A wave of frustration is still sweeping through Nepal’s medical fraternity. On social media, healthcare professionals have publicly criticised the Nepali healthcare system for pushing them out rather than developing them. Recent social media posts emphasise that medical professionals who originally committed to serving remote rural areas in Nepal are leaving the country for better opportunities after a couple of years of suffering from low pay, lack of career advancement, workplace violence, degrading public health facilities, and an unclear future.

Similar voices echo everywhere. The young MBBS graduates question why they are forced to endure mandatory bonding and face stalled careers, where the postgraduate aspirants describe the annual Common Entrance Examination (CEE) as a mental health gauntlet that leaves many broken before they even begin specialising.

The discontent is not abstract. It is rooted in policies that have long treated doctors as bonded labour rather than professionals. Under the bonding scheme introduced after MBBS and extended to MD/MS programmes, graduates who received government scholarships or subsidised seats must serve two years in remote or underserved districts.

Many describe the experience as career-stalling at best and professionally ruinous at worst. Living conditions are often terrible. There is no inspection, inadequate infrastructure and facilities, and low remuneration. Research and in-person evidence from healthcare experts show that the system, supposed to preserve knowledge in rural Nepal, actually fosters animosity.

Doctors describe feeling professionally detached, academically stagnate, and emotionally fatigued. Far from building loyalty, the bonding period accelerates decisions to emigrate. Once the bond is served, many pack their bags for the United States, the United Kingdom, Australia or the Gulf, where better pay, a safer environment, and genuine growth await.

The situation even worsens at the postgraduate level. The Medical Education Commission (MEC) conducts the CEE for 1500-2000 MD/MS seats just once a year. For tens of thousands of young doctors, this single high-stakes exam determines whether they can specialise in Nepal or must wait another 12 months. The syllabus is vast and uncertain, competition ferocious, and preparation often collides with exhausting clinical duties.

Resident doctors are frequently forced to work 36-hour shifts while studying, earning salaries that barely cover their own living expenses. Mental health surveys among Nepali resident doctors consistently show extremely high stress levels, with some incidents of suicide. Unmarried practitioners do not get sufficient time to plan for their families due to academic burden. Whereas those in government hospitals report workplace violence, harassment, uncertainty in salaries, restrictions on their career growth, unnecessary politics, and the highest work burdens. Suicidal ideation frequently appears in the data. The once-a-year Common Entrance Exam for postgraduate aspirants has turned their dreams into a psychological endurance test rather than a merit-based gateway.

Compounding the problem is a rigid insistence that doctors must clear the CEE even if they intend to pursue postgraduate training abroad. The government and MEC argue this maintains standards. Yet the logic collapses under scrutiny. If a doctor receives training abroad and then decides to practise in Nepal, they are required to complete the NMC registration examination.  The same stringent gatekeeper applies to all experts if they want to practise in Nepal, irrespective of their country of graduation.

Using the justification that a single domestic admission test ensures quality at home to deny admittance to international postgraduate programs primarily restricts options and increases discontent among aspirants. Doctors who wish to specialise abroad are effectively punished for seeing excellence elsewhere, even though the system already has a built-in safeguard upon their return.

This is not an isolated policy failure. It is the legacy of successive governments that allowed influential doctors and what many in the profession quietly call a “medical mafia” to shape medical education for personal gain. Private colleges proliferated with questionable standards. Faculty selections were often politicised. Seats in coveted specialities were allegedly traded. Protests by doctors and medical students over the years, from demands for transparent dean appointments to curbs on privatisation, have repeatedly exposed this rot. The previous administrations talked about reform but delivered little. Bonding was retained as a cheap way to plug rural vacancies instead of investing in infrastructure and incentives. The CEE was introduced as a merit tool, but became a bottleneck that favoured those with resources for expensive coaching.

Now, under Prime Minister Balendra Shah, also known as Balen, and Health and Population Minister Nisha Mehta, there were great hopes for reform. Shah built his reputation as mayor via initiatives to combat corruption and an administration focused on the needs of citizens. Mehta, a certified nurse with AIIMS Delhi credentials, has been recognised as a healthcare professional who understands fundamental concerns. Yet weeks into the new government, the medical community sees only continuity of neglect dressed up as publicity. Social media posts from doctors reference high-profile cases where arrested politicians are admitted to hospitals on flimsy pretexts, raising questions about selective medical leniency. The NMC has been requested to investigate this situation, but the authorities have failed to take any real action. Meanwhile, systemic problems such as inadequate employment opportunities, overworked residents, and brain drain remain unaddressed.

The Balen government’s response has been heavy on optics and light on substance. Announcements about free treatment lists and hospital compliance checks echo Shah’s earlier mayoral initiatives but fail to confront the deeper crisis: a profession that feels undervalued, over-regulated and under-supported. Healthcare professionals point out that although the government lectures them about service and patriotism, it offers no real salary reform, no flexible bonding options, no mental health support for medical trainees and residents, and no policy that permits aspiring medical professionals to train overseas without encountering red tape.

The consequence is predictable and horrible. Nepal’s best and smartest physicians are voting with their feet. Every doctor’s departure implies years of taxpayer-funded education lost, remote clinics without experts, and patients who do not receive prompt medical attention. The medical mafia may have been curbed in language, but its structural legacy remains. Despite its reformist appearance, the newly formed government has been unable to stop the cycle.

Instead of focusing on a single annual exam and making decisions about their whole future, they want safe workplaces, equitable pay, academic freedom, and the chance to specialise. Until the Balen administration and Minister Mehta move beyond press releases and address these core grievances, reforming bonding into a genuine development tool, opening genuine pathways for postgraduate training abroad, and confronting the mental health toll of the CEE, the haemorrhage of medical talent will continue. Nepal cannot afford to lose another generation of healers while its leaders pose for photographs. The posts on doctors’ social media walls are not mere complaints; they are a warning that the healthcare system itself is on life support.

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