DefinePK

Abstract

Madam, Pakistan qualifies as one the leading sources of International Medical Graduates (IMGs) in developed countries. An approximate of 1,150 physicians emigrate from Pakistan every year,1 and the number keeps on increasing. Here we will identify the underlying factors that influence this migratory trend.
The major cities of Pakistan have constantly been terrorized by the wave of violence against its medical practitioners. The recent incidences of ongoing targeted killing of doctors and their abductions have led many doctors to call for strikes, protest on the streets or migrate from the country in pursuit of safety. Many doctors live in the constant fear of being the next target. Even hospitals have not been spared from the brutality of suicidal blasts. Where is the protection of lives of those who protect others\' lives?
Medical professionals, especially the ones in government sector hospitals, continually face harassment, violent behaviour and verbal abuse on the part of patients or their families. Besides, lack of reliable equipments and laboratory reports, unhygienic atmosphere, disease transferring insects, lack of proper trainings, prolonged working hours, poor management of the hospital staff — all these factors contribute to the formation of a highly dissatisfying environment for a physician. They are inadequately paid, not properly supervised and lack career growth, causing additional stress to their work. Malik AA et al showed that inadequate salary structure is the most frequently reported "demotivating" factor for physicians, a fact stated in many studies. Also, the mean working hours per week were found to be 56.9, which is self explanatory.2 Another study affirmed that job dissatisfaction among doctors was due to lack of safety and security, pay and benefits, adequate resources along with excess workload and inappropriate working conditions.3 These factors are often aggravated by political instability, bureaucratic obstacles and insecurity in the home country.4
Migration is a symptom of the deteriorating health systems in many poor countries.5 According to the Immigration Bureau of Pakistan, over 6000 doctors have left the country during the last five years.4 Physicians play a very crucial part in the improvement of the health system of a country and their loss affects the overall infrastructure of the system. Moreover, it may affect the quality of care, and impair the ability of the health care system to achieve health objectives for its population.5
These issues require immediate consideration as Pakistan is not in a position to further lose its doctors when the country is facing crisis like war on terror and a series of natural disasters. The government must provide complete protection to every doctor and take immediate actions against the open target killings. Steps should be taken towards improvement of the working conditions, counter unemployment, increment of salaries, prevention of harassment and standardized professional training. Because, as it is said, freedom of movement is every person\'s right, including the ones who have taken the Hippocratic Oath.

Faryal Tahir,1 Anis Rehman2
2nd Year Student,1 5th Year Student,2
Dow Medical College, Karachi.