The crushing cost of compassion: How Pakistan's private medical colleges are betraying a generation

The flickering fluorescent lights of the private medical college admissions office illuminated not just brochures promising "world-class doctors," but the deep lines of despair etched onto Muhammad Riaz’s face. His daughter, Ayesha, held an acceptance letter, her dream of becoming a physician realized. Yet, the paper felt like lead. The tuition: Rs. 225,000 per month. For five years. Totaling over Rs. 13.5 million, excluding hostel fees, books, and exorbitant examination charges. Riaz, a schoolteacher earning Rs. 80,000 monthly, knew the math was impossible. His daughter’s brilliance, nurtured through public school triumphs, had collided with the brutal economics of Pakistan's privatized medical education, a system extracting fortunes from the very families who need compassion most. This isn't an isolated tragedy; it's the systematic commodification of healthcare hope, leaving a generation of aspiring healers drowning in debt or locked out entirely. Walk through the corridors of Pakistan's elite private medical colleges, and the opulence is jarring: air-conditioned lecture halls, gleaming simulation labs, cafeterias serving cappuccinos. But this façade masks a profound moral bankruptcy. Institutions like Ziauddin Medical University (Karachi) charge upwards of Rs. 200,000 per month. CMH Lahore Medical College demands fees exceeding Rs. 1.8 million per year (approx. Rs. 150,000/month). Dow University of Health Sciences (Karachi - Private Programs) and Shifa College of Medicine (Islamabad) operate in similar, devastating ranges. Aga Khan University (Karachi), while globally renowned, sets a stratospheric benchmark with total costs nearing Rs. 20-25 million for the MBBS program. Even newer entrants in smaller cities command Rs. 100,000-150,000 monthly. Contrast this with the nominal fees of public colleges (Rs. 30,000-100,000 per year), which are impossibly competitive, accepting only a tiny fraction of qualified applicants. The private sector, theoretically offering an alternative path, has instead become an exclusive gated community for the affluent, transforming the MBBS degree into a luxury good. This predatory pricing becomes even more grotesque when viewed internationally. Pakistan's private MBBS costs are wildly out of sync with global averages, especially considering the country's GDP per capita:  

1. CHINA: Prestigious universities like Peking Union Medical College or Fudan University offer MBBS programs taught in English for international students for $3,000 - $6,000 USD per year (approx. Rs. 840,000 - Rs. 1.68 million annually). Total cost: ~$15,000 - $30,000 USD (Rs. 4.2M - Rs. 8.4M). Significantly cheaper than Pakistan's private sector.

 

2. UNITED KINGDOM: Among the world's most expensive. Annual tuition for international students at universities like Imperial College London or University College London ranges from £35,000 - £45,000+ (approx. Rs. 12.25M - Rs. 15.712.2per year). Total cost: £175,000 - £225,000+ (Rs. 61M - Rs. 79M+). While astronomically high, these are globally elite institutions with vastly superior resources, infrastructure, research output, and graduate earning potential globally. Pakistani private colleges offer none of this comparative advantage.

 

3. UNITED STATES: Similar to the UK, top-tier private universities like Johns Hopkins or Harvard charge $60,000 - $80,000+ USD per year (Rs. 16.8M - Rs. 22.4M+ per year).

Total cost: $300,000 - $400,000+ USD (Rs. 84M - Rs. 112M+). Again, an entirely different league regarding institutional prestige and global opportunities.  

4. CIS STATES (RUSSIA, UKRAINE, KYRGYZSTAN, KAZAKHSTAN): Historically popular with Pakistani students due to affordability. Reputable universities like RUDN University (Moscow), Crimea Federal University (Simferopol), or Kyrgyz State Medical Academy (Bishkek) charge $3,000 - $7,000 USD per year (approx. Rs. 840,000 - Rs. 1.96M annually). Total cost: ~$15,000 - $35,000 USD (Rs. 4.2M - Rs. 9.8M). Often cheaper than Pakistani private colleges, despite the added costs of travel and living abroad.

The Pakistani private medical education model isn't just expensive; it's fundamentally broken and ethically compromised. The exorbitant fees bear little relation to actual educational quality or resource investment. Many colleges operate with skeletal permanent faculty, relying heavily on poorly paid visiting lecturers or overburdened consultants. Infrastructure investments often prioritize cosmetic appeal over functional educational tools. Regulation by bodies like the Pakistan Medical and Dental Council (PMDC) has been weak and inconsistent, failing to curb rampant profiteering or rigorously enforce minimum standards. The justification of "market forces" rings hollow when the "product" is a societal necessity, future doctors, and the "market" is rigged against the vast majority of qualified students. The consequence isn't just individual hardship; it's a national health crisis in the making. We are systematically excluding bright, motivated students from middle and lower-middle class backgrounds, the very communities most in need of empathetic, local healthcare providers. Those who do enroll face crippling debt, forcing them towards lucrative specializations or emigration immediately after graduation, draining Pakistan of its desperately needed medical human capital. The pressure to recoup family investments fosters a mercenary mindset, antithetical to the altruistic core of medicine. "When the cost of learning to heal becomes a wound itself, the system isn't just broken, it's inflicting the very disease it claims to cure. We are mortgaging compassion to finance exclusion." Meet Ali Hassan. Brilliant, dedicated, accepted into a Lahore private college. His family sold ancestral land, took multiple loans from relatives, and committed his entire future income. Five years later, Ali is an MBBS graduate, but also carries a debt exceeding Rs. 9 million. His starting salary as a House Officer in a government hospital? Roughly Rs. 100,000 per month. Repayment, even just the interest, is a decades long millstone. His dream of serving in his underprivileged hometown is eclipsed by the immediate need to repay lenders, pushing him towards urban centers or foreign residencies. Others, like Ayesha, whose story opened this piece, never even get to start. Their potential contribution to Pakistan's healthcare, lost forever. The psychological toll is immense – anxiety, depression, and a profound sense of betrayal among students who worked tirelessly only to find the door slammed shut by financial barriers erected by their own country's institutions. Pakistan’s healthcare system groans under the weight of preventable disease, doctor shortages and maldistribution. Allowing private medical colleges to operate as unchecked profit centers, extracting exorbitant fees far exceeding both public sector costs and reasonable international benchmarks, is national self-sabotage. It deepens inequity, fuels brain drain, and corrodes the ethos of medicine. The solution demands urgent, multi-pronged action: Stronger, transparent regulation by the PM&DC to cap fees based on audited costs and enforce stringent quality standards. Dramatic expansion of high-quality public medical seats to absorb meritorious students. Government backed, low-interest loan programs specifically for medical students, with debt forgiveness schemes linked to mandatory service in underserved areas. Tax incentives or disincentives for private colleges based on fee structures and service commitments. The goal is not to eliminate private education, but to force it to operate within ethical and national interest boundaries. Muhammad Riaz’s despair, Ali Hassan’s debt, and Ayesha’s lost dream are not personal failures, they are indictments of a system that has lost its way. Pakistan needs doctors from every stratum of society, driven by compassion, not crushed by cost. Reforming this broken model isn't just about education policy, it's about national survival and the fundamental right to health, for both future doctors and the patients they yearn to serve. The time for band-aid solutions is over, PM Shehbaz Sharif needs to do a major surgery of the medical education system.