The study investigated how family collective agency influences the career decision-making of medical and dental students in Peshawar, Pakistan, through 32 semi-structured interviews with students aged 20–25 years (18 medical students and 14 dental students). Research has revealed that career decision-making in this collectivist context does not operate on the basis of individual autonomy, but on the basis of family reasoning and cultural norms. Clinical stress was often interpreted by students as family honor (izzat), and economic responsibilities significantly shaped men's specialization trajectories. For women, career plans were constrained by expectations related to marriage and pre-screening of specialties. Female students faced gender-based marginalization, including exclusion from examinations of male patients and limited access to night shifts. The study identified the "doctor's daughter" paradox, where women's medical education was encouraged but postgraduate practice was restricted. The absence of female role models in surgical specialties reduced female students' surgical self-efficacy. The results suggest that policy in medical education should recognize career decision-making as a family process, not just an individual decision.