It used to be that there were just a few medical colleges in the country. The majority were state run institutions and a handful were private establishments that required hefty fees. Admission to the public medical schools was highly competitive. Students crammed for months, especially those who by the misfortunes of ethnicity were left to fight for the small numbers of spots that were reserved for candidates applying purely on the basis of academic merit. The day the admission list was posted on the bulletin board outside the colleges was one where the futures of many were deigned. In the mathematics of meager opportunity that is the fate of those pushing to get ahead, many thousands competed for a few hundred and those left off the lists faced a dead end.

Then the market responded. Egged on by more lenient rules and the possibility of large profits, the numbers of medical schools increased exponentially. If you couldn’t get into a competitive public medical school, there were suddenly scores of private ones where you could also get a medical education. The quality of the education was of course another matter, but the result in all cases was supposed to be the same; a degree that made you a doctor and set you on the path of riches.

While the number of medical schools increased furiously, and enabled lesser students to obtain a medical education the market for Pakistani doctors declined. In the past few years, a number of global factors have colluded to create a particular sort of crisis. The United States, often the first choice for Pakistani doctors seeking a return on their investment, has implemented a number of security regulations that make it difficult for Pakistani medical graduates to obtain visas with the same ease and speed as medical graduates in India or China or Eastern Europe. This has negatively impacted their ability to compete for residency spots in that country. Similarly, in the United Kingdom, with an economy barely recovering from recession and an influx of doctors from Poland (now benefiting from EU labor regulations), has significantly reduced training and employment opportunities for Pakistani medical graduates in that country. If all this wasn’t bad enough, Saudi Arabia, the longtime importer of Pakistani doctors has in recent years also changed its iqama or work visa regulations with the intention of training Saudi nationals for skilled jobs in medicine. This represents yet another closed door to the Pakistani doctor.

Of course, there is always Pakistan, and serving one’s own country is a noble goal indeed. However, according to statements made by various members of the Pakistan Medical Association and other representative bodies, the number of training spots available for medical graduates is far too small compared to the numbers of doctors that are being churned out. That is, of course, only half of the dismal problem. Month after month, television channels and newspapers report situations where doctors have not been paid any stipends The low morale, unprofessionalism, and apathy of these vast numbers of unpaid and untrained doctors inflicts the sum of its wrath on those more hapless than they – the patients. Recent months and years have revealed case after case of wrong limbs amputated, incorrect medicines administered, as well as the misdiagnosis of illnesses. In the mad mix of all these problems the Federal Investigation Agency revealed last week, that a preliminary investigation of documents obtained from the Pakistan Medical Dental Council showed that 19 medical colleges currently operating in the country have fake registrations. In turn, 40 doctors have fake registrations and 150 have registrations currently under investigations. Those are of course, just the ones that have been caught.

For everyone else, the message is simple. The middle class mantra of becoming a doctor as a means to a better life, or a tolerable life is no longer supported by facts. Unless gullible and shortsighted parents stop pushing their offspring into medical schools based on old equations of supply and demand, the country will continue to produce more and more jobless doctors. While glib suggestions of serving Pakistan’s poor (which are indeed lacking in even the most basic healthcare) may sound comforting, they are unlikely to untie the knots in the system which imagines trained doctors serving them without being paid a wage on which they can survive. There are many things Pakistan needs, more doctors is simply not one of them.