Patients used to trek from Afghanistan to consult my father, a physician trained at the Cleveland Clinic, who practiced in Peshawar, Pakistan. It might be tempting to chalk up such healthcare access to a developing nation. However, California’s economy surpasses that of entire countries, yet individuals in the Central Valley still endure lengthy drives to receive life-saving treatment. I have experienced life and education in both types of “doctor deserts,” one barren and one lush. Both face the same dilemma: the flight of the healthcare professionals meant to care for them. Doctors are trained to preserve lives. Yet in both Pakistan and California’s Central Valley, their absence resonates louder than their presence. The very structures intended to support doctors are constructed in ways that drive them away. When the practice of medicine becomes untenable for providers, it becomes inaccessible for patients.
Annually, Pakistan graduates thousands of new physicians. However, each year, many depart the country for opportunities abroad. In 2022, over 2,500 doctors exited to work in foreign lands. Research indicates that this isn’t a fleeting trend. Almost one-third of medical students explicitly intend to establish their careers overseas.
This “brain drain” has morphed into a pipeline. Wealthy nations rely on Pakistan’s consistent outflow of medical talent, while Pakistan itself is left with scarcely 1.1 doctors per 1,000 citizens, which is half the amount the World Health Organization advocates.
Why do physicians migrate? The motivations involve both politics and remuneration: meager salaries, scarce residency options, instability, and an everyday routine that renders professional life stifling. The harshest irony is that the nation invests years and public resources into training doctors who then escape precisely because the system they were educated in offers no promising future. Patients languish in overcrowded facilities while their doctors tend to patients abroad.
The situation in California’s San Joaquin Valley revolves less around international migration and more around local neglect. This area possesses the lowest number of primary care physicians in the state, and almost a third of its current practitioners are approaching retirement. However, the issue isn’t that California fails to produce enough doctors; it’s that they don’t remain. UCSF Fresno, the Valley’s primary medical training institution, produces new doctors every year. Yet in 2024, fewer than half decided to stay in the Valley post-residency. Family medicine had only a 42 percent retention rate. Internal medicine, 58 percent. In contrast, 72 percent of graduates remained in California overall. Doctors for California, yet not for San Joaquin County. The conclusion is evident: Even when trained in the Central Valley, doctors are lured away by the allure of California’s coastal regions, which offer higher salaries, improved working conditions, and greater respect. What remains are federally acknowledged “Health Professional Shortage Areas.”
At first glance, Pakistan’s outflow and California’s scarcity may seem unconnected: one concerns global migration, the other domestic reallocation. Yet the underlying principle is identical. Health professionals gravitate toward areas that appreciate them most. The more ill and impoverished the community, the weaker its hold on the necessary personnel to thrive. This is systematic neglect, not mere coincidence. Patients in Karachi and Fresno are not both waiting for doctors by chance. They are waiting because both of their underfunded, undervalued, and understaffed healthcare systems render such waits unavoidable.
Efforts to stem the tide are underway. In California, initiatives like the San Joaquin Valley PRIME identify and recruit students with local backgrounds, hoping that their ties will keep them rooted. Initial outcomes are encouraging: in 2024, entire graduating cohorts in psychiatry and pediatrics chose to remain in Fresno.
Pakistan’s journey is steeper. Ensuring retention will demand more than invoking patriotism. It necessitates reconfiguring the system itself: attractive salaries, dependable postgraduate training, and political stability that makes practicing medicine a viable option at home. Absent these changes, the country will keep producing doctors for the patients of others.
Physician shortages reflect core values. When doctors cannot foresee sustainable futures in the communities that need them the most, the outcome is predictable: they depart. And when they leave, the remaining communities bear the burden of longer wait times, postponed diagnoses, and conditions that should have been identified sooner.
Doctors depart. Patients linger. And in the void between the two, entire healthcare systems collapse.
Samah Khan is a premedical student.