Loosely speaking, the Young Doctors Association (or YDA) means a variety of groups. One of them is headed by Dr Salman Kazmi, another by Dr Maroof, yet another by Dr Aamir Bandesha, and then there is one which is led by Dr Asif Hussain. And if this wasn’t enough, there are subgroups that merge with the bigger entities at any given instance.

But all these groups stand united when it comes to defiance. They will go to any lengths to push for their demands, even if it means taking to the streets and shutting the hospital emergencies and outpatient departments (OPDs) ruthlessly.

The YDA has been up in arms since 2008. One is curious to know just where they derive power from -- and so much power that they can close down hospitals. Some suspect the YDA is playing in the hands of influential politicians and commercial tycoons in the health industry who use it as a pressure group to manipulate transfers and postings within the hospitals and government institutions, grab contracts of pharmacies and canteens, and influence admissions in medical colleges.

Some medical practitioners view the YDA as a consequence of lopsided policies of the successive governments in the medical sector. They say that organizations such as the Pakistan Medical Association (PMA) and Medical Teachers Association (MTA) never tried to resolve the long-standing issues of the young, disgruntled doctors.

An official privy to the developments in the Pakistan Medical and Dental Council (PMDC) tells TNS, on condition of anonymity, that the PMA, backed by political groups, have raised the YDA as a rogue band, to serve its own purposes.

"They exploit the young doctors, and sponsor sit-ins in order to thwart the government’s initiative of privatisation of hospitals," he says. "When their favourites are not appointed in the top slots [in hospitals and medical colleges], they incite the YDA members to launch aggressive protests."

Another official says the YDA came into being "as a reaction to the injustices meted out to the young doctors in the health departments.

"We had long received complaints of trainee doctors against maltreatment at the hands of senior professors during house jobs and placements in hospitals. One of these was about how the young doctors had to appease the professors in order to get their completion certificates. Everyone knows that a slight defiance to the seniors could ruin their future."

It is also said that the PMA, decidedly the oldest body of doctors entrusted to advise the regulators and the government in healthcare and medicine, failed to address the young doctors’ concerns regarding their salary and service structure. This prompted them to found the YDA.

Dr Izhar Ahmed Chaudhry, president of PMA Punjab and a senior professor at King Edward Medical College (KEMC) Lahore, comes down hard on the YDA. He says there will be no letup in the protests anytime in the future. "They are politically-motivated. They have some big guns backing them.

He alleges that in 2009, the then parliamentary secretary Saeed Elahi politicised the doctors’ issue: "He pitted the PMA and YDA against each other. This helped the Punjab’s political magnate to raise different groups [of doctors]."

He also accuses the Punjab Chief Minister Shahbaz Sharif of dividing the YDA.

Over the years, the country has seen a mushroom growth of medical colleges. A great number of doctors qualify every year. A PMDC report puts down the number of doctors Pakistan is producing every year to almost 14,000. To quote Dr Izhar Chaudhry, "It’s a profitable business, which is why plenty of commercial tycoons -- from real estate to chemical industry, textile industry, and automobile sector -- have set up their own medical and dental colleges. They use the YDA to influence the government to serve their own commercial interests."

On the other hand, Dr Shoaib Niazi, a YDA leader, believes that as senior doctors and their associations did not play their role well, the YDA had to come forward in order to fight for the young doctors’ rights.

"Almost 50 per cent trainee doctors are forced to work on honorary basis," he says. "They have to go from pillar to post, trying to get their letters and certificates from senior professors who often humiliate us as if we were their slaves. Some of them have also harassed the women trainees in acquisition of certificates."

Dr Niazi reveals that the YDA managed to get the services structures approved in 2012, riding on their street power. "Sixty-per cent of the demands are still unmet. Those who have been working for the last 17 years are still waiting for promotions."

He also attributes the raise in house job salary -- "from Rs6,000 to Rs37,000" -- and that of PG trainees -- "from Rs12,000 to Rs62,000" -- to YDA’s struggles.

However, he insists that the salary structure remains "inadequate.

"Security is another issue for doctors in the hospitals. Anyone can easily storm in and thrash them at the slightest pretext."

Next, the issue of long working hours crept up. As the YDA Pakistan President Dr Salman Kazmi says, "How do you expect the doctors to deliver when they are on duty for 48 hours at a stretch? Exhaustion has often led to fights [between the doctors and patients’ attendees]."

"The YDA has succeeded in obtaining a new order whereby no one would have to work longer than 8 hours in a day."

Dr Kazmi calls for outsourcing hospital security "just as they are doing it for the Safe City Project."

A senior professor at Allama Iqbal Medical College (AIMC) holds the senior lot guilty of highhandedness that led to the emergence of the YDA. He is also quick to blame the influence of commercialisation in medical profession for throwing the spanner in the works. "When the teachers and students are attached to commercial issues, respect vanishes," he states.