KARACHI: Debate over open merit system in medical colleges
By Faiza Ilyas
“It’s a very delicate issue. We are not against merit, but these are ground realities which cannot be ignored,” says Dr Aley Hasan Zaidi, principal of Hamdard Medical College.
KARACHI, May 18: Pakistan will face a serious shortage of doctors, especially male doctors, in the coming years. Besides emigration, one major factor contributing to this shortage is that a large number of graduating girls leave the profession within five to 10 years. There is a dire need for a comprehensive study to determine the exact numbers, so that steps could be taken to find solutions to this problem.
These facts were highlighted in discussions with several health professionals representing various medical institutions in the private and public sectors, including the Dow Medical College (DMC), Sindh Medical College (SMC), Hamdard Medical College (HMC), Ziauddin Medical University and Hospital (ZMUH), Baqai Medical College (BMC), Pakistan Medical Association (PMA), besides many male and female doctors working at private and government-run hospitals.
Although most doctors shared the concern that the number of girls leaving the medical profession within five to 10 years following their graduation is high, they differ on the solution to this problem, stressing the need for a study on the subject.
“It’s a major issue, but we don’t have any research to support our claim,” Dr Salahuddin Afsar, Principal of DMC, and ZMUH Vice-Chancellor Dr Asim Hussain said.
Dr Afsar further said that the open merit system was introduced over a decade ago on the judgment of the Supreme Court, which was based on the principle that there should be no gender discrimination.
The decision was made with good intentions, but what has been observed over the years is that 70 per cent of girls, who hugely dominate medical institutions now, leave the profession within 10 years. The reason, he said, in most cases is marriage.
“In-laws’ pressures and family responsibilities prevent women from working. This is a great loss not only for the nation but also in monetary terms as the state spends about two to three hundred thousand rupees every year on each medical student in public sector medical institutions,” Dr Afsar said. He refrained from suggesting any solution to the problem and maintained that it’s a constitutional matter now and there is a dire need for research to substantiate the argument.
However, there are doctors like Dr Aziz Khan Tank, General-Secretary of the College of Family Medicine, who openly criticised the open merit system. Giving the example of his own family, he said that 10 girls in his family became doctors; four left the field while six are doing part-time jobs.
“Despite the fact that hundreds of girls have graduated since the introduction of the open merit system, it’s still difficult to get a lady resident medical officer for a private hospital. The problem is compounded in the rural areas and the situation is worse in the NWFP. There is no planning involved at the policy-making level and the decision to go for open merit was short-sighted, as it didn’t take into account the conditions we live in,” he said.
The situation is the same in private colleges. There are 80-90 per cent girls and only 10 per cent boys, Dr Aley Hasan Zaidi, Principal of HMC, pointed out. He deplored the fact that many talented girls are deprived of their right to work after marriage.
“It’s a very delicate issue. We are not against merit, but these are ground realities which cannot be ignored,” he observed.
SMC principal Dr Tariq Sharafatullah asserts that there are families which don’t want their daughters to work at all, whether married or unmarried. The married ones who do decide to work have problems in performing night and emergency duties.
Showing the concern of the Pakistan Medical Association, Dr Qaiser Sajjad said the organisation demands that the government take notice of this issue, which would eventually affect patients. Pointing out the reasons why boys are turning away from the medical profession, Dr Sajjad said this is because in terms of remuneration, doctors are offered peanuts here. Girls don’t bother about the financial aspects because most of them are not supporting their families, whereas boys do and this is the reason many go abroad.
Another problem with girls, according to Civil Hospital Karachi’s Medical Superintendent, Dr Kaleem Butt, Head of Cardiac Surgery Department, CHK, Dr Abdul Bari, PMA President Naseer Baloch and General-Secretary Qaiser Sajjad, is that girls, by and large, do not opt for specialities like general medicine, surgery and orthopaedics, perhaps because of the increasing workload, and prefer to go into departments like gynaecology, obstetrics and paediatrics.
“Pakistan already has a dearth of physicians and this trend in girls can create a health crisis in the country in the coming years. The solution is complicated and I wouldn’t like merit to be compromised. The doctors’ community is divided on the issue,” Dr Kaleem Butt said.
Narrating the troubles in finding a lady doctor these days, Dr Samrina Hashmi, who works at the Noor Hospital in F.B. Area, said that she succeeded in finding a lady doctor after advertising the post in the newspapers for two months. “It’s a 2-8pm job. The previous doctor left us because her son was being neglected at home. She was having a tough time with her in-laws and eventually she had to leave when her son’s hand got burnt,” she said.
As an immediate solution to this problem, many doctors underlined the need for balancing the male-female ratio in medical institutions, besides making the profession monetarily attractive to encourage boys to join this field. There are a few, like Dr Syeda Haider, Head of Department of Anaesthesiology, Dow University of Health Sciences, who thinks that if there can be a girls’ medical college, why not one for boys.
“When the judgment came, we were against it because we knew the ground realities. In our conservative set-up, expectations from a mother are too high and women can’t take independent decisions once they get married,” she said.
An option, without comprising on merit, is that the government set up day-care centres at major public sector hospitals and offer tailor-made jobs and incentives to young mother doctors, according to Dr Rashid Jooma, Director at the Jinnah Postgraduate Medical Centre. This suggestion was supported by those who feel that the whole issue is based on an assumption and there are no hard facts in support of the argument.
“Most talented boys go abroad after doing their A-levels and a large number of those who are left behind have other career preferences. The few opting for medical studies don’t necessarily enter the profession either. We have a governor and a chief minister who are not practicing doctors, then why should girls be deprived of their right to a medical education when they are on merit?” says Professor Dr N.A. Jafarey of the ZMUH.
The looming doctors’ crisis was also highlighted in a study, Migration, Medical Education, and Healthcare: A View From Pakistan, conducted by Dr Jamsheer J. Talati at the Aga Khan University and Hospital.
According to this study, approximately 74,000 physicians were practicing in Pakistan in 2005. Annually, local medical schools and international medical graduate certification provides 5,400 physicians, soon to reach 6,800; 1,150 physicians emigrate and an estimated 570 physicians stop practicing for various reasons. The current ratio (0.473) of physicians to 1,000 people is inadequate to maintain the nation’s health. Future physician workforce shortages for Pakistan range between 57,900 and 451,102 physicians in 2020, depending upon assumptions about future needs.
The study also says that: “Gender-related factors, of increasing importance as the number of women in medical schools has increased, are a major reason that physicians stop or slow down their practice. Because of marriage, childbearing and family, a sizeable number of women graduates are not practicing. Anecdotal estimates of the percentage range from 5 per cent to 50 per cent. On average, 50pc of those admitted to medical school are women. However, despite a higher pass rate for women than for men, as of December 2005, only 38pc of registered physicians are women.”
