Almost half of females who graduate as doctors from public universities end up not practicing the profession. Instab Sahi finds out why that is so and what can we all do to make the stats a little more bearable

akistani female doctors are often at the receiving end of unwarranted criticism for often not practicing medicine upon graduation. However, no one is willing to understand why most young, enthusiastic females end up sitting at home after attaining medical degrees from prestigious public institutions across the country.The case of female retention in the medical profession is a thinly veiled issue. Even though most Pakistanis are aware of the reasons behind female doctors abandoning their professional careers, no one seems interested in resolving the problem. Moreover, the focus often, as with any profoundly patriarchal society, is to blame females for wasting government resources by recanting the novel Hippocratic Oath of serving the ones in need.

Albeit, several factors are affecting the doctor-patient ratio in the homeland nonetheless, with a recent observation revealing that over 50 percent of the young female doctors do not practice after graduation, adding to the existing dearth of doctors.At present, females account for 70 percent of the total student population in medical colleges of Pakistan. Unfortunately, only 50 percent of them end up becoming practicing professionals. The non-practicing female doctors are, therefore, believed to be the cause of the overall shortage of doctors in local hospitals.

At present, females account for 70 percent of the total student population in medical colleges of Pakistan. Unfortunately, only 50 percent of them end up becoming practicing professionals

Getting into a public medical college in Pakistan is no easy feat. Every year, hundreds of thousands flock to medical college admission tests across the country in hope of getting a placement. However, the process of becoming a doctor begins years before the actual induction of a student in one of the few public medical colleges.However, the rising number of applicants does not denote an equal rise in the number of doctors in service. Pakistan continues to suffer from an acute shortage of medical practitioners needed to serve over 200 million Pakistanis. Although the burden is laid squarely on shoulders of female doctors, there is an equally pressing issue of male doctors leaving the country in hopes of better career prospects. America, for instance, has close to 30 percent foreign doctor population in its workforce and about 25 percent of those doctors belong to either Pakistan or India.“We prefer blaming female doctors for not practicing but have no qualms letting the males off the hook,” Dr Farzana Nazir, former MPA, told Academia Magazine. “Many male doctors also leave practice, but do you ever see people questioning why they do not to serve the profession?” she asked inquiringly.

A Doctor For A Wife

As he scribbled signatures on documents laid out in front of him, University of Health Sciences VC Dr Javed Akram told Academia Magazine that people in our society seemed to think of female doctors as “marriage worthy”. And since marriage takes precedence over professional achievement in the cultural context of Pakistan, it is no surprise that most girls give up reputed medical careers once they get married.“We want a doctor bahu (daughter-in-law) so that she can monitor the temperature and blood pressure of people in the in-laws if need be,” he said with a distinct sarcastic flavor to his words.

University of Health Sciences VC Dr Javed Akram believes people in our society seem to think of female doctors as “marriage worthy”

There is no doubt that in Pakistan, the prevalent opinion is that parents send their daughters to medical colleges because they want them to find “suitable” partners in marriage. The belief is reiterated every time someone mentions how they are looking to find a “doctor-wife” for their son. Popular opinion continues to create challenges for young doctors who do want to pursue a career and fulfill their duties as responsible medical practitioners.

“As soon as students get admitted, we initiate a counseling process to make them realize that the field they have chosen requires them to act responsibly and serve humanity,” said Dr Shireen Khawar, the pro VC at Fatima Jinnah Medical College University.“We (females) don’t become doctors to not practice; if someone is being forced out of a profession, they cannot be equated with someone purposefully leaving a field,” she told Academia Magazine. It is clear that most female doctors do not want-out, but family pressure often leads them to give up on their dreams.

Dr Anila, a medical officer at Ganga Ram Hospital, Lahore explained how marriage was not simply a responsibility but more of a liability when it came to a woman’s career. She told Academia that as working women started raising families, it became even more difficult for them to juggle two ‘full-time jobs’.

Girls Shining

The dilemma is real. In public medical colleges, students spend only a fraction of what it takes to graduate from a private medical college. Therefore, when a student after having benefitted from public funding decides to forego practice, the capital investment turns to waste. According to Dr Javed Akram, “It takes around Rs 7 million to educate a doctor in government-funded colleges.” The amount may sound ridiculously high, but when compared to the fee charged by private institutions the number seems quite reasonable.

