinion that they were wiser and better off. They believe that it is more cost effective and easy to pursue a postgraduate career at home because it is important to have the knowledge of locally prevalent medical conditions and need, and this is only possible if one remains in one's own environment.

These doctors feel that the social and political situation is generally not conducive in certain parts of the world. Few of these doctors expressed their financial inability to pursue their career abroad, however, and thought that it was always better to get an opportunity in a developed country. They feel that returning doctors will eventually settle in Pakistan; a few may go into general practice, a few may find some training slots, and others may opt for a change in career or employment with the drug industry.

The harsh reality

As the number of doctors is much greater than the available training slots, placement issues will remain a huge problem. Currently the College of Physicians and Surgeons is attempting to increase the number of recognised training slots. Medical schools are also trying to increase slots. The government has suggested affiliating district hospitals with teaching hospitals and the proposed coalition between government and private health care will open new vistas for doctors intending to pursue a postgraduate career.

The fact is that the FCPS qualification is valued in the UK in a few medical disciplines and considered on a par with the membership of the Royal College of Physicians. In the present circumstances, therefore, it is advisable to pursue a local FCPS. Later, as a specialist, you can try for opportunities abroad and gain experience. But it's a difficult path and a frustrating one.

       

           

	CAREERS Back to Pakistan        Amin Muhammad Gadit (December 2006)
	George Sunny (November 30th, 2006)        Primary health care Physician doclife@gmail.com
	Yes, the new rules in UK have indeed resulted in uncertainty for many international medical graduates. I personally feel it's unethical to put the lives of so many doctors into disarray. The sudden decision has affected a lot of medical graduates who have spent precious years and finances to pursue a career and education in UK. The UK government should have allowed the existing doctors in UK pursue their careers, at the same time they could've stopped the fresh inflow into UK. It's depressing to see so many doctors return back after working for 1-2 yrs in UK. Many medical graduates now find themselves back to square one in their career and education. They find it very difficult to re-channel their life in a different direction. It's not easy to go back to basics and prepare for different entrance tests to gain admission for a postgraduate course. Many of them have in fact started a family in UK and the dilemma they are facing can't be ignored.

	CAREERS Back to Pakistan        Amin Muhammad Gadit (December 2006)
	Dr Syed Ghazanfar Mehdi (December 8th, 2006)        MB,FCPS, Medical specialist, Lahore,Pakistan ghaznfar2006@yahoo.com
	I think this is a bit exaggeration of the state of medical system at Pakistan.Doctors should decide at the time of their exit at medical school what should be their career plan.Either they should try their best to become consultants in their fields or they should organize their capabilities to make money out of GP practice.I think going abroad is equivalent to the second option in the present scenario. This is only Pakistan which can offer a Pakistani doctor a speciality of his own interest.I think it is a great boon for which he should be thankful to this motherland of poor and oppressed people.I think making money is not so important as to keep someone's 'oath'. Who will correct this system if the most educated and capable lot will aspire for money and status. Please correct me if I am wrong.