Sunday 15 July 2012

Diary of a young doctor (Part 4)

(published in The Friday Times on 13th July, 2012)

Pay Up
"Please give me some money, I'm hungry and don't have any money to buy food," said the beggar.

"I wish I could, my friend, but I earn less than you do," was my reply. And I was not bluffing. 

There is a simple basic rule that governs almost all professions in the world: you work and that earns you money. There are strings attached to this simple fact according to diferent fields but the basic notion remains the same. Soldiers claim to fight for the country, police officers risk their lives for maintaing law and order, public servants work (or at least they are supposed to work) to provide services to their countrymen. At the end of the day, however, they all get paid for it. From the highest offices of the country to the lowest, from generals to chowkidars, from CEOs to clerks, the maidservants that work in houses, sewage workers, technicians, sales boys, they all get paid for doing their job. But in present-day Pakistan we are making one big exception to this rule: doctors.

I have chronicled the lives of young doctors and have described the trials and tribulations associated with their job. It is hard to believe that despite all this hard work, most doctors working in public sector hospitals are not paid. Imagine a person with 17 years of education, working 28 days a month, doing 30 hr/48 hr duties, and earning a grand total of zero rupees per month. 

Imagine a life with no pay, no job security and no health insurance (given that we deal routinely with HIV positive and Hepatitis C infected patients). All that keeps us going are the 'thank yous' of patients and a hope that someday, things will be better. 

After the doctors' protests last year, pays were increased. This does not mean that everyone is getting that pay. In the department where I work, there are 28 people working as House Officers and around 30 as Medical Officers/Post Graduate Trainees (PGRs). Out of 28 House Officers, only 8 are on the paid seats while the remaining 20 are working on 'honorary' basis (there is not much honor involved; it is a euphemism). Similarly, out of 30 Medical Officers, only 15 are getting paid. The situation is similar or worse in other departments and hospitals across Punjab. People working on honorary seats perform equal duties, do everything as others do, the only difference is that they are not paid for doing that work. This is a unique and frankly disgusting way of treating a professional, and there is no precedent for it anywhere in the world. Apart from interns at offices, everyone gets paid for their jobs. At times, even the Senior Registrars, after 10 years of medical training, have to work on honorary basis. 

There is an inside story to this practice. Theoratically, the seats in wards of teaching hospitals are preferably given to the graduates of the institute that the hospital is attached to. This results in unequality at times because graduates of other institutes opt for institutes in bigger cities. In the case of Punjab, graduates from all over the province prefer to do their clinical training in either Lahore, Multan or Rawalpindi. There is also the issue of non-residents. If a resident of Lahore got admission in Rawalpindi Medical College or Nishtar Medical College, he/she would prefer to complete his/her post-graduate training in the native town. Due to this shuffling, there are more candidates for less seats and departments employ different people on honorary basis. The merit list for giving a job for post graduate training starts from graduates of the same institute. Second on the list are graduates of other government institutes and lastly, the graduates of private medical colleges, including the ones in China and Russia.

There are ways that people bypass the merit system, because in Pakistan there is a single key for every lock: Sifarish. If you have the requisite Sifarish, you can bypass the merit and get a paid seat in your desired department. 

To cope with the economic pressure due to lack of any pay, doctors from public hospitals look for jobs in the private sector which forms 80% of our health sector. As a result, most of the unpaid (and in some cases, even the paid ones) do jobs at private hospitals in the evenings and in public hospitals in the morning. After living for more than 25 years on the largesse of your parents, if you still do not earn anything on your own, it reflects poorly on you. Also, during post-graduation, a lot of doctors are tied in the knot of marriage and it is difficult to ask your parents for sustenance of another person while you earn nothing. I personally know some people who delayed their marriages because they did not have the means to support a new member of the family. In some other cases, the young doctors were the only source of income for their families and had to wait till completion of their post graduation to marry. 

This system of 'honorary' jobs should end as it is nothing but a kind of slavery.


  1. OMG you gave words to my thoughts ....

  2. You have done a great job on this article. It’s very readable and highly intelligent. You have even managed to make it understandable and easy to read. You have some real writing talent. Thank you
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