Being a young medical graduate is not easy in Pakistan. It is incredibly difficult. A dreadful future looms over your head all the time if you planned to stay in the country. There is no one in the administration who can stretch out a hand for help, step forward to support or even lend an ear to listen to your concerns. On the other hand, there are senior colleagues — the professors and associates — who harass you and bait you for your lack of experience or knowledge or both. There are bureaucrats who disparage you and then there are politicians who exploit your financial dependency.In these uncertain circumstances, the Young Doctors Association (YDA) in Punjab has called for a strike once again to temporarily close down the Out Patient Department (OPD) of hospitals. As opposed to last year, the YDA has not jeopardised patient care in the emergency wards and has laudably demonstrated a tremendous self-restraint this time. OPD is a walk-in clinic of the major hospitals and generally treats non-emergent medical conditions. It provides care to patients with stable angina as opposed to the treatment of a heart attack (Acute Myocardial Infarction) or it may evaluate a stable inguinal hernia instead of an Acute Appendicitis.Shutting down the OPD is also their powerful and effective tool, but unfortunately, it always exclusively hits the poor people and significantly intensifies their suffering. Ostensibly, it can endanger their lives as well, although this claim cannot be scientifically validated or independently verified. Invariably, the misery of people hands an opportunity to the ravenous politicians to exploit and to malign the young physicians. It also provides the blazing electronic media with a ticker, a breaking news and a punch line in the evening primetime shows.As a result, the young doctors are invited in the talk shows to expound their point of view. Inevitably, the physicians are put on the spot to defend the affliction of the impecunious patients who, under no conditions, can afford to pay for their healthcare in the private sector. Therefore their only option is to get humiliated in the corridors of the state-run hospitals. Back and forth, in these programmes, the representatives of the YDA are reminded of their professionalism and their Hippocratic Oath that says, “I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone.”We all know very well that it is an impossible position to defend because, simply, moral issues cannot be equated or vindicated with financial demands. The position of the young fellow gets even harder when the host runs a small clip of a cancer patient who is unable to see a physician on a follow-up visit. After that video has been played, more the physician attempts to justify his strike, the more he sounds shallow and covetous to the viewer. He ends up coming across as a person running after money and the mundane luxuries of life.The whole situation is despairing because neither the hardship of the patients is bearable nor the despondency of their physicians is acceptable. In these circumstances, many young physicians decide to look for opportunities outside Pakistan and envisage their future in foreign countries. According to a rough estimate, 30 thousand physicians have so far left Pakistan; 17,000 or more have settled in the US, 5,000 to 8,000 in the UK, and a few more are working in the Middle East and Australia. We have lost them permanently and many more of them are waiting in line. Their emigration has created a big vacuum in the availability of healthcare services in Pakistan and can be explained easily. For example, in a city like Gujranwala that has a population of two million, the number of trained interventional cardiologists are limited (if any), Board Certified Endocrinologists to treat a common condition like Diabetes are almost absent; Rheumatologists are rare and the presence of a Hematologist/Oncologist is nearly non-existent. Even the Shaukat Khanum Memorial Hospital (SKMH) in Lahore had a hard time to hire a single permanent Pediatric Oncologist for years. The SKMH was working with a part-time oncologist visiting them once a week from Karachi.Physicians who have escaped from Pakistan were not felons but obviously they were treated like it by the stubborn bureaucracy, the egotistical politicians and their own senior, yet demeaning colleagues. While in Pakistan, they could not have possibly justified their demands for a better job structure against the tough standards of morality, yet in any other country they did not have to. They are respectable in the eyes of the bureaucracy, praised by patients, esteemed by seniors and admired by politicians.Of course, we do not condone the abandonment of patients, nor we can exonerate the physicians from taking drastic actions that can exacerbate the agony of people. It is their first and foremost responsibility to help the desolate and impoverished sections of our society, but at the same time, it is the responsibility of the state to try to keep their best minds in the country without vilifying them as gluttonous thugs. The writer is a US-based freelance columnist and can be reached at skamranhashmi@gmail.com