Kabirhat Upazila lies 40 minutes down an unpaved road from Maijdi, Noakhali's administrative headquarters. Dr Fariha, a medical officer posted there, took three days of calls to reach. She finally answered between a 12-hour emergency shift and evening preparation for the FCPS, Bangladesh's main postgraduate medical qualification.
"During flu, dengue, or measles season, the pressure is exhausting," Dr Fariha said. "I once saw around 120 patients in a single morning. Unlike large hospitals, we have no clinical assistants to manage the queue. Patients crowd around my table, talking over one another as I try to examine someone."
About 150 kilometres to the north-west, in Manikganj, Dr Abdullah Salman had just started a 24-hour shift at his sub-district health complex when he took the call. Ward staff and the relatives of arriving patients interrupted him three times before he could explain his schedule.
"In Bangladesh, once you finish your five-year MBBS and the mandatory one-year internship, the options narrow very quickly," Salman said, speaking during a brief pause between admissions.
"Either you find a way to leave the country, or you stay. Those who decide to leave will either sit for expensive foreign licensing examinations or abandon clinical practice entirely to pursue other fields," he added.
According to Dr Salman, if one stays, he faces another immediate dilemma: whether to prepare for postgraduate entrance examinations first, or to sit for the Bangladesh Civil Service (BCS) examinations.
"If you are selected for the BCS health cadre, you are required to serve your first two years in an upazila health complex. That rural posting is mandatory."
Every year, roughly 11,000 students graduate from medical colleges across Bangladesh, after competing with over 1 lakh applicants for government seats. Five years of hard work and a one-year internship later, many expect a life of financial security and social dignity.
Instead, many face a harsh reality in rural postings and postgraduate training: an underfunded public health system, inadequate equipment, poor housing, and the threat of violence from patients' attendants.
Dr Tasnia Afroz, 27, is finishing her internship at Chittagong Medical College Hospital, with heavy ward duties and overnight emergency calls. She is already wondering whether she can stay in medicine at all.
"I am completely confused about what to do next," Dr Tasnia said during a break from rounds. "I will sit for the BCS, because that is what everyone does, but I know that serving in an upazila health complex will be quite difficult for me. Moving abroad has become far harder than before. The licensing exams cost an immense amount of money, which I cannot afford right now."
The only visible domestic option for her is to study for the FCPS entrance exam. But that training programme, which is supposed to take five years on paper, realistically takes from seven to twelve years to complete.
"Looking at the sheer physical exhaustion of these shifts, I find myself thinking about changing my career path altogether. The schedule is becoming unbearable," she said.
Patients in the sub-districts often expect something different from what a public clinic can give. At Kabirhat, Fariha spends much of her morning with people who have come for free medicine.
"Many patients come solely for free medicine," Fariha explained. "They arrive with common complaints like back pain or headaches and insist on iron, calcium, or paracetamol, believing these cure everything. It's frustrating to spend ten minutes explaining why they don't need supplements while patients with life-threatening conditions wait outside."
Patients often judge young doctors by gender and age. They often assume they possibly are not "proper doctors".
"I'll be taking patients' histories and writing notes, yet they'll look past me and ask, 'When will the doctor come?' They don't take me seriously. It used to bother me, but I've learned that people are accustomed to seeing older men in white coats. You learn to ignore it and get on with the work."
The strain goes beyond the consultation room. Housing is a problem from the day a young doctor arrives.
"The quarters provided to doctors in the upazilas are in a terrible state compared with the accommodation provided to officers in the administrative cadres," Dr Tasnia noted. "Administrative officers receive well-maintained residences, domestic staff and institutional backing. Doctors, by contrast, are assigned quarters that have often stood empty and neglected for years."
Fariha's own experience shows what that means in practice.
"I live in Maijdi, about 40 minutes away by road, so I do not stay in the government quarters at the health complex. My colleagues live there because they have no other choice. Though relatively new, the buildings still face frequent water shortages and power failures," Fariha said.
