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.
