The Truth Behind Doctor's Migration

The story of human migration is as old as humanity itself. People have always moved in search of something. Safety, opportunity, or simply the hope of a better life are often the driving forces. In the modern world, when a doctor decides to migrate, the motivations are no different, but the stakes feel higher.

You carry two bags when you leave.
One filled with hope — for stability, growth, a fresh start.
The other packed with uncertainty — new systems, new rules, and an unfamiliar professional identity waiting to be rebuilt.

Having gone through the process myself, and listening to colleagues who have either moved or are preparing to, certain themes consistently come up. Professional growth, Better finances, Frustration with current working conditions or plain Curiosity about how medicine is practised elsewhere.

Every reason is valid, as long as you’re clear in head about why you’re doing it and what compromises you’re prepared to make.

Migration isn’t glamorous or tragic by default; the outcomes are shaped by your current situation and expectations.

In this issue, we share the real experiences of colleagues who recently moved abroad. Hearing directly from those who have gone through this transition is invaluable. Their stories are shaped by personal expectations, circumstances, and what they hoped to find. Together, they provide a cleaner, more grounded picture of what doctors can genuinely expect when they step into a new healthcare system.

We’ll follow this issue with a webinar later this week to dig deeper into these themes, answer questions, and discuss the realities behind the decision to migrate.

— Mudassir Hussain, FCPS, FRCS (Urol), Editor

Last week, we asked our readers:

“What innovation in surgical education are you looking forward to?”

🔹 Equality, Diversity & Inclusion (29%)
🔹 Flexible Training Opportunities (29%)

Both reflect the same underlying desire: a training environment that adapts to people, not the other way around. Taken together, they paint a clear picture of what doctors are asking for: more support, fairer systems, and training that recognises the reality of modern medical life.

Results will be shared in next newsletter.

For this issue we asked colleagues around the world to share their experiences about migration, work and plans forwards.

We asked 5 questions to everyone and responses are shared below.

Urologist, Oman

1. What motivated you to move abroad?
   Low pay, rising inflation, and long working hours back home made it difficult to maintain a balanced life — especially with little concept of rest or annual leave.

2. What has been your biggest challenge so far?
   Finding a job aligned with my specialty and integrating smoothly into the system.

3. What surprised you most about working in your new setup?
   Shorter working hours, lighter workload, two-day weekends, and a handsome tax-free salary. The ability to fully utilise 42 days of leave each year for rest or travel has been a refreshing change.

4. What’s your plan going forward?
   I plan to continue here for the next few years and later explore further opportunities within the Middle East, depending on experience and available roles.

5. What will be your advice for doctors considering migration?
   Pros: Financial stability through tax-free income and savings, safety, Islamic and respectful culture, and proximity to home (just a two-hour flight).
   Cons: Limited promotion and career progression, and two-year renewable contracts that can restrict long-term security.

Transplant Fellow, Royal Free hospital, London, UK

1. What motivated you to move abroad?
   My decision wasn’t driven by desperation or circumstances in Pakistan. I wanted international exposure and the chance to see how different healthcare systems function.

2. What has been your biggest challenge so far?
   Adjusting to a new culture, different communication style, and understanding the NHS referral system. Having trained for many years in Pakistan, those habits were deeply ingrained and took time to unlearn.

3. What surprised you most about working in your new system?
   The genuine commitment to equal care for every patient, regardless of background. The focus is on treating the illness with dignity, not just managing the disease.

4. What’s your plan going forward?
   I plan to stay for a few years, complete my FRCS, and build my experience here.

5. What will be your advice for doctors considering migration?
   Plan your move early. I migrated nearly 15 years after MBBS, earlier relocation offers a smoother training path. But it’s never too late; with the right mindset, you can adapt and succeed at any stage.

Urologist, Bahrain Specialist hospital, Bahrain

1. What motivated you to move abroad?

   My decision was driven by several key factors. Primarily, I experienced a biased and non-transparent work environment, where clear criteria for career advancement and the allocation of positions were lacking. When the opportunity to relocate abroad emerged, I viewed it as a valuable chance to pursue a more merit-based and growth-oriented professional path. Furthermore, financial stability was an essential consideration. Improved earning potential provides greater freedom to plan for the future and significantly reduces stress, enabling a more balanced and productive life.

2. What has been your biggest challenge so far?

   Stepping out of my comfort zone has been challenging but rewarding. Meeting new people from diverse cultures, trying new foods, and learning new things has helped me grow personally and professionally. The hardest part has been dealing with loneliness and homesickness, but with persistence and hard work, it becomes easier over time.

3. What surprised you most about working in your new system?

   I was surprised by working in my new system is how welcoming the environment is for expats. There is almost no language barrier, and people are not culturally biased. They are always willing to help in difficult situations, and the flexible working hours allow us to make time for hobbies and leisure—something that means a lot for a healthy and peaceful life.

4. What’s your plan going forward?

   I plan to move forward when a better opportunity arises. For me, it’s not just about money, but also job security and the chance to obtain dual nationality, so that our children can have more opportunities and a secure future without having to struggle as much.

