On a warm afternoon in Lahore, a final-year medical student sits outside her college’s skills lab, waiting for her turn to practise a clinical procedure that may or may not be supervised that day. Inside, the lab contains a few basic diagnostic tools, and limited simulation equipment. “We study a lot of theory,” she says cautiously, asking not to be named. “But when we enter hospitals, we realise we are not confident with real patients. Everything feels different from what we were taught.”
Her experience is not an exception. It reflects a broader unease within Pakistan’s rapidly expanding medical education sector, where the growth of private medical colleges has far outpaced the infrastructure, faculty strength, and clinical training required to sustain quality education.
Over the past two decades, Pakistan’s medical education system has undergone significant expansion under the regulatory oversight of the Pakistan Medical and Dental Council (PMDC), the statutory body responsible for approving institutions, accrediting programmes, and setting minimum standards for medical training. Today, the country is estimated to have around 180 to 190 medical and dental colleges, with more than 120 operating in the private sector alone. This rapid proliferation has created opportunities for aspiring doctors, but it has also raised persistent questions about standards, supervision, and outcomes.
A senior official associated with PMDC, speaking on condition of anonymity due to the sensitivity of the issue, describes the situation as structurally imbalanced. “We have expanded institutions faster than we have expanded faculty and clinical training capacity,” the official says. “In some cases, colleges are approved based on initial compliance, but sustaining those standards over time becomes a challenge. The regulatory framework exists, but enforcement has historically been uneven.”
Behind the official numbers lies a deeper crisis of capacity. The PMDC assessments have indicated that Pakistan requires more than 26,000 qualified medical faculty members to properly staff its institutions, yet the available number remains significantly lower. The gap forces many colleges to rely on visiting lecturers, overstretched professors, or in some cases, minimally experienced staff to fill essential teaching roles.
This shortage is particularly damaging in clinical education, where hands-on supervision is critical. A former dean of a public sector medical university, Prof Dr A. Rahman, explains the implications bluntly. “Medicine is not a subject that can be learned through lectures alone. It requires repeated supervised exposure to patients. When faculty is missing or overstretched, that chain of learning breaks down.” He adds, “In some private institutions, students are paying substantial fees but receiving fragmented clinical training. That is a serious concern for patient safety in the long term.”
The issue is compounded by the uneven quality of infrastructure across institutions. While regulations require private medical colleges to be attached to teaching hospitals and maintain functional laboratories, implementation varies widely. In some cases, students report limited access to real hospital wards or over-reliance on affiliated hospitals where they compete for clinical exposure with multiple institutions.
A senior physician at a major public hospital in Islamabad describes the consequences of this gap when graduates enter the workforce. “We are increasingly seeing young doctors who are academically strong but clinically underprepared,” he says. “They know the theory but struggle with basic bedside skills. The system ends up retraining them during house jobs, which delays their development.”
Despite these concerns, the private medical education sector continues to attract thousands of students each year, driven by high demand for medical careers and the limited capacity of public sector institutions. Estimates suggest that medical and dental colleges across Pakistan collectively enrol and produce tens of thousands of graduates annually, contributing significantly to the healthcare workforce. However, experts caution that quantity is not translating into consistent quality.
Tuition fees in private medical colleges are another point of contention. In many institutions, the total cost of education runs into several million rupees over the course of a degree, placing a heavy financial burden on families. Critics argue that such high fees are not always matched by commensurate investment in teaching infrastructure or faculty development.
A PMDC-linked education analyst summarises the dilemma: “There is a mismatch between commercial expansion and educational responsibility. Medical education has, in some cases, become a business model rather than a public service.” He adds, “When profit becomes the dominant driver, investment in labs, faculty, and training often becomes secondary.”
In response to these concerns, the PMDC has recently introduced measures aimed at stabilising the sector. These include restrictions on the establishment of new medical colleges and tighter controls on student intake in existing institutions. The regulator has also stressed stricter inspections, improved faculty requirements, and better enforcement of hospital affiliation standards.
A senior PMDC representative explains the rationale: “The pause on expansion is necessary to allow the system to catch up. We need to consolidate quality before we expand further. Otherwise, we risk producing graduates who are not fully prepared for clinical practice.”
Yet students remain caught in the middle of reform and reality. Many express frustration at the gap between expectations and training outcomes. “We are told we are future doctors, but often we don’t get enough exposure to real cases,” says a student in Karachi. “We worry about what kind of doctors we will become if things don’t improve.”
Despite these challenges, there is consensus among experts that Pakistan’s medical education system is not beyond repair. Rather, it requires sustained reform, better enforcement of existing regulations, investment in faculty development, and a shift away from unchecked expansion.
As Prof. Dr. Rahman puts it, “Pakistan is producing a large number of doctors, but the question is whether they are fully trained to meet the needs of patients. Medical education is a long-term national responsibility. If we compromise on it, the effects will be felt across the entire healthcare system for decades.”
For now, the system continues to expand, but so too do the concerns about what that expansion truly delivers.