Protesting doctors and baton-wielding police are not an unfamiliar scene in Lahore. The representatives of both the professions with the most civic significance have become the talk of the town yet again, following their recent clashes in the city.

The Young Doctors’ Association (YDA) and medical students were protesting outside an examination centre where the National Licensing Examination (NLE) was being given. The police tried to disperse them by resorting to a baton-charge.

According to some reports, the doctors tried to break the barriers and “cause unrest” and that led to an unpleasant tussle. The protesters claim that they were treated unjustly for protesting peacefully.

The dissolution of the Pakistan Medical and Dental Council (PMDC) and the transfer of authority to the Pakistan Medical Council (PMC) in late 2019 raised many a question for the medical professionals. The NLE was made mandatory, under Sub-Section 2 of Section 21 of the PMC bill.

Since March 2020, all graduating students of MBBS and BDS are requested to sit for the competency test. No degree holder can get the licence to practice without first clearing the NLE. “Now we have to prepare for another test after having cleared all professional and clinical examinations set by the University of Health Sciences, to obtain a licence,” says Dr Sofia Syed, a young dentist and researcher.

The PMC says it has mandated the NLE to standardise medical licensing. Many young doctors consider it an unnecessary hassle and expenditure. “The only apparent objective is to prove their [PMC’s] efficiency,” says Dr Danish Awan, president of the Punjab YDA whose left ulna was badly hurt in the baton-charge.

The young leader believes that the NLE is nothing but a hurdle created instead of fixing the actual problem. “The PMC should focus on regulating private medical colleges that are providing sub-standard education,” says Dr Awan.

The mushroom growth of private medical colleges all over the country should be a cause for alarm, he says. “Many of these shoe-box colleges had their licences revoked by the PMDC. The investors, who happen to be quite influential, got them back. The growing number of colleges operating with little academic regulation has allowed the standards to fall.”

The NLE is a solution to maintain merit and give all graduates a fair chance to secure a practicing licence while upholding the standards of the medical profession by making the students prove that they can tackle the challenges of the local healthcare system. “In a way, the PMC is trying to mimic international practices,” says Dr Sofia Syed.

Since March 2020, all graduating students of MBBS and BDS are required to sit for the competency test. “Now we have to prepare for another test after having cleared professional and clinical examinations set by the University of Health Sciences, in order to obtain a licence,” says Dr Sofia Syed, a young dentist and researcher.

The YDA says that the new provision was implemented hastily while other countries had taken years to fine tune the programme before making it a requirement. “The cost is a concern for many,” adds the dentist, who barely escaped the test. “At the time of my graduation, the NLE was still under consideration.”

The PMC plans to give two licensing exams a year. The fee, set at Rs 12,000, make it a costly assignment if one does not clear the test in one go. “The very thought of never-ending exams is troubling,” says Dr Danish.

To become a doctor is a lengthy process with many tests, literally. “We take more exams than any the students in any other field. From MDCAT, professional and clinical examinations to viva voce, the tests are endless,” says Dr Awan.

The Young Doctors say the new test is “unfair.” “India has a National Exit Test (NET), but it has replaced the final year’s professional examination,” says the YDA president.

As mentioned earlier, standardised testing is a common practice. However, Pakistani medical students are calling it a hurdle created to prevent them from advancing to the next stage in their chosen profession.

Some of the private medical colleges have a reputation for charging exploitative fees and providing sub-standard education. The NLE is supposed to regulate professional achievement and ensure that the best professionals enter practice. However, young doctors assert that it is a way to “increase the number of seats for private degree holders in practice.”

Those taking a less critical view of the test believe that it should be compulsory for foreign graduates but not local students. “Private colleges do not focus on providing quality education. They are pushing for standardised testing so that they can go scot-free,” says Dr Awan.

The burden of clearing the NLE falls on the student. No one questions the private institutions churning out thousands of doctors with the slightest bit of training. “The focus has shifted from educating professionals to clearing the NLE,” Dr Syed says, adding that the private colleges’ only aim is that their students pass the said test. “It is unfair to the students.”

Medicine is one of the most respected professions anywhere in the world. To have one’s child become a doctor is a dream for most Pakistani parents, even if this means spending millions on private college education.

Most countries require foreign graduates to sit for competence tests; the NLE serves the same purpose. However, its implementation is causing a rift between the students and the authorities. “The aim is to produce ‘safe’ doctors and prove that the new council is doing its job effectively,” adds the YDA president.

It is clear that young doctors believe they are being subjected to unnecessary testing after they have graduated from public medical colleges.

The writer is a staff   member