Entering a five-star luxury hotel in Washington DC on the long fourth of July weekend, the Independence Day of the US, if you spot hundreds of well-dressed Pakistani families chatting in the lobby or roaming in the hallway, you do not have to ask who these people are and what is going on. Instead, you can be certain that the annual meeting of the All Pakistani Physicians of North America (APPNA), the largest organisation of Pakistani physicians in the US, has commenced. This year, because of Ramzan though, APPNA has moved its dates to mid-August. Although the conference is highlighted as a learning activity, in reality it is far more than that: it is a place to party, a gathering to enjoy music, an opportunity to shop and a forum to discuss Pakistani politics. As most physicians attend the lecture series during the daytime, their families either leave the hotel for a tour of the city or spend time shopping in the temporary mini-mall within the premises, set up by Pakistani brands to sell their overpriced clothes, rugs, paintings and jewelry. Then why is the annual APPNA meeting so popular among physicians? Notwithstanding the lack of excitement in the daytime, the real fun begins in the evenings for almost three consecutive nights in which the group enjoys lavish dinners and music concerts. Not only that, they also share old memories with their friends during the meetings of their respective medical colleges, go to poetic symposiums and discuss current events in Pakistani politics. One more thing that you cannot ignore: once you enter the lobby and take a closer look at the people, you will notice the ruthless display of wealth. It is flaunted in everything — their luxury suits, their upscale jewelry and branded handbags, in their shoes and their make up, in their cars and their unique timepieces. With hundreds of dollars in annual fees and thousands of affluent professional members, we know APPNA is not a poor organisation; it is a rich one. Furthermore, according to the latest trend, much like a seat in a provincial Assembly in Pakistan, the contestants for the executive committee spend thousands of dollars out of their own pockets to get elected and represent the organisation for one year. It has become a rat race, seriously. Albeit, hesitantly though, I call APPNA poor, poor in its imagination and its ability to bring much needed reforms to the medical education of Pakistani physicians and poor in its progress sheet in building any consensus for such an effort. Even the constitution of APPNA, where its aims and objectives are enumerated, is quiet on this subject. It does not mention any plan to improve the quality standards of medical training in Pakistan. Here are the two points of interest from its constitution: article 3.4) To encourage medical education and delivery of better healthcare in Pakistan specifically by arranging donations of medical literature and medical supplies, and by arranging lecture tours, medical conferences and seminars in Pakistan. Article 3.6) To inform and educate decision makers and opinion making leaders in problems confronted by the medical community in general and Pakistani-US physicians in particular. The reasons for its failure as an effective organisation in leading the reform agenda are numerous and beyond the scope of this column. However, relentless bickering of the members against each other, the ethnic divisions within the association and focus on self-projection are just a few one can name. And this is how it is done in the community to impress others: some members gloat over their handshake with the president of the US, the others boast about their tour of Capitol Hill and still others crow about a conference with US legislators. Furthermore, just like the jealous wives of a polygamous husband, the members squabble with each other over petty issues, as a matter of routine, despite their professional success and seemingly decent behaviour. Arguments can begin with something as small as the seating arrangement at the annual meeting. All hell can also break loose if their name has not been announced in the list of contributors and their ‘hard work’ has not been acknowledged. However, in case one of them has not been given enough time to make a small speech during the conference, the sky will have to fall down at that moment, leading to years long rivalries and further fragmentation in the organisation. Is their any hope to turn things around then? Even with all its minor and major shortcomings, we have to admit APPNA still has great potential for serving the medical community in Pakistan, not because it can supply modern medical equipment and updated literature but because it can help and guide policy makers to improve the level of training in their country of origin. If only the former is done then, as it is experienced by many well intended physicians who have provided ventilators and other expensive medical devices, physicians in Pakistan get intimidated, and, instead of appreciating the noble cause, they start questioning the real motive behind the fund raising. This leads to bad taste: on the receiving end the equipment is never utilised and, on the giving end, empathy gets converted into apathy, which we cannot afford as a nation. With all the private medical schools that have mushroomed in the last few years, I believe the quality of medical education, which was not commendable to begin with, must have further dropped and the standard of training compromised. After graduation, these young physicians without proper support can wreak havoc in society with misdiagnosis and maltreatment. The whole profession of medicine will eventually suffer along with the patients. To avoid this impending ‘tsunami’, APPNA needs to write policy papers, meet with the authorities, challenge quality in the courts and, in short, use its full potential to improve medical education in Pakistan. The writer is a US-based freelance columnist. He tweets at @KaamranHashmi and can be reached at skamranhashmi@gmail.com