Pakistan, Already Suffering From Doctor Shortage, Losing Physicians To 'Greener' Pastures In Middle East

 @Gooch700
on August 29 2013 10:08 AM
Pakistan Hospital 2012
A hospital attendant transports a patient in a Pakistan Hospital. Reuters

The Kingdom of Saudi Arabia plans to import scores of doctors from Pakistan, already one of the biggest sources of medical professionals for the Persian Gulf region. According to a report in Pakistan’s Express Tribune, a delegation of Saudi officials will interview potential candidates over the next two weeks in the cities of Lahore, Multan and Islamabad. A source linked to the consultants organizing the interviews told the Tribune that the Saudis expect to hire about 150 physicians -- including specialists in general medicine, endocrinology, neonatology, general surgery, hematology, obstetrics and gynecology and various other fields -- during this go-around.

For Pakistani doctors – many of whom receive substantial subsidies for their medical education from their own government – the financial lure of working in Saudi Arabia and other wealthy Middle Eastern states is simply too tempting to pass up. “A doctor with two years of experience gets a salary of 6,000 Saudi riyal [166,205 Pakistani rupees or about $1,600] per month, while a consultant gets 20,000 riyal [Rs554,016 or $5,330] a month at least. Those with more experience get more,” the consultancy official told the paper.

For example, Dr. Ahmad Asghar, who worked as a medical officer and consultant at Jinnah Hospital in Lahore, one of the largest hospitals in Punjab province, will see his monthly salary jump by a factor of ten (to 20,000 riyals) when he takes a new position in Saudi Arabia. Another Pakistani physician, Dr. Shahid Imran, who was employed at the Punjab Institute of Cardiology, also in Lahore, resigned earlier this year to take a position in Qatar where he will earn 32,000 Qatari riyal [Rs911,000 or $8,800] per month.

According to Arab News, some 6,000 Pakistani doctors already practice in the Saudi Kingdom, with 600 in Riyadh alone. The exodus of trained medical specialists presents a dire problem for Pakistan, which is in the throes of a doctor shortage. “The Gulf countries aren’t establishing any higher medical education institutions. They say they don’t need to as they can just buy doctors from countries like Pakistan,” said Dr. Amir Bandesha of the Young Doctors Association in Punjab.

Bandesha lamented that “almost half” of the specialist seats at Pakistan's district headquarters hospitals and 40 percent at teaching hospitals are empty. Pakistan also loses its enormous financial investments in these physicians. “The government spends Rs2.5 million on a student to make him a doctor and an additional Rs10 million to make him a consultant or specialist,” Bandesha added. “During training, doctors are paid Rs44,000 per month, which comes to a total of Rs2.7 million per doctor.”

But Saudi Arabia, which is constructing many new hospitals, also has its own doctor shortage – and much deeper pockets to pay them than Pakistan does. An unnamed doctor – who left Pakistan for Saudi Arabia last year for triple his income – complained to the Tribune that at the Mayo Hospital in Pakistan he sometimes had to work shifts of up to 48 hours straight, while in the Kingdom he receives two days off each week and works regular eight-hour days. “Here [in Pakistan] we have a lot of uncertainty. We cannot get a raise unless we protest and boycott work,” he said.

Dr. Izhar Chaudhry of the Pakistan Medical Association also warned that Pakistani doctors are leaving the country because the Punjab government’s Health Department does not permit state-employed physicians to go on leave abroad for more than 10 days at a time, prompting many to quit outright. “Many doctors have made up their mind to resign and go abroad after being denied … leave,” he said. “The Health Department has made no policy to stop this brain-drain. Rather, it seems as if they are teasing government-sector doctors to promote private colleges. The four new public medical colleges are still short of faculty. [Their] policies encourage doctors to go to countries like Saudi Arabia.” He added that the Health Department has failed to provide additional allowances to doctors who finish their post-graduate degrees, after promising to do so.

In fact, when the Saudi Ministry of Health hired 1,000 Pakistani doctors in 2011 at one stroke, state doctors in Punjab staged a walkout for higher pay. The PMA has long warned that the country is losing its best and brightest physicians to Saudi Arabia. “The government on one hand claims to invest in health and education and on the other it does nothing to stop the brain drain,” said PMA Joint Secretary Dr. Salman Kazmi. “The government announces a pay package for doctors and nurses only when they go on strike or take to the streets. This is no solution. The government needs to develop a structure, otherwise we may run out doctors.”

Pakistan not only has a shortage of doctors, but spends an abysmally small proportion of its federal budget on health care. “Unfortunately public health is a neglected field in our country. More manpower and resources must be allocated to this sector,” Dr. Raja Amjad Mehmood of the Pakistan Medical and Dental Council said at a conference at the School of Public Health at the Dow University of Health Sciences in Karachi. Mehmood indicated that Pakistan’s total expenditures on health care amounted to 2.6 percent of GDP, while the public health sector received only 0.86 per cent of GDP.

Dr. Nadir Abbas, who is currently working in Wales, explained in an op-ed in the Tribune why he departed his native Pakistan. “We live in a country where 10,000 people are attended to by just one physician on average,” he wrote. “Fifteen thousand doctors leave the country every year."

It is not surprising that the U.S., U.K. and now the Middle East have become the biggest importers of Pakistani doctors, Abbas noted, “with the latter [Gulf states] now even recognizing Pakistani doctors without any further examinations and giving them 20 times the amount of remuneration that they could have ever received in Pakistan.”

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