The young doctors’ movement: What’s all the fuss about?

If the doctors movement is successful, we will change Pakistani society. Much more is at stake than salaries.

The criteria for a nation's progress is often measured in terms of the health service provided by the state.

Welfare states spend much of their Gross Domestic Product (GDP) in maintaining the health of the population. Sadly, in Pakistan the health sector has never been paid much attention.

One of the reasons for this is that we were so obsessed with “security” that resources were often not available to invest in hospitals. This has resulted in much frustration in the doctor’s community, especially young doctors who have to toil hard to maintain a white collar standard of living.

What happened in 2008

In 2008, in response to very low salaries and long duty hours and poor working conditions, doctors in Lahore started a very big movement which was organised by the newly formed Young Doctors Association Pakistan (YDAP).

At that time the pay of a House Officer (HO) was Rs11,000, while that of a Postgraduate (PG) trainee and Medical Officer (MO) was Rs13,000. They were soon joined by their colleagues all over the country. The government was forced to accept their demands. The pay of an HO was increased to Rs18,000 while that of an MO and a PG trainee became Rs22,500. Most of the contract doctors of Punjab were regularised as a result of this movement.

Here's the problem

Over time, rising inflation and cost of living made it very difficult for young doctors to make ends meet. Living is exceptionally tough for PG trainees who have to often work for 48 hours, have no job security and are not allowed to do private practice. In a meagre Rs22,500 they have to rent accommodation, pay for their children’s education, and bear the expenses of food, clothing and fuel.

The future for FCPS trainees today seems very bleak as compared to 10 years ago. In 2000 there were just 2,000 CPSP fellows. However today there are 11,000 fellows and 35,000 PG trainees. In 10 years time it is expected that 50,000 CPSP fellows will be in the market.

Already the value of FCPS has been decreased greatly. 10 years ago, upon obtaining on FCPS, a doctor was expected to assume the post of a consultant. Today hardly the post of a Senior Registrar (SR) can be secured. One can only imagine the situation 10 years from now.

It is not that we have an overproduction of doctors. In Pakistan the population per doctor is 1,218, one of the lowest in the world. The reason for such a crisis is that the health sector has been neglected so much that no system exists to accommodate and utilise the services of these doctors. Much of the health facilities that exist today, were present 30 years ago. Hardly any improvements are expected over the next 10 years. This will result in a lot of unemployment of even specialist doctors. Such concerns prompted more than four thousand specialist doctors to leave the country.

Improve health now

Today Pakistan's health budget is just 0.3 per cent of our total budget. As a result, patient care is neglected throughout the country in the public sector.

In the light of these developments the YDAP and Pakistan Medical Association (PMA) planned to launch a movement through out the country to improve healthcare facilities. The solution to the doctors leaving the country was determined to be Special Pay Scale (SPS), whch is implemented in certain departments such as the judiciary, police, Atomic Energy Commission, and Dr AQ Khan Research Laboratories.

If doctors are brought under the SPS, the pay of an HO would increase to Rs35,000, PG/MO would be given Rs80,000, SRs would take Rs150,000 and the pays will also increase for doctors of senior cadre.

One of the other major demands of YDAP was to increase the health budget from 0.3 per cent of the GDP to 6 per cent, a minimum to establish a reasonably working health system. Another demand was to hire doctors in this pay scale for basic health units and tehsil hospitals.

The YDAP and PMA had brought all the doctors associations on board and started an awareness campaign throughout Pakistan. Posters were put up at public places, walks and meeting were held to highlight these issues and create public sympathy and support on this issue. The reason this was done was because we felt that this campaign is for the people and it can not succeed without the support of the people. Ours was a four-month-long campaign which was to peak at the time of the budget in June to create sufficient pressure of the government to accept our demands.

Doctors gone astray

However, a group of few overzealous doctors misunderstood the whole campaign and suddenly announced a strike all over Punjab. Because once a movement is started an activist can not stay away from it, therefore YDAP supported the doctors movement. However there were certain mistakes which were made and one needs to learn from those mistakes.

First of all there was no adequate planning. Some groups were demanding 100 per cent pay raise, while some were demanding 50 per cent. Others still were demanding the evacuation of Rawalpindi Medical College hostel. Some groups demanded SPS while some demanded a pay raise equivalent to SPS. Latter on an additional demand was made to increase Punjab’s health budget.

Confusion also stemmed from the fact that the doctors made their demands from the Punjab government, which is incapable of fulfilling them as it has no funds. The demands can not be accepted until the federal government creates a special fund, which it gives to each provincial government.

Protest, not boycott

Some doctors also feel that the call for strike was also inappropriate as it resulted in much suffering of the patients and resulted in loss of sympathy for the doctors. These doctors felt that they should protest instead of go going on strike. Also some segments commented that the strike benefited the private health sector, by forcing patients to go to private hospitals and clinics. The strike and the resulting loss of sympathy with the public gave the state justification for its heavy-handed tactics against the doctors.

Hospitals exist because of patients. If we do not have patients then we cease to be doctors. Therefore, many doctors felt that we can not neglect the patients which would result in unnecessary deaths. Many colleagues felt that if we with our own hands close the very institution that makes us noble, then we degrade our own self, our profession and our status in society. Thus the tactic of strike was very controversial.

It is due to these mistakes that not much progress has been made since 2008. However, all the doctors associations met again and held a meeting in Peshawar to make a joint strategy for a future course of action. They decided to continue the movement as planned throughout Pakistan. A press conference was also conducted the YDAP, PMA and PDA representatives in which this strategy was announced.

Much more is at stake than doctors’ salaries. If this movement is successful then we will change the Pakistani society, changing the focus of the state from security to welfare. That is why we hope that the doctors and public will join us in this mission.

Published in The Express Tribune.