Professional Obstacles to Anaesthesiology Practice in Punjab, Pakistan: Qualitative Study of Consultant Anaesthesiologists’ Perspectives

Abstract

Global anesthesia workforce limitations contribute to the emigration of skilled anesthesiologists from lower- to higher-income countries, jeopardizing workforce balance and patient outcomes in Pakistan. This study aimed to explore the challenges experienced by anesthesiologists in Punjab, Pakistan’s most populous province, and the necessary changes to encourage their retention. We conducted a qualitative study to examine the perspectives of anesthesiologists who chose to serve in Pakistan. We drew data from semi-structured interviews conducted with 25 purposively sampled consultant anesthesiologists. We analyzed the data thematically and distinguished the practice hurdles faced by anesthesiologists in the public and private hospitals of Punjab. The main reasons many consultants chose to work abroad instead of in Pakistan differed between public and private sectors, which provided distinct challenges that compromised anesthesia workforce numbers and quality. Key outcomes were security, promotion/incentive structures, and gender inequalities in the government sector versus inadequate salary and facilities, surgeon dependency, and the lack of out-of-theatre practice in the private sector that minimized the scope and earnings of anesthesiologists within Pakistan. There is a need to increase performance-based incentivization, qualification-dependent promotion, along with overcoming surgeon dependency and hospital manipulation by fixing salary percentages for each surgical case and encouraging direct patient–anesthesiologist relationships.