"In some remote areas, the quarters have stood empty for years and fallen into disrepair. When a female doctor is posted to such an area, basic living conditions become an urgent personal safety concern. That is why almost every doctor looks for an opportunity to transfer to a district hospital or a major city."
Before the latest batch of civil service postings arrived, Kabirhat had only three doctors. They split the 24-hour emergency cover, ward admissions and outpatient work between them. Earning extra through an evening practice is mostly closed off as well.
"If an MBBS doctor posted to an upazila wants to open an evening chamber, it is usually impossible unless you are a local resident or possess strong political connections," Dr Tasnia explained.
"In these sub-districts, private practice is largely controlled by Sub-Assistant Community Medical Officers (SACMOs), who hold diplomas rather than MBBS degrees. Having practised locally for decades, they have established clienteles, family networks and political influence. They often see newly posted MBBS doctors as a threat and use local syndicates to make it difficult for them to practise," she said.
Doctors who skip the rural postings and go straight into fellowship training at urban teaching hospitals are not much better off.
"If you do not enter the government cadre and pursue FCPS training after your internship, you must first pass an entrance examination," Dr Tasnia said.
"The monthly stipend for non-government trainees was recently raised to Tk35,000, but it is paid only every six months. By then, trainees are typically around 30, many with spouses, children and ageing parents to support. How can they cover their families' living costs without an income for six months at a time?"
She added, "When I look at my school friends who went into engineering or general universities, many of them have already secured good jobs or moved abroad. If they want to leave, they can pursue fully funded master's degrees or PhDs on scholarships."
The public perception of doctors, she said, comes from the small number of senior specialists who are visibly successful.
"People assume doctors earn vast amounts because they see senior practitioners running private chambers," Dr Tasnia said.
But reaching that stage often requires multiple postgraduate degrees and takes until your 40s. Without those qualifications, an MBBS doctor's income depends on luck, family support and local popularity.
"Many trainees still rely on their parents despite exhausting shifts, low pay, delayed stipends and public hostility. After completing my MBBS, I understand why so many young doctors feel defeated."
That hostility sometimes turns physical. When a seriously ill patient reaches an upazila facility, the hospital's limits can put the doctors on duty in danger.
"We now refer seriously ill patients to better-equipped hospitals because we cannot safely manage them here," Dr Fariha said.
"Recently, a patient arrived with acute asthma and severe breathing difficulties. I referred him to Maijdi district hospital because we have little beyond basic oxygen support. But his relatives insisted on admission, and we had to comply."
"When his condition worsened despite initial treatment, they threatened to attack us before we could even adjust his oxygen support. We managed to defuse the situation, but I was terrified. You realise then that you have no physical security whatsoever."
It has happened elsewhere, with worse results. On 16 May 2026, a patient died at Shariatpur Sadar Hospital, and a group of relatives stormed the emergency department and beat the doctor on duty, Dr Md Nasir Islam.
Police rescued him with head injuries that the district hospital had no equipment to treat, and he was flown by air ambulance to the intensive care unit at Dhaka Medical College Hospital. Doctors' associations responded with protests across the country, including human chains along public roads, over the lack of protection.
Senior doctors are not spared. In August 2026, Professor Dr Asadur Rahman, head of the ear, nose and throat department at Dhaka Medical College Hospital, was attacked in the capital as he tried to get into a vehicle outside a private diagnostic centre. Police remanded a suspect, Farhan Shahriar Evan, in connection with the attack.
Similar assaults have been reported in Sylhet, Panchagarh, Dhaka and Rangpur. The World Medical Association has issued statements voicing grave concern about the safety and working conditions of healthcare workers in Bangladesh.
Young doctors are often criticised for abandoning the communities that need them most. But a sense of duty cannot compensate for unsafe accommodation, the threat of violence or an uncertain income.
A health system that relies on its youngest doctors to endure such conditions will continue to lose them. Those who choose to leave are not turning their backs on their profession; they are trying to build a future in which they can practise it with dignity, security and hope.