One of the recent cases taken up by the current Chief Justice of Pakistan (CJP) Saqib Nisar, through a public interest notification, has doctors across the country taking notice. The issue relates to the salary paid to physicians who have returned to Pakistan after having been trained in the West. In a case against the Pakistan Kidney and Liver Institute (PKLI), the monthly income of the American-trained Urologist, Dr. Saeed Akhtar, was contested. As the president and the CEO of the institute he was being paid 1.2 million Rupees (PKR), which in today’s economy equals to almost $10,000 per month. However, in contrast a Pakistani physician working in the tertiary care centre at a senior level, makes somewhere between Rs. 100,000 to Rs. 200,000 per month, as per the government pay structure. In private medical colleges, their income becomes slightly higher and can vary between PKR 200,000 to Rs. 400,000 per month depending on their experience, the financial standing of the organisation that hires them, and the area of their expertise. Still, both of these systems still fall short of what Dr. Akhtar was being paid, which is what prompted the CJP to inquire further into this matter. How much do physicians get paid in the West? Well, in the United States, except for orthopaedic surgeons or Neurosurgeons who can make more than a million dollars a year, most salaries are between the ranges of $250,000 to $700,000 per annum. The majority of doctors, however, would settle between $350,000 and $500,000 pre-tax annual income. If we deduct 40-50 percent for taxes and insurances, it still means that an urologist would net somewhere close to $20,000 a month. Compared to that, Dr. Akhtar is offered half of that salary in Pakistani rupees, barring the extra benefits he was offered alongside the amount. In the United Kingdom, the annual income of physicians varies from £100,000 to £150,000 per year. As such, after deducting taxes, most of them get paid around £6,000 to £9,000 per month, which, if converted into Pakistani rupees, would amount to the same as that of Dr. Akhtar (minus the benefits). What about the Middle East? It depends on your nationality and the colour of your skin! However, when US-trained physicians negotiate their contract with hospital administrations, the management follows a simple formula to entice them, by replicating the same pay structure as in America. Plus, they don’t have to pay any local taxes, which mean a bump of forty to fifty percent in net income. Now the question that arises is this: how should physicians trained in the West be paid in Pakistan? The answer is quite complicated. If we hire them at the same salary as of a senior consultant in Pakistan, after conversion, they might end up earning up to $1,000 to $4,000 a month. This large pay cut will force them to reject the chance to come back to Pakistan, and instead remain abroad where they can make a lot more money, for the same job. This is why almost 25,000 Pakistani doctors live in the USA today. On the other hand, if you pay them more, like the Punjab Administration under Shahbaz Sharif did, you create an even bigger problem for yourself; you end up undermining the physicians who chose to stay in Pakistan to complete their basic medical education. In a way, you penalise them for their patriotism, hard work and patience by appointing an outsider to a position that they can also easily fulfil. How should physicians trained in the West be paid in Pakistan? If we hire them at the same salary as of a senior consultant in Pakistan, after conversion, they might end up earning up to $1,000 to $4,000 a month, which may cause them to leave. On the other hand, paying them more can undermine physicians who chose to stay in Pakistan Think about it,after working for decades, instead of the senior most Supreme Court judge being promoted to the post of chief justice, a foreign qualified judge is selected for the job instead. How would the institution react? As icing on the top you find out that the foreign educated judge is also being paid ten times more than his Pakistani colleagues. Who is responsible? None other than Shahbaz Sharif and his philosophy of total administrative control, his micromanagement on every level, and his makeshift approach to erect new institutions while destroying the old ones. He has been in power for ten years, during which time he built PKLI without paying attention to the professional requirements of the institution. Had he possessed the vision, he could have selected a team of doctors based on merit, sent them for appropriate training and brought them back to run PKLI, but he did not. He could also have paid attention on methods of how Pakistan too could train and produce doctors that work on international standards. What he did instead was that he created this mess in which we find ourselves today. However, the person responsible is busy looking to become the next prime minister of Pakistan. The writer is a US-based freelance columnist. He tweets at @KaamranHashmi and can be reached at skamranhashmi@gmail.com Published in Daily Times, June 24th 2018.