Thirty-six thousand doctors no one can verify

In November 2024 the Bangladesh Medical and Dental Council said something a regulator almost never says out loud. It admitted it did not know who its doctors were.

The numbers it gave: roughly 134,568 registered physicians. About 36,000 of them practicing on registrations never renewed. An unknown number registered with forged documents, unknown not as a turn of phrase but because the council cannot tell. And no count at all of the people practicing with no registration whatsoever. The body whose entire job is to say who is a doctor told the country it could not reliably say who is a doctor.

Sit with what that does to a piece of paper. A prescription in Bangladesh is signed, and the signature is supposed to mean a licensed physician stands behind it. But if the register itself cannot separate the licensed from the lapsed from the forged, the signature means whatever the person holding the pen wants it to mean. The honest doctor with thirty years of training and the man who bought a stamp produce the same artifact: a name, a scrawl, a prescription. At the point of care, nothing tells them apart.

This is not the doctor's failure. It is a verification failure, and it sits underneath almost everything else that is broken. The pharmacy cannot refuse an antibiotic with confidence, because it cannot confirm the prescription came from a real prescriber. The patient cannot trust the specialist, because the registration on the wall could be anything. The hospital admitting a transfer cannot check the referring doctor. Every one of these is the same hole: the prescriber's legitimacy does not travel with the prescription, and the registry that should settle it cannot be trusted and often cannot be reached.

The instinct is to fix the registry. Clean the list, renew the lapsed, hunt the forgeries. That work matters, and it is slow, and even a perfect list does not solve the problem, because a list sitting in the council's office does nothing for the pharmacist in the Lakshmipur bazaar at nine at night. He is not going to phone Dhaka. He needs the answer at the counter, in seconds, and the list cannot come to the counter.

A signature that verifies itself can come to the counter. Give the doctor a cryptographic identity, an identifier that resolves to a public key, and his prescription is now signed with a key only he holds. Anyone can check it against his published key without calling anyone: the pharmacy, the hospital, the next doctor, the patient. The forged prescription fails the check. The lapsed registration shows as lapsed. The real doctor's signature verifies every time. The legitimacy travels with the prescription instead of waiting in a registry no one trusts.

The bootstrap is the honest part. On day one the council is not yet issuing these credentials, so the first version is weaker: a doctor's identity is self-asserted, with its provenance disclosed plainly. This is a doctor who signed up and showed his registration number, not yet a doctor the council has vouched for. As institutions begin to issue, the same identity grows stronger without the doctor changing anything. A hospital confirms he is on staff. Eventually the council itself signs his registration, and the credential reaches its full weight. The trust is built in layers, from self-asserted to institution-vouched to council-anchored, and no layer pretends to be a later one.

There is a doctor at the center of this, and it is worth ending on him. Today his real registration is indistinguishable from a forged one, which means the forgery costs him something. It cheapens the thing he earned. A verifiable identity is the first time his legitimacy becomes legible at the point of care. He is no longer asking the pharmacy to take his word, the same word a forger could offer. He is offering proof. Thirty-six thousand unverifiable registrations is not a scandal to be managed. It is the clearest statement anyone has made of why the identity layer has to exist. The council named the hole. This fills it.