The missing female doctors

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It is no secret that there is dearth of female doctors in Pakistan. Do you think it is because females lack the opportunity to get medical education? Well, the answer is no. Interestingly, the number of females that graduate from medical colleges is more than that of male graduates. The chairman of Pakistan Medical and Dental Council (PMDC), Dr Masood Hameed informed during a news conference in October 2014 that the country is producing around 14000 graduates every year and 70 percent of them are women. It sounds strange for a country where girls who do not have much access even to formal education are more in medical colleges as compared to male students. Dr Masood however adds, “but almost 50 percent of the female graduates never work after completing their degree”. At present, there are 78037 male and 65324 female doctors, 5420 male dental practitioners and 8300 female dental practitioners in the country. This means, even though they manage to bag more seats in entering the medical colleges, they fail to show their presence when it comes to practice. As a result, health care needs of the population remain unmet with already insufficient health care resources.

Medical education is not in any way less expensive. But to add icing to the cake, students in public institutes do not have to pay the actual amount for their medical education. According to Dr Hameed, the government spends 2.4 million on each student who gets admission on merit in a public medical college. On the other hand, the student just has to pay a minimal amount of Rs 15000-20000 a year. Even after getting such a high subsidy from the government, most of the students, especially females never work. What a sorry state of affairs this is!

There is a general notion in our culture that women should not work after completing their education. This is because men are thought to be responsible for earning bread and butter for the family. And the main duty of a woman is to stay home and look after the children. Whatever the reasons, either social or cultural this mindset is paralyzing almost half our population. Unfortunately, the situation is not much different in uneducated and highly educated families.

Considering the statistics of PMDC, out of 14000 medical graduates every year around 5000 female doctors do not pursue their profession. This is a horrible situation when we look at the demand and supply situation in the country. “There are around 50000 to 60000 medical practitioners against the demand of 600,000 in the country,” said the chairman of PMDC. Moreover, the College of Physicians and Surgeons Pakistan (CPSP) has so far produced only 32879 specialists out of whom 40 per cent have left the country. “So there are only 20000 specialists against the requirement of 100,000”. With such low numbers, one can imagine the situation of a country where the disease burden has already crossed all red lines.

The pertinent question here is that if the female doctors do not work then where do they go? “Most of them get married and stay home”, says Gen Mahmud Ahmad Akhtar, an ex-principal of Rawalpindi Medical College. Is it not a big price to pay for just getting married? Another common perception in our culture is that if a girl becomes a doctor she will get a good rishta (proposal). A good rishta probably means a potential suitor that has six or seven digit monthly income. There is however, another aspect to this. Many girls, who do not wish to become a doctor, end up doing so just for the sake of fulfilling their parents’ desires. Amna Younus, a student in a private medical college in Islamabad is one such example. “I wanted to be a painter but my father wanted me to study medicines. So I respected my father’s choice”. She also agrees to the fact that there are a lot many parents in our society who pressurize their daughters into getting high scores in pre-medical so they easily get a seat in a medical college. “And hence they will get a good proposal with the prefix doctor to their names”.

Well, the society has its own ways. Rishta-seekers demand a doctor-bahu (daughter-in-law) that is probably why the girl’s parents seek the easy-way-out, especially at a time where finding a suitable suitor has become difficult. But these rishta seekers are either unaware or fail to realize that the government spends 2.4 million on a single student to teach her medicine so that she can treat the ill, not just bring a good name to their family. It costs billions of rupees loss to the economy when a girl decides not to enter practice. There is also a trend that many medical graduates attempt CSS for more lucrative posts in the government machinery as compared to going into their field. “They have worked really hard so it is their right to opt for higher positions”,says Amna. But the thing overseen here is that whether a student joins civil service or gets married, she wastes a medical seat and taxpayer’s money as well.

 

Another pertinent question here would be why women do not prefer coming into practice in the medical profession. “Unfavorable and unsupportive environment from the in-laws makes it difficult for them to continue their practice”, says Dr Mahmud. Besides, those who want to work do not find jobs in their areas. Students prefer staying home rather than going to remote areas where they are offered jobs in hospitals and health units. “Lack of facilities in these areas being a major reason”, adds Dr Mahmud.“Furthermore, those who desire for pursuing career in medicines, try to leave the country and settle abroad”, he adds. And this brain drain is not only happening in medical field but in other fields too. Other countries provide these experts with facilities and better salaries. Why would anyone work in the country when they can get a better salary and safe future abroad?

Having a clear direction in life is necessary but in medical field it is a must because it is not a short-term study profession. It requires a lot of hard work, millions of rupees and continuous efforts of teaching staff. But unfortunately, we do not decide our future according to our inclinations but by the standards and family and society. Talking about career counseling  abroad, Dr Junaid, a graduate from abroad and trainee at SIH in Psychiatry Department says, “this does not happen in America. There are counseling committees in every college and university to guide the student about their future field”. He further adds that women who want to become house wives do not go to medical colleges. “They know well what to do instead of going after parents’ wishes”.

According to Prof Khalida Adeeb Khanum, chief editor of Journal of Society of Obstetricians and Gynecology of Pakistan, domestic responsibilities do not allow women to do long-hour duties in this profession. On average, a doctor has to work 12 hours a day. This is besides the work in emergencies where sometimes they have to work for 24 hours. “It is not possible for a woman to accommodate these lengthy and tough timings with her responsibilities of married life, especially when it comes to raising children”. She suggests that women should be allowed eight hours duty so that they can easily manage things. “Moreover, an appropriate day care center should be established at every hospital so female doctors can work without any tension regarding their children”.
As a strategy to make sure females stick to their profession, PMDC chief says female doctors should be bound to work after completing their degree. “We are formulating a proposal under which every student who gets admission to a medical college on general seat would be bound to work in the government or private sector for at least three years after graduation”.

Nevertheless, in addition to this a strategy could be taking bonds from the students that if they wish to settle abroad they  would have to pay the subsidy amount that was previously covered by the government. Moreover, policies can be formulated to attract the doctors who have gone out of the country. This is because the country’s disease burden is increasing day by day. And we are not in a position to wait for new doctors to come and take over the burden of tackling the problem. “Political stability, peace and safe working conditions are also  must for bringing the doctors back”, says Dr Mahmud. Fortunately, other countries like China have started to invest huge amounts in Pakistan. Now it is high time to turn this investment in an opportunity to accommodate more male and female doctors in health sector and save their expertise from wasting or flying abroad.

Females are almost half the population of Pakistan. They also need health care when they get sick. A country where, seeking treatment from a male doctor is a social taboo or cultural barrier for many, it is not wise for female doctors to discontinue their profession. A doctor is supposed to treat patients and not sit home.

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