any students who have completed their MBBS degrees seek post-graduate training in various specialties. This decision may be influenced by their family background and responsibilities. There is a wide range of clinical and non-clinical options available to medical graduates.

Medical students begin making up their minds regarding future subspecialty right from the beginning of their medical career. Once they get some exposure to clinical practice, their perceptions change. This affects their decisions and choices.

A medical career requires a lot of hard work. Doctors are expected to be sound in knowledge and skills. They are also expected to work long hours - sometimes more than 80 hours a week. In return, they expect stable jobs with attractive salary packages and prestigious designations.

Factors affecting the post-graduate career choices of medical students have been studied, both nationally and internationally. Common factors identified in the literature that influence the post-graduate career choice of students include gender, future security, prestige, physical and mental stress, working environment, patient interaction, role of tutors, profession of parents and relationship commitments.

A country needs to be aware of the extent of brain-drain (the number of its doctors going abroad) as this affects the community’s health and can lead to a supply-demand crisis. It is important for the community healthcare system to acknowledge the demand for various specialties so that the balance of supply and demand can be maintained. Our fresh graduates and consultants are our future leaders and innovators in healthcare.

According to the World Health Organisation, there is a global shortage of 2.8 million physicians, especially in low- and middle-income countries due to the migration of physicians to high-income countries. These high income countries include the UK, the US, Australia and New Zealand.

The decision to move to a First World country or stay back depends on several considerations such as personal, political, economic and social influences. This includes those who migrate for post-graduate studies and those who want a better future in terms of finances and security.

The physician-to-population ratio of 7.8:10,000 in Pakistan doesn’t measure well against meet the WHO-recommended 23:10,000. There are also notable urban-rural discrepancies in human resources, particularly for doctors in Pakistan. There are currently an estimated 14.5 physicians per 10,000 population in urban areas and 3.6 per 10,000 population in rural areas.

Further studies are recommended in medical institutes of Pakistan to identify and document the factors potentially leading to brain-drain from our country. 

A cross sectional study at a private medical university in Karachi in 2022 found that the most common sources of information about career choice were social media (22.6 percent) and family (21.9 percent). Only 28.2 percent students had attended a formal session regarding their field of choice. 90.4 percent were interested in post-graduation career counselling sessions. The most common clinical fields of choice for post-graduate studies among medical graduates were cardiothoracic surgery (14.3 percent), general surgery (13.6 percent), neurology (12.2 percent) and obstetrics/ gynaecology (11.5 percent).

The most common non-clinical fields of choice were medical education (53.3 percent) followed by research (20.0 percent). The most preferred clinical fields for post-graduate training of male students were neurology (15.9 percent) followed by cardiothoracic surgery (15.0 percent) and general surgery 914.2 percent). Female students, on the other hand, opted mostly for obstetrics/ gynaecology (16.8 percent), followed by cardiothoracic surgery (13.9 percent) and general surgery (13.3 percent). The choice may be influenced by social orientation as most female patients in Pakistan prefer to consult female doctors for gynecological issues and obstetrics.

The study also showed that a friendly learning environment, personal interest and ambition were considered important by a greater proportion of respondents preferring the clinical field. Less exposure to infections, less mental stress, short waiting time for getting residency, good expected salary in future, quality of training and hands-on opportunity were considered important by a greater proportion of respondents preferring non-clinical fields.

A majority of students wished to pursue post-graduate studies abroad due to better facilities, better law and order conditions and diverse opportunities of residency abroad. Among those choosing to stay in Pakistan, 50.4 percent wished to work in rural areas while 49.6 percent chose to work in urban areas. Providing service to the community and greater opportunities for professional growth were considered important by a majority of students opting for practice in specific areas.

The study showed almost equal predilection for practice in rural and urban areas of Pakistan.

Another study conducted in government and private hospitals of Islamabad found that poor facilities and quality of life, transport issues, lack of career growth, poor salary, adjustment issues in rural settings, security issues, educational institutions for their children and working opportunities for their spouses were the main concerns of most young doctors.

Further studies are needed in various medical institutes of Pakistan to identify and document the factors potentially leading to brain-drain from the country. The findings will be helpful in working out solutions to stop the process of losing highly skilled manpower.

The writer is a consultant in family medicine, MBBS, FCPS, MRCGP(INT)