Pakistan is home to K2, the second highest mountain in the world; the ancient Indus Valley city of Harappa; and the bustling city of Lahore. Pakistan is a kaleidoscope of natural beauty, ancient civilizations, and a handful of expats and American diplomats. For American physicians wanting to practice medicine in Pakistan, there are lots of opportunities to pursue academic and clinical work. Here is a guide to practicing medicine in Pakistan.
Pakistan’s Healthcare System
The healthcare system in Pakistan is comprised of public and private sectors. The federal and provincial government contribute to healthcare administration, though the provincial government is responsible for delivering health care. There is no government provision of health insurance and private health insurance is uncommon, hence the majority of the expense is paid by the patient, out of pocket.
The majority of the population receives care within the private sector, consisting of private hospitals, clinics, pharmacists, traditional healers, and lab technicians. Those who cannot afford to pay private hospitals for treatment turn to the public sector.
The public sector delivers care through a three-tiered system: primary care units, secondary care centers, and tertiary care teaching hospitals. Primary care centers are predominantly outpatient; secondary care centers provide acute, ambulatory, and inpatient care; and tertiary care centers are often teaching hospitals and provide more specialized inpatient care. Treatment in government hospitals is provided free of charge or for a very nominal fee. Recently the government introduced the “Sehat Sahulat Program”, a social welfare program to support medical treatment for the poor and underprivileged.
The Pakistan Medical Commission (PMC) is the regulatory body for physicians and issues medical licenses. US-trained physicians can apply through Licensing Pathway 3 which recognizes American qualifications including medical school, residency and fellowship training, and board certification. American training is not only recognized in Pakistan but it is considered to be superior to the local qualifications. Additional exams are not needed and there is no need to repeat training.
The PMC will verify the American qualifications and the PMC medical license will mention the American qualification and board certification. To obtain a Pakistani Medical License you will need to complete and mail a paper application to the PMC office in Islamabad. The process of obtaining a medical license may take up to 2-3 months. The license is valid for 2 years and the renewal fee is typically minimal. A Pakistani Medical License is valid in all four provinces, hence you will be able to practice throughout Pakistan.
Finding a Job
Recruitment agencies are not common in Pakistan so you will typically have to find a job on your own. You can start by browsing the careers section of university and private hospital websites, emailing the head of the department at an academic institute directly, and by searching Facebook pages such as Pakistan Psychiatric Society, Pakistan Society of Neurology etc. You can also connect with medical professionals in Pakistan via LinkedIn, ResearchGate, or by emailing their correspondence address in published papers. You can also search the local job search engines like Indeed.
The salary depends on the specialty and work setting. An internist or family physician working in a government hospital will make around Rs. 150,000- 300,000 ($1000-2000) per month. Work hours in government settings are usually short and doctors typically leave in the afternoon to work in their private practice where they will earn more.
Most private practice physicians work on a 70:30 commission which means that 70% of the fee that the patient pays goes to the physician and 30 % goes to the practice owner. The fee that a patient pays varies depending upon the location and reputation of the practice. On average, in a good location in Karachi, a patient pays Rs.2000- 5000 ($15-30) per visit.
The salary tends to be higher in private teaching hospitals where you are provided a base salary and revenue from patient care. In this setting, a family physician or internist may earn up to Rs.300,000- 500,000 ($1500-3000) per month. In private non-teaching hospitals it is possible to have a higher income in the range of Rs.500,000-1000, 000 ($3000-6000) per month depending on the hospital location, specialty, and patient volume. Physicians are often reluctant to refer patients to sub-specialists as they do not wish to lose patients and earnings.
Academic institutes and teaching hospitals are very competitive, and advancement is heavily dependent on relationships with senior faculty rather than getting published or receiving grants or funding. People often use their own personal connections to be promoted. Senior colleagues or directors may ask you to include their names on grants and publications without making any contribution.
Government hospitals receive very little funding and often the funding is unfairly distributed. Physicians working in government hospitals may be on the payroll of one hospital and may be working elsewhere during the same hours. “Yes sir” culture, a culture of hierarchy where the person on top enjoys unquestionable authority and power, is prevalent. Physicians may also receive a commission or kickback from pharmaceutical companies for prescribing certain medications or a commission from certain laboratories for ordering certain tests – this incentivises the prescription of medications and the request for additional lab tests. Patients ultimately bear the brunt of the costs.
You need a work visa to live and work in Pakistan. You can apply for a Pakistani visa online and it typically takes up to 12 weeks to obtain.
American credentials and training are accepted in Pakistan. Living and practicing medicine in Pakistan is hard and establishing yourself as a medical professional is not very easy. That said, American credentials are valued, and for those motivated to live in Pakistan, you can overcome these challenges.
Dr. Qurat ul ain Khan was born and raised in Pakistan. She finished medical school in Pakistan, and then came to the US for her Psychiatry residency and her fellowship in in Behavioral Neurology and Neuropsychiatry. After living in the U.S, she returned to Pakistan, and lived and worked there for 8 years, before returning to the US.