he professional stagnation, frustration and helplessness of junior doctors in Pakistan irks me, a Pakistani doctor having been trained as a specialist in the National Health Service, United Kingdom, who in 2016 returned to his homeland as a diabetes specialist. The ongoing, albeit worsening, professional plight of junior doctors is determined by:

(a) competence and professionalism of fresh medical graduates;

(b) specialist training opportunities; and

(c) the quality of training and future prospects to flourish professionally if they wish to continue to work in Pakistan.

My root cause analysis over the last eight years points to the following clues:

The ever-increasing rate of birth of private medical colleges is an ever worsening challenge. Here I do not wish to dwell on the details of how the licensing authorities ensure maintaining quality standards for both pre-existing and new colleges. Some of these colleges seem to be only adding to the numbers. On the whole, this exercise seems to be only multiplying the quantity at the expense of the quality of medical graduates in terms of professional expertise, etiquettes, communication skills and empathy. The blame has to be split between the licensing authority, the faculty and the staff, who are directly responsible for grooming and professional training of young doctors.

There is an unending paucity of slots for specialist training and an ever-growing number of new doctors produced by the medical colleges. So, we are producing a large numbers of doctors every year through private medical colleges without requiring these colleges to provide them specialist. Consequently, there is a gross mismatch between the numbers of doctors and specialist training posts. This is evident from the fact that there are hundreds of applications for every specialist training post advertised.

For trainees who are fortunate enough to enter specialist training, it’s like a post-code lottery. While there is standardisation of specialist training across the country, the implementation of this standardisation varies a lot. Hence, while some training centres are producing ethically and professionally sound specialists, others are just adding to the numbers. The responsibility of training the younger specialists rests mostly on the senior faculty. Once these young specialists turn out to look after the health needs of the public, they are up against heavy odds to settle down. Peer and family pressure, financial woes in the face of ever-rising inflation, and last but not the least, the professional jealousy and politics that plague the system in general.

All this results in the following undesirable outcomes:

The two countries have been facing the impact of climate change on wheat crops since 2010. The current year, however, has been exceptionally favourable. There has been no terminal heat wave or out of seasonal rains.

Attempts to seek training opportunities abroad. Pakistan is one of the largest suppliers of junior doctors to the United Kingdom. Some call it brain drain; I like to call it “train drain.” This journey is long (resulting in, on average, at present, 2-3 years being spent to get the treasured first job) and arduous both mentally and financially.

Settling for mediocrity and lack of professional growth. This gets to most not only to make ends meet but also to just get on with life rather than their profession.

Having reflected on how we got here, I am offering my two cents worth regarding where to go from here, should there be a national resolve to do so. Three virtues needed to even start scratching our heads and looking the young Pakistani doctors in the eye are will, leadership and the autonomy to “just do it.” We need:

Reconstitution of an autonomous medical licensing and regulation authority.

Immediate moratorium on licensing of new medical colleges.

Strict, unbiased and independent inspections and regulation of existing medical colleges as per statutory parameters of regulation with harsh penalties, including fines and withdrawal of licences.

Legislation to ensure that a medical college is only granted a licence if they develop a postgraduate specialist training programme.

Reshaping of undergraduate and postgraduate training curricula to polish our medical graduates and specialist trainee doctors in professional domains rather than just drilling theoretical knowledge into them. This has to be executed through a team of academics and medical faculty with special interest and expertise. Training the trainers is the next step before implementation and revaluation. Checks, trainee feedback and accountability of colleges and postgraduate institutions can ensure the sustainability of quality teaching and training.

Being one of the most literate sections of civil society, the salary structure of junior doctors should be revised on an ongoing basis, thus improving their quality of life and sense of professional satisfaction.

Keeping our eyes closed and harping on the “all is well” mantra will not get the medical profession out of this quagmire it is in. Are we ready to take the bull by the horns?

The writer is a consultant endocrinologist at Khair-un Nisa Hospital, Lahore