Emergency Medicine is a very new phenomenon in Pakistan. Like every new specialty, it is going through the defining phase and it is, at times, amusing to come across people who are working in the Emergency Department and does not know its boundaries. The Emergency Medicine training is done at two centers in Pakistan. It is a five year training program and at the end of this training the doctor has to appear in the exit examination to get the status of FCPS in Emergency Medicine.
We at Shifa International started the training in Emergency Medicine in 2011. Currently we have 2 supervisors of training with the 13 resident physicians in different years of training. Our first doctor will finish his training in 2018. All our doctors who have opted the training in Emergency Medicine are facing the question of their job prospects in Pakistan. They all know that the work is there, but there is no job structure or prospects of jobs in Pakistan. Contrast that to the rest of the world. Countries in Europe, the Middle East and Australia are eagerly looking for doctors with the training in Emergency Medicine. These countries require people to come and work to share the increased burden and workload. Although this creates a marvelous financial opportunity for the doctors who are trained in Emergency Medicine, at the same time it is seen as a threat to the residency programs as well as the field of emergency medicine in Pakistan. I will comment into this phenomenon a bit later on.
We are all aware that there are two parallel systems of patient care in the world. A government based and government backed system of public hospitals and then the private system of health care. In Pakistan the government based system of Public Hospitals see around 25% of the population and is either completely free or very cheap. The care is provided by the trained doctors and the management of these hospitals is usually ineffective or inept resulting in preventable harm to the patients with extreme dissatisfaction and mistrust on the institution. The private hospital system is providing the care to the other 75% of the population. It is expensive and still does not do a good job either. More recently this phenomenon started to change when these private hospitals started their medical colleges and then started imparting the training in different fields of medicine. This resulted in improved level of care and a better standard at the private hospitals.
Let me now take you to another aspect of medical and health care system in Pakistan. Up until very recently the residency training in any medical specialty or a sub-specialty was a task done by the Public Sector hospitals only. Private hospitals were not considered at par or worthy of providing training to the new doctors. Part of the reason was to do with finances as to who will finances these doctors in the training. This all changed when the two private hospitals of Pakistan started the training and after a struggle with the College of Physicians and Surgeon became successful and a very viable option for the training. Interestingly these two places are the only two spots of training in emergency medicine for the College of Physicians and surgeons. No public sector hospital has taken up this task yet to start this important residency in Pakistan. Besides the ownership issues of the Emergency Departments of the Public sector Hospitals, the lack of service structure is the big hindrance.
When we started the residency training in Emergency Medicine, we had this vision that we will be able to convince either the governments of the province or the Public Sector hospitals to start the residency training in these institutions. We are still hopeful that the job creation will start in Pakistan and that our finished products; our trained doctors will be serving our nation through the public sector hospitals. This phenomenon is at risk due to the world wide increased demand. The United Kingdom is struggling to bring an enormous number of trained doctors into their country to support its overburdened emergency system. I routinely get emails, phone calls and other inquiries regarding availability for any emergency trained doctor for temporary as well as permanent work in UK. Their purchasing power gives them the edge of enticing the young graduate to work for them. It puts me into a very odd place and creates a dilemma. Either I send my trainees and lose them, or deprive them of the chance that may be life changing.
I fear for the long term survival of the Emergency Medicine in Pakistan. The two programs creating the trained physicians in emergency medicine cannot continue producing doctors if our trained doctors continue to get out and serve other people with no resultant change in the Emergency Medicine system of Pakistan. How can we stop this from happening, and benefit from the increasing demand?
I would like to get the input from my colleagues and friends and then will conclude on this topic in my next blog, Insha Allah. I can be reached at erdoc@shifa.com.pk
(Posted after the review of Zain Alvi…….our young budding reviewer)