Pakistani expat doctors: a story of hope? - I

When shiny doctor Saab/Madam comes to Pakistan and walks into the room, one enviously surmises that they sure have it easy. But boy do they deserve a pat on the back.

We do not see the years, sometimes decades of struggle, to first enter the medical systems abroad (especially for subspecialty training) that are wrought with challenges of assimilation, visa issues, and stringent foreign medical standards.

The untenable pressure to take exams in a short period of time that locals otherwise have years to study for or the unabashed tendency of the west to shun any foreign education as sub-par — these struggles that carve a hole not only financially but also mentally.

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Unsurprisingly this also results in cases of doctors, who despite having spent a decade practising in Pakistan, are now relegated to menial jobs because of the hurdles to enter foreign medical systems. The brain waste is appalling but makes for a ludicrous situation given the the shortage of doctors in the USA, UK and Canada.

There has been plentiful coverage about the plight of entering the medical system so this article intends to shed light on the next stage – training/residency – and the associated struggles of staying within the system and trying to progress.

Racism

That racism is deeply embedded in the Western World’s healthcare systems is evident just by how patients who cannot speak English are automatically treated as ignorant. A similar mindset comes through when medical residents are casually asked how their English is “so good” or questions like “where is your accent from?”. As if asking these questions aren’t a form of social faux pas.

However, language barriers are only the beginning of how being an immigrant Pakistani renders the western world a non-level playground.

“Although the National Health Service (NHS) attracts many international doctors due to its ethos, there’s a palpable undercurrent of bias,” says Dr K. Akhtar (name changed upon request) trained in the United Kingdom and currently working as an Emergency Medicine Consultant.

“Over my 20-year journey from training to consultancy, I have faced micro-aggressions and subtle forms of discrimination from colleagues, even senior nursing staff.”

One notable incident Akhtar talks about during his training experience with the NHS was when he was wrongly implicated in a case of patient harm.

“The internal investigation eventually cleared me, but the incident still left me with emotional scars as there was no disciplinary action taken against those who made the baseless allegations.”

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In 2018 while Akhtar was pursuing his consulting career, another type of racism was looming at the Home Office level in the UK. The Guardian reported that at least 1,000 skilled migrants including doctors were wrongly facing deportation. The then shadow Minister for Immigration, Afzal Khan MP, had said “Going after NHS doctors, lawyers, teachers and engineers on the basis of tax errors is another example of the misguided injustice of the Home Office.”

It seems that immigrant doctors get no respite but instead a barrage of extra challenges in a situation where there is already considerable amount of stress.

“The financial and emotional sacrifice has been demanding,” says Akhtar. “High taxes, examination fees, General Medical Council fees, and indemnity fees make the financial aspect daunting. Moreover, restrictive immigration policies add an emotional toll by making it difficult to bring family members to the UK.”

Interestingly, it must be noted that on the other end of the spectrum (because the chance of being an immigrant doctor in training would really nullify the chances of this happening), are wealthy doctors in the USA who can buy their way out of jail despite having a legitimate case of patient harm.

A special report by the Reuters mentions: “Over the last decade alone, at least 540 doctors and healthcare practitioners collectively paid the government hundreds of millions of dollars to negotiate their way out of trouble…”

Culture shock

“Coming from a bustling city in Pakistan to the UK was like stepping into a different world,” says Akhtar. “The climate, culture, and especially workplace etiquette were a shock to my system.”

“Every task—from using public transport to opening a bank account—presented a steep learning curve.”

As if culture shock was not enough to contribute to a ubiquitous state of imposter syndrome - there are also stories of being mistaken for the help due to the utter lack of awareness in the western world’s medical systems.

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“In medical school, an African American friend and I were routinely mistaken for a janitor or cleaning person,” says Altaf Saadi, in her conversation with the Association of American Medical Colleges that resulted in both friends constantly wearing white coats to avoid such an encounter again.

Unequal access to information

Connections that can put in a good word for you to the hiring committee. The latest tool of learning for that medical exam. Research opportunities, internships, externships. All the many ways in which immigrants have a disadvantage because of their lack of a network and thus lack of information in a foreign country.

This brings the spotlight on the importance of a mentor to guide medical residents that will give the necessary boost up the ladder making them equal competitors to the locals. The Pakistani diaspora does really need to band together for the overall success of its people abroad.

Akhtar recounts the essential impact mentors had on his career: “I was fortunate to find mentors who have guided me; their advice and support became the building blocks of my professional life in the UK.”

Is it worth it?

Pakistani and Indian nationalities together represent 1 in 9 doctors in the NHS according to the Independent. Pakistan is also the third largest source of doctors in the US. Clearly Pakistanis are critical to the western world’s medical systems.

Our doctors are also setting world records in robotic surgery - Doctor Amer Raza is leading the treatment of endometriosis that impacts female infertility. Furthermore, steps are being by the western world to counteract racism. A doctor was recently suspended for making a racist remark to her Pakistani colleague in the NHS.

Akhtar claims that the struggle is worth it: “Driven by a passion for emergency medicine,my love for the UK’s countryside, the professional satisfaction and friendships I’ve built - the journey has been rewarding.

“The journey will be hard, but with resilience and integrity, you can make a lasting impact. Remember, you’re never alone; there are far more resources and community support groups available now than when I first started.”

The article does not necessarily reflect the opinion of Business Recorder or its owners