Why Young Doctors
Are Leaving Nepal: Beyond Salary
Every year, Nepal produces thousands of new doctors. More than twenty medical colleges across the country now graduate approximately 2,000–2,500 medical doctors annually. On paper, Nepal should be steadily strengthening its healthcare workforce. Yet, the country is experiencing the opposite.
More young doctors are choosing to build their careers abroad than within Nepal. The trend has become so pronounced that the number of doctors obtaining a Good Standing Certificate (GSC); a document required to work or pursue further education overseas; has nearly matched, and in recent years even exceeded, the number of new medical licenses issued by the Nepal Medical Council (NMC).
What the Data Says:
According to the Journal of the Nepal Medical Association (JNMA), applications for Good Standing Certificates increased nearly 1.5-fold between 2020 and 2023, rising from 1,087 to 2,582. Recent Nepal Medical Council data further shows that since 2020, more than 11,000 Nepali doctors have obtained Good Standing Certificates to pursue opportunities abroad, with the United States, the United Kingdom, Australia, the Maldives, India and several other countries emerging as major destinations.
The migration is no longer limited to a handful of graduates seeking specialist training overseas. It has evolved into a sustained brain drain that is steadily reshaping Nepal's healthcare workforce.
Nepal Produces Doctors, But Struggles to Retain Them:
Nepal has expanded medical education considerably since the first MBBS programme began at the Institute of Medicine in 1978. Today, over twenty medical colleges produce thousands of graduates every year. Despite this expansion, the country's healthcare system continues to face shortages of doctors, particularly outside major cities.
The JNMA trend analysis notes that Nepal's density of medical doctors increased from 2.07 doctors per 10,000 population in 2004 to 8.92 in 2017, before slightly declining to 8.67 per 10,000 in 2021. However, this overall improvement masks a striking geographical imbalance. While Kathmandu Valley reportedly has approximately one doctor for every 850 people, exceeding the World Health Organization's recommendation of one doctor per 1,000 population, some remote districts have as few as one doctor serving 150,000 people.
This uneven distribution means that producing more doctors alone has not translated into equitable healthcare access across Nepal.
The Numbers Show an Accelerating Brain Drain:
The increasing demand for Good Standing Certificates provides one of the clearest indicators of migration. According to Nepal Medical Council data cited in the JNMA article, GSC applications rose steadily between 2020 and 2023.
| Year | Good Standing Certificates |
|---|---|
| 2020 | 1,087 |
| 2021 | 1,502 |
| 2022 | 2,189 |
| 2023 | 2,582 |
The United States consistently remained the leading destination, followed by the United Kingdom, Australia, India, the Maldives and other countries. More recent reports suggest the trend has continued. Nepal Medical Council data published in 2025 and 2026 indicate that the number of doctors obtaining Good Standing Certificates has approached; and in some reporting periods exceeded the number of newly licensed doctors entering Nepal's workforce.
Better Opportunities Abroad Continue to Pull Young Doctors:
Migration is rarely driven by a single factor. A recurring theme across multiple studies is the interaction between push factors within Nepal and pull factors abroad. The 2022 Journal of Kathmandu Medical College editorial describes physician migration as the result of these combined forces.
Within Nepal, commonly identified push factors include:
- low salaries;
- limited employment opportunities;
- unsatisfactory working conditions;
- lack of postgraduate and specialist training;
- political instability; and
- inadequate opportunities for professional development.
At the same time, countries such as the United States, United Kingdom, Australia and Canada offer significantly higher salaries, structured postgraduate training, better working conditions, clearer career progression and stronger professional support systems. Rather than one issue driving migration, young doctors often weigh the cumulative difference between the two systems.
Limited Postgraduate Opportunities:
One of the probable underestimated cause is the shortage of postgraduate training positions within Nepal. The comparison of Nepal Medical Council licensing examinations illustrates this imbalance.
Between 2018 and 2022, the number of candidates appearing for postgraduate licensing examinations remained roughly one-quarter of those appearing for undergraduate licensing examinations. For example, in 2022, 5,687 candidates appeared for the undergraduate licensing examination, while only 1,673 appeared for the postgraduate special licensing examination.
As per JNMA, this disparity reflects the limited availability of postgraduate seats within Nepal and contributes to graduates seeking specialist education abroad.
Other analysis similarly suggests that limited postgraduate programmes encourage graduates to prepare for examinations such as the USMLE, PLAB, and the Australian Medical Council (AMC) examinations, creating pathways toward specialist training and eventual employment overseas.
