In 2022, 204,253 candidates registered for MDCAT. This year, 138,160 did. That is a 32% drop in four years. The Pakistan Medical Association says it is not a blip. The data shows what changed.
The Trend in One Table
| Year | MDCAT Registrations |
|---|---|
| 2021 | 194,133 |
| 2022 | 204,253 (peak) |
| 2023 | 180,534 |
| 2024 | approx. 182,000 |
| 2025 | 140,071 |
| 2026 | 138,160 |
Source: PMDC official registration data, reported in Dawn and The Nation.
From peak to 2026 that is a drop of 66,093 candidates, or 32%, in four years. The Pakistan Medical Association has formally described this as a "structural decline" in interest rather than a cyclical fluctuation.
What is driving it?
Doctors Are Leaving and Young People Are Watching
Pakistan lost more than 5,000 doctors to emigration in the two-year period spanning 2024 and 2025 alone. In 2025 specifically, approximately 3,800 to 4,000 doctors formally emigrated, a historic annual record according to Bureau of Emigration and Overseas Employment data.
Primary destinations are the United States, United Kingdom, Canada, Saudi Arabia, and the UAE. In 2025 alone, over 1,000 Pakistani doctors secured residency positions in the United States. That makes Pakistan one of the largest sources of foreign-trained physicians for that country.
These doctors are not leaving because they hate medicine. They are leaving because the working conditions and compensation in Pakistan make a career here economically irrational for a large share of practitioners. The push factors in PMDC and research literature are consistent. Low salaries, excessive hours, unsafe public hospitals, no career progression, and no meaningful protection from workplace violence.
A 17-year-old planning their future in 2026 can see this. The role models who stayed are overworked and underpaid. The ones who left are, by most visible metrics, better off.
The Salary Math Does Not Work
A fresh MBBS graduate in Pakistan begins as a House Officer on a stipend between Rs. 15,000 and Rs. 75,000 per month depending on the hospital and province. After house job, entry into government service is typically at BPS-17, with total monthly compensation (basic pay plus allowances) in the range of Rs. 80,000 to Rs. 120,000.
Put that in context. A software engineer with two years at a mid-tier Pakistani IT company earns more than this. That route has no mandatory internship, no five-year undergraduate degree, and a clear path to remote work for international clients.
To reach a senior medical officer or consultant salary in government service (Rs. 200,000 to Rs. 300,000 per month), a doctor typically needs eight to twelve years post-graduation. The opportunity cost measured against any other professional field is severe.
The Female Doctor Attrition Problem
Approximately 65% of MBBS seats in Pakistan are now occupied by women. This is widely cited as a success story. It is also part of why the registered-to-practicing ratio is structurally troubled.
Research data, including Gallup Pakistan's analysis of Labour Force Survey figures, shows that roughly 35% of female medical graduates in Pakistan are not practicing medicine. Of that group, around 15% are unemployed and actively seeking work. Another 20% have left the labour force entirely. The reasons are domestic expectations after marriage, rigid hospital hours, no childcare, and safety concerns on the commute to a public hospital.
The "doctor bride" phenomenon is well documented in the Journal of Pakistan Medical Association. A medical degree functions there as a social credential rather than a career pathway. When a large fraction of trained doctors do not practise, Pakistan gets the worst of both outcomes. It pays for a medical education and still has too few active clinicians. It also signals to prospective students that the profession does not reliably lead to a stable career.
Alternative Paths Are More Accessible Than Before
For high-performing FSc Pre-Medical students, the alternatives to medicine have expanded considerably.
Computer science, artificial intelligence, health data analytics and biotechnology offer faster degrees and stronger early-career salaries. At LUMS, NUST, GIKI and Aga Khan University they also offer international mobility without a postgraduate degree. An MDCAT score is valid for three admission cycles, which softens the cost of a gap year. The psychological and financial cost of a repeat attempt is still far higher than applying to a second professional field with no single qualifying exam. Engineering admissions, by contrast, allow students to apply to multiple programs simultaneously and accept merit-based scholarships without sitting a single high-stakes qualifying test.
The Paper Leak Legacy
Fake leaked MDCAT papers circulated in 2023, 2024, 2025 and again in 2026. The Sindh testing service had to warn candidates publicly, days before the exam. The 2024 Sindh paper-leak allegations reached the Sindh High Court. That record created lasting institutional distrust. Students and families who lived through cancelled and rescheduled cycles have not fully returned. Preparing for an exam that might be invalidated carries a real psychological cost, and hedging by pursuing alternatives is a rational response.
What This Requires
The decline in MDCAT registrations is a downstream indicator of a profession in crisis. PMDC can tighten eligibility rules, raise the passing threshold, or redesign the exam format. None of that addresses why doctors leave. It does not explain why a third of female graduates do not practise. Nor does it explain why the government salary structure makes medicine a poor financial choice for a growing share of talented students.
The fix is economic and institutional. Pay public-sector doctors competitively, legislate workplace protection for healthcare workers, and create flexible postgraduate training that does not require a decade of near-poverty to complete. Until that happens, MDCAT registration numbers will continue declining, and Pakistan's rural health crisis will deepen accordingly.