FJMCU Pro VC Dr Shireen says you cannot deny women the chance of studying in public colleges if they are making the merit

All public medical colleges have 50-50 quota for males and females, however, more females secure seats because of their own abilities. “You cannot deny women the chance of studying in public colleges if they are making the merit,” FJMCU Pro VC Dr Shireen added.To get on the merit-list of a public medical college is nothing short of achieving the pinnacle of success. Every year at least 100,000 applications pour through the mailboxes of public med-schools and only 10% receive acceptance. If more than five of every 10 acceptances are females, it is enough indication of the fact that women deserve to remain in the field, putting their learning to good use.

Dr Javed Akram said just the UHS tested some 150,000 students each year and only about 7,000 students got enrolled. According to Dr Akram, if women secure more seats in fiercely contested examination, it goes on to show how deserving they are of remaining associated with a profession they work relentlessly to become active members of. 

Legislation For Leavers?

One way of resolving the pressing problem of doctors fleeing service (male and female) would be getting them to sign binding contracts. Every student who gets admission to a medical college on general seat should be bound to work in the government or private sector for some time after graduation. And those who wish to either abandon the profession altogether or go abroad should have to pay the amount of subsidy paid by the government for their education.

“A good way of retaining female doctors in the system would be through legislation. Doctors can be made to sign affidavits. When they’ll be bound by law to serve, no one can force them to leave the profession,” said Dr Amir Bandesha, an experienced cardiologist and ex-member of the executive committee of former PMDC.Dr Shireen also seconded the idea. “Getting medical students to sign affidavits would be a good way of ensuring that they practice.”Interestingly, there is no existing legislation on the matter and legislators themselves reluctant to offer a comment, therefore, none of their take could be included in the report.While legislation on many matters is long-overdue, however, the real need of the hour is an ideological change. Parents need to understand that doctor-daughters are worth way more than what the “marriage-business” suggests they are.“We are trying to bring parents in the loop as well. Whenever a new batch is inducted we host a dinner-cum-counseling session,”

A good way of retaining female doctors in the system would be through legislation, believes Dr Amir Bandesha

Dr Shireen confided in us.“The trends are changing. In earlier days, it was common for young doctors to not practice but today the girls are more aware. They know the significance of their contributions in the society”, Dr Shireen added.Another way of solving the continued issue of female doctors’ retention would be overturning traditional social beliefs and making structural changes alongside. “Facilitating female doctors would be a step in the right direction. Legislation is a tedious process but making sure that every hospital has a daycare center is very achievable,” suggests fomer MPA Dr Farzana. 

She believes, at present the shortage of female doctors can be reduced by resolving immediate issues. In Pakistan, motherhood, more than marriage, hands the decisive blow in deciding the course of a woman’s career. Therefore, it is imperative that there are proper daycare facilities in hospitals for young mothers. This way, a doctor has less to worry and she can easily work and payback the system that funded her education. On surface it would appear that Pakistani females are excelling in the medical field. The reason being a continued increase in number of females attending med-school. However, the number is more of a false-positive. Women are undoubtedly, attending medical colleges but since more than half of them do not get to work, their education becomes meaningless. 

The World Economic Forum’s (WEF) Gender Equality Report, 2018 places Pakistan at the lowest rung of gender equality index. This means that gender disparity is rampantly visibly in the countries socio-economic sphere. The report revealed that while on one hand Pakistan had made improvement in provision of higher education to women, the country continued to lag behind the rest of the world when it came to the number of women in workplace, especially, at managerial positions. This further proves the point that a country’s well-being suffers when the general mindset does not support female inclusion in the workforce. Today more women are working towards financial independence, however, many socio-cultural factors continue to hamper their way to success. 

Becoming a doctor is a sign of prestige in Pakistan, but hanging a degree on the wall is not enough. Female doctors deserve to remain associated with the profession for their sake and the country’s sake. Policymakers and the general public need to look inwards and find a workable solution. Without incisive policy-making, female doctors will continue forsaking their duties and continue to bear the blame burden any time someone talks of shortage of doctors in Pakistan. 

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