My Take on Pakistan Medical Ordinance 2019

In October 2019, the President of Pakistan introduced Pakistan Medical Ordinance 2019. This Ordinance has dissolved the existing Pakistan Medical and Dental Council (PMDC) in an attempt to replace it with Pakistan Medical Council (PMC).

Take-Home Points from the Ordinance

For Pre-Medical Students

  • The newly formed, National Medical Authority will conduct an annual Medical and Dental College Admission Test (MDCAT).
  • It will be mandatory to pass the MDCAT to be eligible for admission in any medical college.
  • The MDCAT will be conducted once a year.
  • Private medical colleges will be allowed to conduct additional entrance tests.
  • Private medical colleges can choose to give weightage to the MDCAT scores as per their policy.
  • No student will be awarded a medical or dental degree without passing MDCAT.
  • Passing MDCAT is applicable for all students who enter medical colleges in 2019 and thereafter.

For Medical Students

  • Medical students graduating after March 2020, will need to pass the National Licensing Exam (NLE) to become eligible for House Job.
  • Medical students graduating before March 2020, can begin their House Job without taking NLE. But they will still need to pass the NLE to become eligible for a full license.
  • NLE will be held at least twice a year.
  • There will be no limit on the number of NLE attempts.
  • Pakistan Armed Forces cadets, on completing their graduation and pre-requisite military training and after being commissioned in the Pakistan Armed Forces, will be granted an Armed Forces provisional license. They will still need to pass NLE during their service before they can be granted the full license.

For Fresh Graduates

  • All medical and dental graduates will need to complete a 12-month House Job.
  • All medical colleges will be responsible for providing paid House Jobs to their graduates who pass the NLE and hold a provisional license.
  • Salary for House Job at private hospitals will be equal or more than the highest-paid House Job salary at government hospitals.
  • If House Job is completed at a non-affiliated hospital, it will be the parent medical college’s responsibility to reimburse the non-affiliated hospital with the amount paid as House Job salary.
  • Doctors will not be allowed to practice without holding the license.
  • Any doctor with a full license can practice as a “general practitioner” without having to go through formal GP training.

For Trainees and Specialists

  • All doctors will have to go through a revalidation process every five years.
  • Only doctors registered as specialists on their license will be able to practice as specialists.

Now let’s examine what all of this means

The Good

  • Centralized, merit-based system for admission to medical college.
  • Centralized, merit-based system for exit from medical colleges.
  • No limit on the number of NLE attempts.
  • All doctors will receive a salary during their House Jobs.
  • Private institutes will have to pay a healthy amount (to match the salaries paid by the government hospitals) to House Officers.
  • Five-yearly revalidation process.

The Bad

  • Changes introduced haphazardly, without proper planning.
  • Not enough time to implement these changes.
  • No functioning medical licensing body at present.
  • Difficulties for doctors who were about to start their careers.
  • Difficulties for doctors who were planning to take foreign exams
  • Recognizing doctors as “general practitionars” without formal GP training.

The Unclear

  • Passing MDCAT is mandatory for any students who enter medical college in 2019 and thereafter. The ordinance does not clarify the situation for students who have already started medical college in 2019 without passing MDCAT.
  • Will other foreign regulatory bodies like the GMC recognize PMC?
  • Will PMC issue Certificate of Good Standing to doctors who hold provisional registration but did not take NLE and did not get the full license after completing of House Job?

What is Missing?

  • A proper contract for junior doctors, listing their rights and duties, including details of pay-scales and working hours.

What does this mean for doctors who wish to move to the UK?

  • Keep in mind that without a House Job, it is very difficult to find employment in the UK. Lack of a medical licencing body in Pakistan can lead to a delay in starting House Job. This can lead to career gaps. All career gaps have to be justified abroad. This will not stop anyone from getting a job in the UK. But it can cause unnecessary stress and paperwork while applying for GMC registration.
  • Awaiting to pass NLE before starting House Job can cause further gaps.
  • These changes will not stop doctors from taking IELTS, OET, PLAB 1 and PLAB 2.
  • There will be hurdles in GMC registration as the GMC will ask for a Certificate of Good Standing (CGS) from PMDC/PMC. Since PMDC/PMC does not exist at present, doctors will not be able to get GMC registration at present. However, this issue should resolve as soon as PMDC/PMC starts functioning again. For doctors who are currently facing this issue, my advice would be to email or call the GMC and to discuss this directly with the GMC. They will give you the best advice.

So overall, doctors who wish to move to the UK can still move to the UK. Only doctors who are currently about to apply for GMC registration might face a delay.

My Opinion about the NLE

Understandably, a lot of students and doctors have concerns regarding the NLE. The main concern is the added stress of an additional exam.

This will be an unpopular opinion but I personally feel that it would be beneficial for the system to have an exit exam as it will standardize the merit for becoming a doctor. However, the Ordinance seems to have been implemented in a haste.

Also, since the PMDC has been dissolved, it was not the ideal time to introduce a new exam.

Did you know that the General Medical Council UK plans on introducing a similar exam, the MLA in 2024 for UK graduates?
However, the GMC had already introduced the idea of the UKMLA in 2014. So, it took the GMC ten years to properly plan the introduction of the exam.
Did you know that the General Medical Council UK plans on introducing a similar exam, the MLA in 2024 for UK graduates? Click here to read more.

Will this affect patient care?

Yes, it will as there is no medical licensing or medical regulatory body at the moment in Pakistan. This means that there is no regulation of licensing. This will cause numerous licensing problems for doctors, which in turn can affect patient care.

What should we do about this?

First of all, we need to read the Ordinance to be able to understand what it means and how it can affect us. So I will strongly urge everyone to read it in detail. You can find it here.

Secondly, we need to understand that opposing the Ordinance or opposing the NLE without any rational arguments will be counterproductive. The best argument is to discuss how these changes will affect patient care. The government and the PMC need to consider delaying the implementation of these plans until a formal line of action has been announced in such a way that it would not compromise patient care.

In the end, I will strongly request all medical students and doctors to be on their best behavior while opposing these changes. If you are not well behaved, your arguments will not be taken seriously. Not only this, but you will also damage the reputation of doctors in the public eye, which will not benefit your cause in any way.

Link to the Ordinance

You can read the Ordinance in detail here.

6 thoughts on “My Take on Pakistan Medical Ordinance 2019

  1. AOA sir. Will the gap that will likely be introduced into our career history since we can’t immediately start housejob after graduation now have a negative effect on GMC registration later down the line? Since I believe they require an internship immediately after graduation

    1. As long as you explain the gap with documentary evidence and as long as the gap is not more than a year or two, you should be fine.

  2. This NLE exam being introduced both before and after housejob is highly ridiculous. It will be an extra burden on the hardworking students and increase their dependency on their parents even further.

    1. One of the biggest problems I’ve seen in fresh graduates starting their hose jobs, is the the sudden lack of preparation they have with regards to dealing with the practical side of practicing medicine. Thanks to this lack of proper guidance , Pakistan sees a very high rate of negligence at the hands of young graduates, in many cases it not being their fault. If this NLE addresses even some of these concerns, I support it. Setting a standard for new doctors before they start their career is extremely necessary

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