Why Pakistani Medical Graduates Must Remain Free to Emigrate

Student Forum T he current debate about the brain drain of health professionals from low-income countries such as Pakistan to the rich world often demonizes medical graduates who choose to leave their countries. Such graduates are sometimes considered to be insensitive to the plight of their country's struggling health sector. But what is forgotten in this debate is that some doctors who emigrate to the West have every intention of returning after their higher-level training overseas. And while the brain drain is often blamed for Pakistan's difficulty in meeting its people's health care needs, other factors play a major role, including the increasing demand for health care from the growing population and the adverse conditions that cause disease [1]. There are no reliable statistics on the total numbers of students from low-income countries who receive higher-level training abroad, nor on what proportion of these students return to their home countries [2]. It is true that large numbers of medical graduates leave Pakistan. A 2005 study by Fitzhugh Mullan found that Pakistan had contributed about 13,000 medical graduates to the United States, the United Kingdom, Canada, and Australia [3]. But a proportion of these Pakistani graduates do return. For example, by 2004, Pakistan's Aga Khan University had produced 1,100 graduates, 900 of whom went on to higher-level training in the US—but about 40 alumni have so far returned [4]. There are four main reasons why medical graduates of Pakistan emigrate to the West [5]: 1. The long-standing belief of young doctors and their parents that training outside their home country is superior and a mark of achievement. 2. The expectation of bigger incomes. 3. The lure of high-tech training and super-specialization. 4. A reaction against the Pakistani government's poor management of the education system, and the corruption associated with this management, in favor of what are perceived to be the more merit-based medical training systems of the West. Medical students plan their migration well in advance: most start planning to take the US medical licensing examination or the PLAB (the Professional and Linguistic Assessments Board) test immediately after graduation, or sometimes even sooner. Such advanced preparation is a marker of our foresightedness, and not simply an indication of our desperation to leave. The undergraduate medical students of the Indian subcontinent are a motivated generation. The world's rapid progress excites us, and we want to be involved in the latest medical advances. …