Job Dissatisfaction Extends Beyond Salary:
Although income is frequently cited as the major cause factor, the dissatisfaction among young doctors extends well beyond financial compensation.
A 2024 study cited in the JNMA article found that 83.42% of doctors surveyed expressed dissatisfaction with their jobs, reporting the lowest satisfaction in job privileges, career development and human resource management. Also, the younger doctors often become dissatisfied because of low remuneration, limited career progression and inadequate employee benefits.
Long Working Hours and Burnout:
Burnout has become another significant contributor. According to the JNMA review, approximately 48% of healthcare professionals work more than eight hours daily. Doctors in Nepal were found to work an average of 53.19 hours per week across nearly six working days, exceeding the 48-hour weekly limit established under Nepal's Labour Act 2017.
As per the journal, nearly two-thirds of doctors experienced burnout, while more than two-thirds reported secondary traumatic stress.
Heavy workloads, understaffed hospitals and limited support services collectively contribute to physical and emotional exhaustion.
Violence Against Healthcare Professionals:
Safety has also become an increasingly important concern. There are reports of workplace violence among 62.9% of Nepal Medical Council-certified physicians working in Nepal. Verbal abuse, physical assaults and repeated threats create unsafe workplaces and contribute to stress, burnout and migration.
Although Nepal has amended laws aimed at protecting healthcare professionals, the stronger implementation and accessible mechanisms for addressing complaints remain necessary.
Employment Opportunities Have Not Kept Pace:
While Nepal continues producing new graduates, employment opportunities have not expanded at the same pace. Although Nepal now has over twenty medical colleges and numerous tertiary hospitals, government employment opportunities remain limited, as the opening of PSC Health Vacancies are slim to none. Many young doctors struggle to secure permanent government positions, particularly at the medical officer level.
Political Environment and Health System Governance:
Interestingly, political factors are also a factor contributing to dissatisfaction. The JNMA article states that political instability creates an unhealthy working environment for healthcare professionals and disrupts effective implementation of healthcare policies.
Although a new Majority government is in power, the fruit of good governance in healthcare system is yet to be seen. The issues of political appointments within medical institutions, with political influence over leadership positions undermines professional confidence and contributes to frustration among senior clinicians and younger doctors alike.
Rural Nepal Faces the Greatest Consequences:
Migration does not affect all parts of Nepal equally. Doctors have historically concentrated in Kathmandu and other urban centres while rural districts continue to face severe shortages.
A British Medical Journal study found that among Institute of Medicine graduates, 36% had migrated abroad, 37% practiced in Kathmandu, while only 27% worked outside Kathmandu.
The same research found that graduates from rural backgrounds, those with paramedical experience before medical school and older graduates were more likely to remain in Nepal and serve rural communities.
These findings suggest that admission policies and educational strategies may influence long-term workforce distribution.
A Growing Policy Challenge:
It is a simple yet crucial fact that retaining doctors requires addressing multiple structural problems simultaneously.
Suggested approaches include expanding postgraduate training seats, increasing government employment opportunities, improving salaries, strengthening workplace safety, reducing burnout through workload management, enforcing protections against violence, improving hospital infrastructure and ensuring stable investment in the health sector.
Ultimately, the evidence based on reports, surveys and datas suggest that Nepal's challenge is no longer producing doctors. It is retaining them. Thousands of young physicians continue to graduate each year, but increasing numbers are seeking professional futures elsewhere. As more doctors obtain credentials for overseas employment while shortages persist within Nepal; particularly in rural areas; the country faces a growing challenge of sustaining its healthcare workforce.
Unless the working conditions, career opportunities, postgraduate training and professional support improve within Nepal, the migration of young doctors is likely to continue, placing further strain on an already fragile health system.
Editorial Note: This article is written by MedicoNepal with the data available from the research papers, reports and articles referenced below. The discussion is based on the published evidence available at the time of writing.
- Trend Analysis of Good Standing Certificate Applications Among Nepalese Doctors and the Growing Brain Drain – JNMA
- Brain Drain in Nepal and the Plight of Young Health Professionals - Researchgate
- Why Some Doctors Stay and Others Go Away – Nepali Times
- Nepal Medical Council Data on Good Standing Certificates – Radio Nepal
- Nepal's Migrating Doctors – The Kathmandu Post