Sunday, April 3, 2011

Are we human, or are we doctors?

A recent study has shown that doctors have stomachs, reproductive organs and families. This is an outrage and will not be tolerated by the government.

I am a medical student in a government hospital. I am witness to the doctor-government saga and would like to share the facts which lie behind the propagandas of both the doctors and the government.

Firstly, this is not a protest. This is a breaking point. The doctors have been protesting for many many years and the government paid little, if any, attention. The facts underlying this event are actually beyond the comprehension of anybody who has not been to the wards of the hospital but I will try my best to explain them.

The wards:
The patients outnumber the beds in such a way that there are upto 3 patients on one bed at times. The paramedics and nurses are understaffed. But there is an ample number of doctors which I'll explain why.

The dysfunctional system:
The first question in a medical student's life is where he'd work after MBBS. This is not a joke. An estimated 1500 doctors leave Pakistan every year to work abroad. This year, 5000 post-graduate trainees are estimated to leave. This is not a small number. These are the cream of the doctors attracted by different countries including the Gulf, US, UK and Australia. These doctors do not return. The few who do, are appointed professors, who then start private practice for the elite. They are mere parasites with no intentions of "helping humanity". The doctors who work hard for decades in government hospitals hardly get any professors' posts and hence, not that good private practice either.
The junior doctors suffer the most. There are about 30-40 house officers in every ward among which only 8 are paid and the rest are unpaid. These are doctors who have studied for five years without any social life and now getting Rs 18,000 as house officers, ie if they're lucky enough to get the paid job. After a year of house job, they start their fellowship for which they have to appear in the FCPS part I (Fellowship of the College of Physicians and Surgeons). About 12,000 graduates appear in all disciplines in FCPS-I and 250 are declared successful. These 250 then apply to the hospitals for fellowships. At a given time, 10 or more post-graduate trainees are to be present in a ward. Among these only 8 are paid at Rs 16-22,000. After 4 years of training, they are supposed to leave the hospital and appear in FCPS part II which is the toughest exam in the medical field. The few who manage to pass it and have a strong backing from someone of power, are hired as Registrars in government hospitals at a pay of Rs 30,000. Here on, their pay increases on yearly increments and their seniority increases on political backing.
Now, a doctor of the age of 35 (if he aced every exam in first attempt), is earning Rs 30,000. With that money, he has to run a family. During the past 15 years, he has spent his days and nights in hospitals and served patients for 10 years. As a house officers he has worked non-stop shifts of 36 hours. Side-by-side, a matric-pass driver is earning 35,000 in a government office. The bank the doctor goes to to collect his pay has a security guard earning more than the doctor. If he goes to get a car on lease, the bank tells him his monthly salary needs to be at least 40,000. If you do not understand the injustice here, there is no point of carrying on.

The conflict:
Towards the later part of the strike, the government agreed to increase the salaries of the young doctors (house officers and trainees) to Rs 28,000 and Rs 44,000. This was injustice to the senior doctors who in this scenario would be earning about as much as house officers and lesser than the trainees. This was unacceptable to the doctors and hence they refused.
Currently, the Professors, Associate Professors and Assistant Professors are running the hospitals. Out of respect, the Senior Registrars are visiting to help their seniors and the patients from time to time but not on a regular basis.

The future:
The doctors have handed over their resignations. There is no point in a compromise on their side because they have better options elsewhere (even as a driver or a police constable). They would now be looking for alternative jobs eg private hospitals which pay enough money for a doctor to make ends meet. Others would apply abroad where their talent is appreciated (in the US, a trainee earns about Rs 300,000). The government is running out of options to run the hospitals. They are hiring house officers as medical officers (equivalent of trainee without FCPS-I).

While people play the blame-game, the general public is suffering. It is easy to blame the doctors but for that you'd be denying them basic human rights. They have the right to work or resign. If the government is not able to give attractive packages to the doctors while they enjoy in mansions, the doctors cannot be blamed for looking for a way to make ends meet for their families. They have compromised for years, blackmailed emotionally not to do anything lest patients will suffer. But now they have reached a breaking point and given up.

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