The curious case of PMDC’s quota

The 50/50 gender split is not the solution

A new law promulgated by the PMDC has declared that the quota for girls and boys will rest at 50 per cent each. Anyone that wishes to take an admission into a medical college, be it private or public, would have to fall within this quota to be successful. Open merit is no longer applicable.

The announcement hasn’t surprised people since many were expecting it. It echoes comments made by the PMDC chair at the AKU graduation ceremony last year. The reason this move is a bad one is because it does not present a long term solution to the problem.

During 1991 a 60:40 male to female quote was abolished by the Supreme Court. While the decision was originally applauded, and open merit welcomed, the situation has since then changed. In 2012, the Pakistan Medical Association implored the Supreme Court to revert to the quota system and do away with open merit. Their main motivation? The claim that 75 per cent of the women often graduate never to return. The healthcare sector is facing a definite crisis. What’s left is a crippling healthcare system that is in serious need of some aid.

But does a change in the quota fix the system? Will a 50:50 ratio ensure that doctors, both male and female, actually get serious about practising? The answer isn’t all that simple. The healthcare system is facing a multifaceted set of problems, even within the current context. To start with there is a dearth of medical colleges in the country. Some colleges are recognised and derecognised regularly which means that the number of seats that are available changes each year.

The healthcare system is facing a multifaceted set of problems, even within the current context. To start with there is a dearth of medical colleges in the country. Some colleges are recognised and derecognised regularly which means that the number of seats that are available changes each year

Last year, the FIA launched an investigation into fake doctors and fake colleges. Over 150 doctors were put under the microscope. In a single day around 19 medical colleges were “registered” as soon as the 18^th amendment fell away. They were able to do this with the approval of Dr Ahmad Nadeem Akbar, the registrar of PMDC at that time. The police was even able to pinpoint 40 doctors that were absolutely fake. So the problem on PMDC’s hands isn’t as simple as just a quota or undoing open merit.

The statistics on the PMDC website are a clearer indication of the problem than anything else. The male/female ratio for Sindh and Punjab is nearly the same. However, that is not the case with either KP or Balochistan. Here the ratio is much lower. Do women in KP and Balochistan magically not care about being doctors? Or is it the cultural and societal pressure that keeps them from moving forward?

And that leaves us with the question: what is the actual issue? Is it the fact that authorities are miffed at girls who enrol into competitive programmes, seemingly only so they can raise their worth on paper. Is a good rishta really worth that amount of gruelling work? The fact is that it isn’t as black or white as the future choices a woman makes. At times it boils down to security. Hospitals almost never have enough security. Both BHUs and RHCs are notorious for the risk they present for female doctors. Women who shy away from practice because of these reasons would take up their jobs if these issues were fixed.

The quota will also create a large gap in the difference in merit for boys and girls. Girls come to the table with better grades, and they will be competing with a larger number of other girls with grades just as good as their own. The margin through which one would get in and another would be rejected would be miniscule. How will PMDC deal with this disparity, how will it decide which female will take up the degree and not quit and which one will go ahead and become a successful doctor? That issue remains unresolved, even with the quota being set in place.

Then there’s the male side of the problem. There is a growing concern that men are either opting out of further education in medication or they’re headed to foreign countries. Surprisingly, the blame for even this trend lies with the women as per the Pakistan Medical Association. They are of the view that male students aren’t as interested and look for other opportunities because women snag all the top positions — there is no question of why these male students can’t work as hard as the women to get better scores for the merit lists, however.

If a quota system such as this is implemented at this point it can have dire consequences. When one place starts a trend many others may follow suit. Where open merit is concerned women have come on top time and time again. The solution is not to help shove women into another box that they can’t get out of it, the solution lies in creating an environment where they don’t feel threatened and harassed and can easily work. The solution lies in breaking out of our social stigmas which celebrate doctor bahus, but lament and hassle the same women if they choose to go to work.

The solution is not to help shove women into another box that they can’t get out of it, the solution lies in creating an environment where they don’t feel threatened and harassed and can easily work. The solution lies in breaking out of our social stigmas which celebrate doctor bahus, but lament and hassle the same women if they choose to go to work

By some estimates the government spends over 2-2.5 million rupees per medical graduate per five years. Instead of introducing quotas, the government should introduce measures that will ensure that only people who are serious about their degrees — be it men or women — go ahead and enrol. The government should develop a bond for twice the amount of money it invests in students, the condition being that any student that does not serve as a doctor in Pakistan post graduation will have to pay the amount on the bond. The amount can be commuted to three years if the person in question moves on to a post graduate degree or specialisation. In the event that a person refuses to go to work, and refuses to pay a bond, their degrees, registration and transcripts should be withheld and/or declared invalid.

This solution can even work with doctors that want to leave the country. Prior to their foreign work/degrees they can sign reciprocal agreements which would require that they learn whatever they have to but return to their own country and work for a specific period of time. Much like the Fulbright programmes.

Even if a bond is paid in full it won’t be a waste. The money received therein can be spent on improving security and infrastructure, and other issues that the healthcare sector faces. That money can also be used to increase the living standard for house officers and PGRs and PGMOs, to make sure that they keep working here.

In the long run, this will result in better doctors, better access to healthcare, and better quality of healthcare administered.

It is true that the healthcare system needs a top-down overhaul but making 52 per cent of population pay the price for a twisted scheme is not the way to go. PMDC needs to think long and hard about the consequences of this decision. Their solution will help no one except a few men that fall below the fringes of the merit that they weren’t able to achieve.