By Zubeida Mustafa
THE medical profession in Pakistan is in a continuing crisis. For the second time in less than 18 months, the Pakistan Medical and Dental Council has been suspended and an interim committee set up to suggest ways to restructure the Council.
At the root of the crisis is the rotten state of the PMDC. Its assigned mission, amongst others, is to safeguard the public interest by prescribing uniform minimum standards of medical education, ensuring their implementation, registering doctors and deciding cases against practitioners for “infamous conduct and professional negligence”.
But if the regulatory body itself fails to meet the best standards of integrity and competence, can it really perform these functions effectively and transparently? For decades, medical education in Pakistan was solely in the public sector and it produced many outstanding physicians and surgeons who won international recognition.
It was only when the private sector was allowed to enter the field in a big way that multifarious problems set in. By the turn of the century, private medical colleges outnumbered the public-sector medical teaching institutions. Today, PMA sources tell me there are nearly 150 medical colleges and universities in the country. Nearly 65pc are privately owned.
At the root of the medical crisis is the rotten state of PMDC.
As a result, the private entrepreneurs, whose sole aim in life is to mint money at the cost of people’s health, began to exert pressure in insidious ways to have a say in decision-making in medical education. The direct route to power was to seize control of the PMDC. This they did with the government’s connivance by stacking the regulatory body with their own cronies. It is unheard of anywhere in the world that a proprietor of a private medical university should head the body that supposedly checks his own institution. Yet Dr Asim Hussain, who is chancellor of the Ziauddin Medical University, was appointed head of the PMDC and also the chairman of the Sindh HEC (another controversial body). Soon, the PMDC went into a tailspin as corruption allegedly reached new heights.
Dr Shershah Syed, a stalwart of the PMA, recalls the long list of wrongdoings the PMDC is accused of. Seats at the Ziauddin Medical University were arbitrarily increased from 100 to 150 while 19 medical colleges were granted recognition peremptorily without inspection. Medical colleges without teaching hospitals attached to them and incomplete faculties have been granted accreditation while staff has been allegedly appointed in violation of the requirements stipulated by the PMDC.
The PMDC has also been accused of playing favourites in licensing doctors. Many who qualified from unknown universities abroad have got their licence without being tested as per requirement while other local graduates are awaiting registration. Dr Shershah, himself a senior gynaecologist and an FRCOG, has still to receive a response to his application for the renewal of his licence.
A suggestion has been put forward that the membership of the Council be scaled down from the present 120 to 35. Its composition must be such that it gives broad-based representation to major stakeholders from all walks of life including doctors, dentists, nurses and their professional bodies such as the PMA and the CPSP, It is time the patients were also recognised as stakeholders and represented in the PMDC. Health department technocrats and representatives of medical teaching institutions should also have a presence. Those who have served as members in the last few years should be kept out of the reform and reconstruction process.
What should be the fate of dubious colleges mushrooming in the country? They cannot be arbitrarily shut down as thousands of students would suffer. Dr Shershah suggests they be given a six-month grace period to put their house in order. If they fail to comply they should close down.
The entire focus of the present exercise appears to be on the Council’s composition and the mode of electing/nominating members. Vested interests have to be kept out — they cannot be expected to clean up the Augean stables
Once this is done a major challenge will remain —redefining the PMDC’s functions. Until now it has performed a licensing and regulatory role. That is important as uniform minimum standards for medical educational institutions need to be set. It would help if it shared with the HEC the function of ensuring compliance with these standards and responsibility of inspection of institutions.
If the PMDC is to be really effective in its performance it should focus on two issues of vital importance to the medical profession. The first is the excellent concept of Continuing Medical Education that has been introduced in Pakistan recently. There is much scope for fine-tuning in terms of its outreach especially to the rural areas and ensuring honest implementation. And second, there is a need to address the issue of ethics in the medical profession which has already emerged as a major challenge.