Pakistan produces a great number of doctors, but many of them choose to migrate abroad to pursue further education and continue their careers. This creates a shortage of doctors to the general public and a heavy load on the already suffering health care system. The current study figures out factors responsible for this migration and the related gender differences so that these factors can be evaluated in order to control the ‘brain drain’. We have found that overall, 50.6% of medical students are keen to go abroad for further training while 49.4 percent are willing to continue their training in Pakistan.

These results are somewhat in line with the previous research conducted in the same medical college in 2015 in which 52.9 % of participants replied in favor of and 44.5% answered against migrating respectively [6]. These results are also supported by research conducted at Ziauddin Medical University in 2006 where 51.7% of final year medical students wanted to continue their practice in the home country [12]. On the Contrary, results were quite different when similar research was conducted in AKU, where 95% of students had definite plans of continuing the training outside the country [7].

In our study, 37.8% of students replied to a lack of affordability as a reason for not choosing to go abroad. We found that among those students, who wish to go abroad 44.3% of students were having an average monthly income of 60-100K while 55.12% of the same income range do not plan to continue for training abroad.

Among our responders, 228 were females and 88 males. Out of them, 45.6% of females and 63.6% of males choose migration. Therefore, a marked difference in priority was observed among male and female students.

In Pakistan, the number of registered doctors is 108062 which makes only one doctor for 1404 patients; hence the country is already suffering from a shortage of doctors [13]. In this instance migration, and particularly the migration of male doctors will intensify the shortage. Although our study results reflected a somewhat better inclination of students to stay in Pakistan, as opposed to the previous research conducted in 2011 where 60% of participants intended to go abroad [8], the current physician to patient ratio is still low, and so the factors influencing student's migration still need to be considered. Still, in a country like Pakistan, which ranked third among low-income countries in exporting the physicians [14], indications with such results can be the flame of hope for scintillating the future of medical sciences here.

According to the results obtained in our study, the important pull factors encouraging healthcare professionals to continue their careers in Pakistan included 'social and cultural aspects' as evidenced by 42.9 % out of 49.4% of participants strongly favoring this factor. Besides this, 'desire to serve the country' and 'settling in Pakistan' also came as responses by 66.7% of participants. Similar factors were noted as important pull determinants in a research conducted in one of the private medical colleges where 73% of newly inducted medical students preferred staying at home country [15].

On the other hand, the two most unfavorable factors hindering the doctors from training in Pakistan appear to be 'zero empathy' and 'lack of facilities for both fellow doctors and patients'. In this regard, the results were 100%, and all respondents considered it a foremost reason. 'Poor salary and doctor security' contributed as the main factor in 50% of cases for going abroad because doctors in Pakistan are underpaid compared to their working hours and the expertise and skill required in their setup. These results are homogenous with one of the similar researches conducted in Pakistan which pinpointed low pay, violence, and job insecurity as some of the important factors ⁽¹⁶⁾. These push factors have no border restrictions as graduates from other developing countries like Nepal, India, and Bangladesh, etc. also contemplate these factors i.e., poor salary structures, poor quality of training, and poor work environment as the cardinal factors for leaving their mother country [17]. The thought of gaining International experience was supported by 76.3% of students. Comparing our study to earlier ones, although the ratio has decreased, brain drain is still a major problem for a third world country like; Pakistan where after spending as much as 35,000 US Dollars on medical students [8], no significant positive outcome related to improvement in health sufferings is seen.