Why did the axe fall on Pakistani doctors?

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By: Dr Amjad Mehmood

The crisis is not settling. In the beginning of August, led by Saudi Arabia, certain Gulf countries such as Qatar, Bahrain and the United Arab Emirates, ended job contracts of Pakistani doctors holding medical research degrees such as Master of Surgery (MS) and Doctor of Medicine (MD). In its wake, there surfaced certain moot questions.

Of them, this opinion piece will address three main questions. First,in Saudi Arabia, how did the crisis emerge affecting Pakistani doctors particularly? The answer is that, in 2016, the Saudi Government decided to invest in clinical research to conduct clinical trials with the prime focus on the discoveries of new modes of drugs and disease management, and so on., suitable to the local environment. The Health Ministry of Saudi Arabia did two things. First, the ministry started inviting multinational pharmaceutical companies trained in giving results on clinical research. Second, the ministry started looking for a trained medical workforce to initiate the clinical research projects immediately.

In Saudi Arabia, multinational pharmaceutical companies had filed complaints, which they may not be ready to withdraw. Second, Saudi Arabia recognizes the degrees accredited by the CPSP. That is, Saudi Arabia and other Gulf countries will not recognize any MS and MD degree not approved by the CPSP. Further, the CPSP has no mechanism to judge the quality of post-graduation medical research degrees issues by sundry medical universities across the country

The Saudi Health Ministry already used to hire doctors from Pakistan holding medical degrees in the field of treatment of diseases. In 2016, the ministry decided to hire doctors from Pakistan holding degrees in clinical research. Resultantly, as per the past practice to approach Pakistani doctors, the Saudi Health Ministry advertised in Pakistan’s national dailies its intent to hire medical researchers holding MS ad MD degrees. Subsequently, a team from the Saudi Health Ministry visited Pakistan, conducted interviews of the aspirants and hired the services of doctors holding MS and MD degrees. Seeing this development, several medical universities, in both private and public sectors, across the country initiated MS and MD programs and the trend became a business venture to earn more money.

Saudi Arabia, which had decided to invest heavily in clinical research, faced a new problem near the end of 2017. Hospitals started receiving complaints from multinational pharmaceutical companies that certain medical researchers were incapable of handling patient’s specimens, conducting drug trials, and diversifying research as per the given disease and patient. Further, medical researchers were even incompetent at identifying and applying a correct research method and writing a research paper, either for inviting grants or for publication. Hospitals conveyed these multiple complaints to the Saudi Health Ministry. In 2018, the Saudi Health Ministry conducted an inquiry into the matter and found out that most complaints were related to the MS and MD degree holder doctors (clinical researchers) from Pakistan.

Around mid-2018, the Saudi Health Ministry contacted the College of Physicians and Surgeons of Pakistan (CPSP) and informed them of the problem. The CPSP replied that it did not validate these MS and MD degrees. Further, neither did the CPSP issue these degrees nor was the CPSP answerable to anyone for the deficiency in training of such degree holders. The CPSP also informed the Saudi Health Ministry that certain medical universities in Pakistan were issuing such degrees not accredited by the CPSP. This reply cautioned the Saudi Health Ministry, which issued a general warning to other Gulf countries as well. In March-April 2019, all Pakistani doctors holding MS and MD degrees were barred from working. In July-August 2019, the Saudi Health Ministry finally decided to sack all these clinical researchers. Other Gulf countries such as Qatar, Bahrain and United Arab Emirates followed suit.

The second question is thus: in Pakistan, what has led to the emergence of such a scenario? The answer is that, during the era of General Pervez Musharraf, the composition of the Pakistan Medical and Dental Council (PMDC) was changed. With their stakes, the newcomers opened space for the introduction of private medical colleges in the country. Consequently, businessmen jumped in to invest and earn profit. The tendency created three problems. First, the quality of medical education got compromised. Second, medical students paying high fees in private medical colleges started demanding high salary from the government after they joined government hospitals. This factor has led to frequent doctors’ strikes characterized by closures of emergency and even outpatient departments. Third, private medical colleges started their own post-graduation courses and delivered degrees including MD and MS degrees.

In the post-graduation medical field, the College of Physicians and Surgeons of Pakistan (CPSP) was already working. The CPSP is an internationally recognized institution issuing clinical fellowship or membership degrees such as FRCP and MRCP. After the upsurge in the number of medical colleges upgraded into medical universities issuing MS and MD degrees, a parallel system of qualification emerged challenging FRCP and MRCP. In this way, in the post-graduation medical field, two-degree awarding bodies exist: the CPSP and medical universities.

The strength of the CPSP is that it is one holistic body overseeing the quality of postgraduate medical education and clinical research throughout Pakistan. The CPSP has a standardized syllabus and examination. The weakness of the medical universities running postgraduate medical research courses is that each medical university has its own curriculum and examination system. Neither is there any centralized body nor there is any standardized system of delivering postgraduate medical education or research and conducting examination. This multi-pronged weakness opened space for exploitation and led to the issuance of sub-standard postgraduate medical research degrees of many types.

The third question is: will Saudi Arabia restore Pakistan’s doctors holding MS and MD degrees?

The answer is in the negative. There are two reasons for that. First, in Saudi Arabia, multinational pharmaceutical companies had filed complaints, which they may not be ready to withdraw. Second, Saudi Arabia recognizes the degrees accredited by the CPSP. That is, Saudi Arabia and other Gulf countries will not recognize any MS and MD degree not approved by the CPSP. Further, the CPSP has no mechanism to judge the quality of post-graduation medical research degrees issues by sundry medical universities across the country. Hence, Saudi Arabia may not restore Pakistan’s doctors holding MS and MD degrees issued by medical universities in Pakistan.

The writer is a PhD from the King’s College London in Clinical Pathology and may be contacted at [email protected]