Summary Causes of brain drain
By Ahmad Rehan Khan
Brain Drain is "the departure of educated or professional people from one country, economic sector, or field for another usually for better pay or living conditions" (Merriam-Webster). It's a common term that we usually hear in developing countries like Pakistan.
In this article, I will summarise the current situation of brain drain in the healthcare system of Pakistan, the factors responsible for it and potential strategies to address it.
Current situation:
In the past decade, the brain drain rate has been increasing, especially in the past year; it has reached an alarming level. According to an article written by Ujala Siddiq in Daily times: "The last few years have witnessed a sharp rise in brain drain in Pakistan. According to the Bureau of Emigration and Overseas Employment, over 765,000 Pakistanis headed abroad for employment in 2022. The Tribune broke down the composition of those leaving; over 900 teachers, 2,500 doctors, 1,600 nurses, 5,500 engineers, 2,000 computer/IT experts, 2,600 agricultural experts and 6,500 accountants left Pakistan. The remaining were labourers travelling to the Gulf States for earning their livelihood – and are invaluable sources of remittances for the country – but it is the high number of skilled individuals departing that is cause for concern".
The above data makes it crystal clear that many Pakistanis are inclined towards trying their luck in foreign countries.
For Pakistani doctors, there are different routes to move to a foreign country. The most common is taking USMLE (United States Medical Licensing Exam) and applying to their residency (post-graduate training) match process. It is an arduous journey because of the difficulty of exams, the competitive nature of the residency match process and the uncertainty of getting a US visa. The whole process requires at least Rs2 to 3 million.
The second common pathway is via PLAB which allows Pakistani doctors to work in the UK. Exams are relatively less complex and the job placement process is not that complicated. The main difference is that in the USA, if you get matched (completing the residency match process), you directly get a training job in the specialty of your choice, but in the UK, one usually starts with a non-training job, as a senior house officer, registrar, etc. More exams and experience are required to get a training job.
Pakistani physicians can work in Ireland without taking any licensing exams due to an MOU between the PMDC and the Irish Medical Council. Those jobs will be non-training ones, similar to those in the UK.
Other avenues for Pakistanis doctors include Australia, Canada, the Middle East, New Zealand, Singapore etc.
Factors responsible for brain drain are a lack of opportunities, less salary, a misanthropic work environment, a lack of progress, security concerns and, most importantly, political instability. Getting admission to a government medical school has become more difficult than ever, and most cannot pay the fee for private medical colleges. Five years of MBBS aren't a piece of cake either due to tough exams and a lack of modern teaching techniques.
After successfully passing MBBS, Pakistani doctors need to take a test named NLE which started during the previous government tenure, followed by 12 months of house job which doesn't even pay the bills.
The residency training structure in Pakistan is questionable at best and lacks uniformity and fairness. During the training, doctors are paid 1/10th of the amount in the USA or UK.
The training supervisor and the senior colleagues usually don't spend enough time teaching the trainees and questioning them is considered a crime. Contrary to this, in the USA, the programme director of residency training is responsible for the clinical training and well-being of the trainees.
The training exams in Pakistan are neither fair nor uniform because of the dependence on the oral portion of the exam (viva). It entirely depends upon the person taking the exam to pass a candidate or not without any checks and balances.
Many doctors stay unemployed even after passing the specialty exams (FCPS, MD, MS, MCPS) due to a lack of jobs in the government sector and the monopoly of private hospitals. The trajectory of progress to the senior registrar, assistant, associate and full professor rank is unfair and depends upon connections rather than competence.
A lack of clinical research is a significant factor crippling the Pakistani healthcare system. There is little to no research in 90pc of the teaching hospitals, primarily due to the high clinical workload, a lack of basic research understanding and limited funding. So moving out becomes an obvious choice for Pakistani doctors interested in advanced clinical research.
Strategies to halt this brain drain:
Increase in the number of jobs and salary
Better work atmosphere
Improvement in training induction and structure
Uniformity in the promotion system
Overall improvement in law and order situation
Political Stability.
The writer is Consultant Psychiatrist in the USA and can be reached at doctorpsychiatrist@hotmail.com
