Rama's confirmation letter has arrived! Now he will reach the US next month.' Hari has also been matched. Got medicine.'

Your marriage with a green card holder is already confirmed! Now go there and give the second part.' 

'Your destiny is to rot here. Well, but trying to continue as a medical officer. What's wrong with sitting here?' 

Let's see what happens next? I don't want to work as a PG here.'

This is a conversation between a young man who has just completed MBBS and came to interview for a medical officer. They are having lunch in the canteen near our hospital. I am also sipping tea at a nearby table and humming their words in my mind. 

The dialogue above depicts the current state of mind of a graduate young doctor who has to take the reins of the country's health in his hands and continue on the path of duty. None of them want to stay in the country. Suppose, this country is a factory, producing qualified technicians (doctors) cheaply (?), and supplying them to the countries of America, Britain, Australia, Europe. And, our country is only a platform for those technical manpower, who wait as if they are doing something until the opportunity is ready for the foreign country. 

We professors teach all those 'doctors of the future'. We teach healing system skills. We become proficient in research methods. We provide ability to do, speak, write and drive. We pass, we hand over the doctor's certificate. But when the time comes for them to start working in the country, a letter of recommendation should be made for them, a recommendation for a good standing certificate should be made. 

That's why I'm starting to feel like this, there are a lot of students studying medicine in our country, but there is a lack of qualified technicians to provide medical services. Even the medical graduates who remain here without getting the opportunity to go out or without the process, they stay here until they complete their master's degree for three years, then the same cycle, the same result.

The news in the print network says the same thing, the study shows the same thing. Looking at the data of a year ago (year 2023), 2,692 new doctors were registered and 2,318 made documents to go abroad. This scenario, where the ratio of doctor production and migration is almost equal, confirms the statement that doctors will not last in Nepal. And don't you think that the future of our country's health situation is painful?

Nepal Medical Council's registration register (at the end of 2023) indicates that there are 34,910 graduate doctors, almost one-third (10,588) of them are specialist doctors, but how many are there in Nepal based on the migration rate as stated above? This is a subject that still needs to be studied. Has Nepal really achieved the doctor population ratio of 1:1000 as recommended by the World Health Organization? It seems to be possible on paper but not practically.

In the study report prepared by the International Labor Organization on the increasing migration of health workers, some reasons why Nepalis want to study and work abroad have been pointed out. Quality education, good lifestyle and living environment, easy to find employment after studies, international recognition of foreign degrees, good salary and working environment attract Nepalis to go abroad. Due to the political instability in Nepal, it seems that many people plan to go abroad. Because there is a good system of scholarships, it is easy to get a permanent residence card. 

Studying the report submitted last week by the committee formed by the Ministry of Health (Barkoti, 2081) to study the various problems of Nepalese health workers (especially interns, medical officers, resident doctors), it seems that the state of mind of doctors working in Nepal revolves around the above factors.

When you see your classmates-colleagues living a good lifestyle abroad, living with self-respect with enough vacations and rest, why should the human mind not be disturbed when they have to live with extremely low income and self-pity while always being in fear and risk (even insecurity from the sick side at the workplace)? Having spent almost two and a half decades in the medical field, MBBS on government scholarship, MD and PhD in collaboration with the university and currently working as a professor at the university, I sometimes feel inferiority complex. Why should these newly born doctor brothers and sisters not have the desire to go abroad for their own psycho-social, family, economic and domestic reasons of Nepal? 

When I don't get self-esteem according to a very intensive and sensitive job like saving human life, when I am separated from my family, when I take many risks, and I don't appreciate the professional religion that is followed without even taking vacations, sometimes my heart is sour. Even though one-third of the monthly income is to be paid to the state as a tax, when one has to take personal responsibility in every matter of social security, when assessing the situation of having to rely on the limited low capital in the retirement situation, and when I feel that the investment of time and labor is wasted compared to other fields or professions, I also feel that 'why? Are you here?'

It is essential to specialize medical education and profession based on personal experience and practical facts. However, our society is trying to remove the neck of the 'commercial' side by giving it the moral label of 'service'. In simple terms, five and a half years of MBBS and three years of MD/MS take two to three years more than the time taken to complete a master's degree in other disciplines. When it comes to specialization above that, three-four years of DM/MCH/PhD is added. The hard work involved in the preparation of the scholarship entrance exam etc., the investment made to prepare the basis for it, the sacrifices made by the parents and family are difficult to calculate. The financial investment required for reading at private expense is more than other genres. 

No less stressful is the licensing exam that must be passed in order to transform medical education into a profession. Not understanding the difference between academic and screening tests, it is made a subject of pass-fail in the media by applying the test of medical qualification. Again, our society does not hesitate to physically attack the doctor by branding him as a 'murderer' if the fate of the patient is going to happen while performing the profession of religion. The media is also involved in that process knowingly or unknowingly. And there was the issue of treatment fees.

Not only in technical subjects, maintenance, cleaning, construction work, tailoring, catering, hair cutting, but also in teaching tuition, astrology, advocacy, we are ready to pay any fee for essential matters like saving our lives. "Let's not be late. Our society does not care about the future trend of government and non-government employees who are tied to daily 10-5 office hours and the people's representatives, parliamentarians, ministers who are made by getting our votes and make huge wealth through corruption. But doctors who are ready to serve patients 24 hours a day, threaten them as if they don't have a private life, make character-personal attacks and give sermons on ethics. Physicians always fall under the grip of excessive deification and rapid demonization. 

What is the irony of our society? Those who want to demonize doctors are the ones who want their children to become doctors in the future. In this way, if the relevant bodies do not take positive steps regarding self-esteem, personal-social security, satisfactory lifestyle, future of children, stress-free life, financial strength, there is no possibility of reduction in the number of doctor exodus. Hollow nationalism alone will not work. Therefore, radical changes in medical education and health services are necessary if we want to create an environment where doctors can enjoy themselves in the country and attract foreigners here. The government can take the first step of reform only by daring to implement the report that has now been made public.