These days medical college’s admissions process is underway in Pakistan. Almost 150,000 students appeared in government administered medical college entry tests, out of these only 15,000 (10%) lucky students will get admissions in 114 public and private sector medical colleges of Pakistan.

It is often said that Pakistan has too many medical colleges and too many doctors whereas on the contrary Pakistan has acute shortage of GP and Specialist doctors in more than half of Pakistan. Healthcare facilities in Pakistan are not only inadequate but also do not meet international standards. More than 70 per cent of healthcare in Pakistan is provided by the private sector.

Doctors are very precious and essential members of any community; they prevent, diagnose and treat disease, illness, injury as well as other mental and physical impairments that population suffers on a day to day basis. They also supervise and evaluate treatment and care provided by the other staff members of the health care team such as the nurses and allied health professionals. 

There is a shortage of doctors not only in Pakistan but worldwide, which is true in most countries and on almost all continents. The paradox is that the number of medical colleges is consistently rising around the world but this increase in medical colleges is not adequate, is unevenly distributed and is unable to meet the rising demand of doctors. One of the reasons of shortage of doctor’s in Pakistan is rapidly increasing population (4 million every year) and aging population due to increase in life expectancy, and their growing medical needs. The shortage is more acute in rural and small towns.

There are almost 3,000 medical Colleges in the world. With India having 532 medical colleges, Brazil 277, China 194, USA 192 and Pakistan on number five position in the world with 114 medical Colleges.

India’s annual student Intake in its medical colleges is 76,753 medical students and Pakistan annual intake is about 15,000 medical students.

Out of 114 medical colleges in Pakistan 44 (38%) are public and 70 (62%) are private. Province wise, Punjab and Federal area has 62 (53%) medical colleges 19 public and 43 private. Sind has 26 (23%) medical colleges 11 public and 15 private, KPK has 20 (17%) medical colleges 10 public and 10 private, Baluchistan has 2 ( less than 2%) one public and one private and AJK has 4 (3 %) medical colleges 3 public and 1 private 

There are 10 to 15 million doctors in the world. With one million in USA and one million in India, four lakhs in Brazil and 232,358 doctors in Pakistan ( GP 186,980 and Specialist 45,378) 

Are 232,358 doctors adequate for Pakistan? Are they available in Pakistan? The answer is no, they are insufficient. Out of these two lakh thirty two thousand total Pakistani doctors, 110,000 are female doctors (Female GP 92,448 and Female Specialist 15,064) out of the total of 110,000 female doctors almost more than 60% (60,000) of female doctors are not practicing due to family compulsions.

Physician migration and Medical brain drain affects many countries including Pakistan, Only the brightest can pass the U.S. USMLE exams or UK, PLAP exam, meaning that those who emigrate are often bright and top doctors.  More than 40,000 Pakistanis doctors are working abroad, 18,000 Pakistani doctors are working in USA, 6,000 in UK and other European countries and in thousands in Middle Eastern and other countries. 

After deducting non practicing female doctors and overseas Pakistani doctors Pakistan is left with only 130,000 doctors, out of these more than 30,000 or more are working in administration or basic science faculty positions or are doing some other business or are retired. So Pakistan is left with 100,000 or less practicing doctors. 

To provide adequate cover to population of a 218 million we need 2 doctors per 1,000 persons at least. This means Pakistan needs 436,000 practicing doctors, at present, Pakistan has one fourth of the required doctors strength. 

Majority of the doctors especially the specialist doctors are concentrated in big cities or big towns leaving small towns and rural areas at the mercy of quacks.

It takes five years to produce a doctor by a medical college, followed by one year of house job, and additional four years of postgraduate training and many exams to become a specialist. 

A medical College is an educational institution that teaches medicine and imparts medical knowledge, skills and ethics for five years, and awards a professional degree for physicians and surgeons after successfully passing very tough five annual professional university examinations.

Majority of the countries have overcome doctor’s shortage by encouraging the private sector investment in the medical education and healthcare. 

It is not easy to establish a private or a public medical college. Besides spending billions of rupees on capital and operational costs, one has to fulfill strict and ever changing PMDC laid down criteria. You are required to establish a college building, hostels, furnish and equip them completely, hire the teaching faculty at hefty salaries and to also establish a teaching hospital of 500 beds with most of the medical and surgical specialties, in which you have to treat at least 35 % of patients free of cost.

Private medical colleges are not allowed to admit students on their own, as admissions are centralized and done by government universities in each province. The Fee is also fixed and is audited and strictly controlled. Because of these strict measures from last year many students and medical colleges faced many problems in the admission process, some students admissions got delayed by three to four months and even some college faced great difficulties in completing their allocated seat quota, most of the seats remained vacant especially very few colleges were able to fill their foreign quota seats.

In order to overcome shortage of doctors Pakistan needs to increase production of doctors. Government should encourage individuals and business concerns to invest in healthcare and to establish medical colleges and teaching hospitals along with nursing and allied professional colleges. The medical students from backwards area who avail reserved seats for admission in public medical colleges must serve after graduation in those same areas from where they came for at least 5 years, only than the MBBS degree should be awarded to them.

Pakistan is a human resource rich country, our oil is human resource and it is floating above the surface. By training this human resource in healthcare we can fulfill our own deficiency and also export them as according to the World Health Organization (WHO) estimates there is a shortage of 4.3 million physicians, nurses and other health workers worldwide. The United States relies on foreign-trained health-care workers. About a quarter of doctors in the United States and 27 percent of U.S. medical resident doctors come from abroad. Of these, foreign doctors almost 25 percent were trained in India and Pakistan.

We need to make consistent policies on healthcare. Government should involve opposition and all stake holders and should make a short term and long term healthcare plan with consensus of all stake holders, it should have consistent policies not change or bring new PMDC council every year, each PMDC council making new rules according to their whims discouraging private sector and making unachievable criteria. 

Government should increase the healthcare budget substantially in order to improve healthcare delivery. Private sector should be encouraged to participate and contribute; this can be done by doing healthcare projects on public private partnership.

Pakistan needs immediate action to improve healthcare delivery, government should form a team of persons who have experience and understand the healthcare issues, who can not only devise a holistic health delivery plan but also have the capacity to execute the plan within a stipulated time.