5. What is your advice for doctors considering migration?

   Migration isn’t just a move—it’s a transformation that offers financial stability, career growth, and advanced skills. Doctors leave for different reasons, and the choice depends on personal priorities. Stepping out of your comfort zone builds confidence, independence, and resilience.

   So if you get an opportunity, it’s worth taking.

Urologist, Saudi Arabia

1. What motivated you to move abroad?

   In Pakistan, everyone strives for financial stability to provide a better life for their children. For me, there were two main career paths:

   Karachi, where the work environment was excellent but the salary was modest.

   My hometown, where I could earn significantly more due to a high patient volume, but only at the cost of my physical health, as my working hours stretched from 10 AM to 2 AM consistently.

   Eventually, I felt that moving abroad would offer a better balance—less physical strain, better financial rewards, and an opportunity to gain experience in a more developed healthcare system. This combination motivated me to take the step.

2. What has been your biggest challenge so far?

   Communication barriers and adapting to a new workplace culture.

   Adjusting to the workflow, where even routine cases take longer due to strict protocols. For example, patients we typically manage within 20–30 minutes in Pakistan may require 2–3 hours here once ER calls you.

   Long working hours, including an 8-hour daily schedule that can extend to 10 hours, along with around 15 days of 24-hour on-call duties each month.

   Mental stress, as the system feels restrictive. Unlike Pakistan, where we can think and act more freely with clinical wisdom, here you often feel constrained by rules, documentation, and strict adherence to protocols.

   Altogether, the workload combined with the mental pressure has been one of the most significant challenges.

3. What surprised you most about working in your new system?

   The most surprising aspect has been the completely paperless system. I even brought two packs of pens from Pakistan, which I haven’t used at all. Every detail must be documented electronically, and once entered, nothing can be changed or overwritten, making accuracy crucial.

   Another major surprise is the extent of medicolegal concerns and litigation. Every doctor must have medical insurance, and due to these legal risks, surgeons prefer less invasive procedures, such as performing REZUM for all prostate sizes or doing multiple RIRS sessions for stones that we would treat with PCNL back home.

4. What’s your plan going forward — stay, move again, or return home?

   My stay here is temporary. I came primarily to save some money and gain exposure so that I can eventually establish my own setup in Pakistan, where I can practice more freely, apply my clinical wisdom, and serve my own people—who, in my view, have the greatest right over me.

   So yes, I definitely plan to return home.

5. What is your advice for doctors considering migration?

   It truly depends on the individual’s goals:

   If someone’s primary aim is financial stability and they are not particularly focused on performing a wide variety of complex surgeries, then migration can be a good option.

   However, if a doctor wishes to perform diverse surgeries, grow surgically, and work with independence and clinical wisdom, then Pakistan—especially government and trust hospitals—offers far better opportunities for skill development.

   Also, healthcare systems abroad are not like Pakistan. Treatment is extremely expensive, and while their residents are insured, patients from other countries often suffer due to costs. In contrast, Pakistan’s government and trust hospitals provide free or highly subsidized care, which makes it emotionally difficult when I am unable to help my own people in the same way while abroad.

Urologist, Samtah General Hospital, Jizan, Saudia Arabia

1. What motivated you to move abroad?
   Every country offers a different advantage — some promise academic growth (UK, USA, Malaysia), others offer financial uplift (Middle East). For me, the move was driven by one reason: securing a better financial foundation for my family. I wanted to provide my children with quality education and a higher standard of life, and the Middle East gave me the opportunity to do that.

2. What has been your biggest challenge so far?
   The toughest adjustment has been the working environment. Unlike Pakistan, hospitals here are filled with doctors from diverse countries, religions, and training backgrounds — everyone brings their own approach. Even simple procedures become multi-step tasks: paperwork, bookings, approvals, coordination. Something as basic as placing a DJ stent or arranging a PCN, which I could easily handle independently, now requires extra layers of process and inter-departmental negotiation. And the moment an intervention is in another hospital, the complexity doubles.

3. What surprised you most about the new system?
   The biggest shock has been the pace. In this part of the world, “urgent” rarely means urgent. Delays don’t seem to bother anyone. What can be done today is comfortably pushed to tomorrow.

   The second surprise is the fear of complaints and litigation — it heavily shapes decision-making. People prioritise protecting themselves over taking responsibility, and the entire system becomes overly cautious.

4. What are your future plans?
   I strongly believe the most meaningful place for a Pakistani doctor is Pakistan. My plan is clear: use this phase to secure my family’s stability, fund my exams, strengthen my CV, and then return home. I see myself working in my own clinic in Pakistan within the next five years. Our own people deserve competent care from their own doctors.

5. What advice would you give doctors considering migration?

   Have a clear reason for moving. Once you step out, the path changes permanently — weigh your decision carefully.

   Don’t expect a problem-free world. You’re swapping one set of challenges for another.

   Be ready to start from zero. New country, new system, minimal support — the first year will test you.

