Clip_28The Government spends Rs 2.4 million on each medical student who takes admission to a medical college on general merit seat.

It is a general perception in Pakistan that uneducated people do not allow women to work and girls should be provided education to make them an effective part of society.

But it has now been learnt that about 50% of women, who graduate from medical colleges, never work.

Pakistan Medical & Dental Council (PMDC) president Prof Dr Masood Hameed is of the opinion that female medical students occupied the general merit seats in public sector medical colleges and got subsidy but after completing their education they never started their professional career.

Dr Hameed said at the moment there were 78,037 male and 65,324 female doctors, 5,420 male dental practitioners and 8,300 female dental practitioners in Pakistan. Out of the total medical and dental practitioners, almost 50% are women, he added.

Only 50 per cent of the female doctors are working. On the other hand, a number of doctors (mostly males) have gone out of the country. There are around 50,000 to 60,000 medical practitioners against the demand of 600,000 in the country.

We need more medical and dental colleges. Pakistan is producing around 14,000 doctors per year out of whom 70% are women. It is feared that almost 50 per cent of the medical students would never work.

In Pakistan only $9.3 were spent on the healthcare of each citizen per year against the international standard of $60.

With such scant resources and number of medical practitioners, Pakistan cannot meet its needs for healthcare.

Moreover, migration of doctors and the rapidly increasing population is adding to the problem.

The College of Physicians and Surgeons Pakistan (CPSP) produced only 32,879 specialists out of whom 40% left the country. So there are only 20,000 specialists against the requirement of 100,000.

As if the above was not enough, the PMDC says that the teachers currently being produced are not up to the standard. This is why the quality of medical education is deteriorating.

Students who get admission to medical colleges on general merit seats pay around Rs 15,000 to Rs 20,000 fee a year, so they completed their MBBS by spending around Rs 100,000.

On the other hand, the government spends almost Rs2.5 million on each MBBS student. Unfortunately, after completion of the course, most of the female medical graduates never work. Those who want to work try to leave the country and settle abroad, especially in the US, or Saudi Arabia.

The US prefers to get doctors from other countries because on the production of each doctor it has to spend $250,000. So the US hires the services of doctors from other countries and spends that amount in the health sector.

The PMDC chief said he was formulating a proposal under which every student who get admission to a medical college on general seat would be bound to work in the government or private sector in the country for at least three years after graduation. Those who want to go abroad would have to pay the amount of subsidy – Rs 2.4 million – paid by the government for their medical education.

Moreover, there is a suggestion that doctors who have studied on general merit seats and are earning well should pay back the amount of subsidy to the government. A pool should be made and doctors should be asked to deposit the amount of subsidy in it. That amount can be spent in the health sector.

Clip_66Clip_66Are Pakistan’s female medical students to be doctors or wives?

Image caption women outnumber men in Pakistan’s medical colleges

In Pakistan’s prestigious medical schools, female students outshine and outnumber their male counterparts. However, many do not end up as practising doctors – and now there are calls to limit their numbers, the BBC’s Amber Shamsi in Islamabad reports.

It is almost as if men are an endangered species in Pakistan’s medical colleges.

The government body that regulates the medical profession, the Pakistan Medical and Dental Council (PMDC), says more than 70% of medical students are women.

Competition to get into these medical colleges is tough – at one college I was told that they receive 10,000 applications for a 100 places. In the more prestigious colleges, students must get 90% grades or more in order to be considered.

I ask one male student why the women were outshining the men. He is in his fifth year, specialising in ear, nose and throat.

“Boys go out, hang out with their friends,” he says. “Girls can’t go out as much, so they stay at home and rote-learn.”

Image caption Entry into the country’s top medical schools is fiercely competitive

In other words, perhaps the success of women students is not so much their own hard work, it is embedded in the culture of keeping girls at home.

And government figures suggest most of these bright female undergraduate doctors do not actually go on to practise. Only 23% of registered doctors are female.

The vice-chancellor of the prestigious Shaheed Zulfiqar Ali Bhutto medical university in Islamabad, Dr Javed Akram, says that girls are more focused on excelling academically than boys.

At the same time, he accepts that some female students are more keen on catching a husband than on pursuing a career.

“It’s much easier for girls to get married once they are doctors and many girls don’t really intend to work as professional doctors,” he says.

“I know of hundreds of hundreds of female students who have qualified as a doctor or a dentist but they have never touched a patient.”

Image caption Dr Javed Akram, who rejects the idea of quotas, says his university’s female students “study harder so obviously they are better students”

Privately, many doctors – both male and female – tell me that a medical degree is an extremely hot ticket in the marriage market.

To confirm this claim, I visit the Aisha Marriage Bureau run by Kamran Ahmed and his wife. Business is so good they are opening their second branch in Islamabad.

Mr Ahmed says his best clients are mothers seeking doctor wives for their sons. “In social gatherings, it’s very prestigious to introduce your daughter-in-law or wife as a doctor.”

And he says if a young female doctor is even a little good-looking, then finding a match for her is a breeze. “By the way, if you know of any single doctor girls, please let me know. I have boys who are looking,” he adds in a cheeky aside.

Image caption Kamran Ahmed says having a doctor for a daughter-in-law is considered prestigious

But the “doctor wife” is more than a trophy: her absence from hospitals has serious implications on the healthcare system of a poor country like Pakistan.

The government spends millions of rupees on subsidies per student – yet there is a serious shortage of doctors, especially in rural areas where women prefer to be examined by female doctors.

Dr Shaista Faisal is an official with the PMDC whose research into the subject led the council to try and introduce a limit on the number of women being admitted to medical colleges.

When news of the “quota” on male-female admissions broke in the local media it quickly drew flak and controversy. But the PMDC insists it is the only solution.

“It’s not a quota. We want 50% of admissions to be for males and 50% for females,” Dr Faisal says, a little defensively.

“It’s not discrimination. I don’t think we’re allowing boys who don’t study to get into medical schools. This shortage of doctors is the biggest challenge to Pakistan’s health system.”

Image caption Many female medical students face a dilemma: their careers or their families

Image caption Human rights lawyer Shahzad Akbar argues that quotas in medical colleges are unconstitutional

Human rights lawyer Shahzad Akbar strongly disagrees. “The wrong here is that women are being discriminated against here for being too smart.”

Mr Akbar has filed a petition in court challenging the decision to introduce the “quota”. He calls it unconstitutional and says the government should encourage women to stay in the profession instead.

“The answer is that they have to make the working environment more women-friendly rather than saying, no, you can’t be a doctor because you end up leaving the profession.”

Columnist Fasi Zaka also believes that the government has the wrong end of the stick.

“Yes, doctors are leaving, but the restrictions should be at the point of exit rather than entry.” He suggests asking those who fail to practise to reimburse the government the large sums it costs to train them.

Image caption More than 70% of medical students are women

Back at the medical school, two starry-eyed female students tell me they are determined to become doctors. But if they were asked to choose between their careers or their families, which would it be?

“I’d try to convince them,” says 20-year-old Eliya Khawar. “But if they aren’t, I’d choose family.”

Her classmate Manza Maqsood concurs. “Family. In our culture, family always comes first.”

Everyone seems to agree on the diagnosis of the problem, but not on the cure. Maybe, it’s time to introduce a quota for women with pushy families.