In the last few decades, Nepal has made significant leaps in medical education, but important disparities remain, necessitating a debate on the way forward. Having scaled its annual MBBS intake to 2635 seats across 29 Medical Education Commission (MEC)-accredited colleges—a near-50-fold increase since the 1990s—the country confronts a “paradox of abundance and scarcity”: abundant graduates and scarce specialists, especially where they are most needed!