   Keep your family’s needs at the centre — education, well-being, responsibilities back home.

   Blend in initially. Even if you’re skilled, people can feel threatened — be smart and steady.

   Stay alert to workplace politics. Multinational environments come with their own complexity.

   Don’t lose your identity or drive. Keep progressing even if others are stagnant.

   Stay level-headed. Frustration is normal. Remember: they need your skillset more than you need their approval.

Here is summary of Ureteric stone management based on EAU guidelines.

1. When is conservative / MET appropriate?

   • Stable patient, no sepsis, no solitary kidney, no obstructive AKI.

   • Distal ureteric stone, usually ≤10 mm.

   • Offer medical expulsive therapy (MET) with an α-blocker (e.g. tamsulosin) mainly for distal stones >5 mm if no contraindications.

   • Ensure clear safety-netting and follow-up imaging.

2. When is urgent decompression mandatory?
   Immediate drainage (stent or PCN) is indicated if there is:

   • Obstructed kidney + infection / sepsis

   • Anuria, solitary kidney, or bilateral obstruction

   • Progressive or severe renal impairment

   • Pain refractory to analgesics

3. Choosing the definitive treatment (once stable):

   • <10 mm distal stone: URS or SWL; URS preferred if rapid, definitive clearance is required.

   • Proximal or >10 mm stones: URS is usually first choice; SWL can be considered if anatomy and stone characteristics are favourable.

   • Very large / complex burden or multiple stones: consider staged URS or PCNL depending on size, location, and local expertise.

4. Imaging and follow-up:

   • Non-contrast CT (NCCT) is the gold standard for diagnosis and planning.

   • After conservative management or intervention, arrange follow-up imaging (US, KUB, or CT depending on context) to confirm stone passage and exclude silent obstruction.

In this issue, lets dive into SUSPEND trial (Lancet, 2025) which contradicts widely used practice of using alpha-blockers for MET

Study design

• RCT, multicentre, UK

• 1167 patients with ureteric stones ≤10 mm confirmed on imaging

• Randomised to: Tamsulosin 400 µg, Nifedipine 30 mg, or Placebo

• Follow-up at 4 weeks

• Primary outcome: Need for further intervention to achieve stone clearance

Primary Results

• No difference in the need for intervention

  • Tamsulosin: 19.1%

  • Nifedipine: 20.0%

  • Placebo: 22.4%

• No difference in pain, time to passage, or quality of life

Limitations

• Too many small stones that would pass anyway

• Mixing proximal and distal stones

• Weak primary endpoint (“need for intervention”) rather than confirmed stone passage. Short follow up (4 weeks)

When doctors think about migrating, most of the focus goes to exams, visas, contracts, and salaries. What rarely gets space in the conversation is the emotional weight that comes before the move. The quiet fears, the guilt, and the internal tug-of-war that starts long before the plane takes off.

There’s the guilt of leaving parents, the worry about missing milestones, and the uneasiness of stepping away from a system where you finally felt competent. It’s normal to wonder whether you’re being selfish, whether the move is “worth it,” and whether you’ll still feel connected to the people who matter most once distance enters the equation.

Homesickness starts even before you leave. You begin noticing the things you’ll miss. Familiar routines, effortless social interactions, the comfort of being understood without explanation. And then comes the biggest uncertainty:

Will I belong there? Will life feel lighter, or will it get heavier in new ways?

If you’re considering migration, give yourself permission to acknowledge these feelings early. They’re not signs of weakness — they’re signs of awareness.

Bring clarity by asking yourself:

• What am I seeking — money, growth, stability, or escape?

• What trade-offs am I genuinely willing to live with?

• What parts of my life here will I miss the most — and can I maintain them from afar?

• Who will I become if I step into a completely new system?

And remember: feeling torn is normal. Migration is not just a career shift — it’s an emotional shift.

Preparing for that side of the journey is as important as preparing your documents.

Next Webinar – 28th Nov 2025
Topic: Navigating International waters - The Pros, Cons and Logistics of Migration as Doctor
Time: 10:00 PM (Pakistan Standard Time) / 5:00 PM (UK)

🔗 Register here

Migration isn’t just a professional move, it’s a recalibration of your entire life. The conversations and experiences shared in this issue show that every doctor who steps into a new system carries a mix of ambition, fear, hope, and doubt. There is no “right” reason to move, and no perfect timing. What matters is clarity. Knowing what you’re seeking, what you’re willing to trade, and what you hope to build next.

If you’re considering migration, treat it as both an opportunity and a responsibility. The opportunity to grow in ways your current system may not allow and the responsibility to understand the emotional and practical realities before you dive in. Listening to those who have already walked this path helps create a more honest picture, and that honesty is what we hope this edition delivered.

We’ll continue the conversation in our upcoming webinar later this week, where we’ll unpack these themes further, answer questions, and explore what it truly means to build a career across borders. You’re invited to join, share, and reflect, because the journey is easier when it’s not taken alone.

— Mudassir Hussain, FCPS, FRCS (Urol), Editor