This is just a click-bait. I am going to talk about something else.

First of all, let’s understand the risk in becoming a doctor. A driver starts his career at age 18 when he gets his license.

A doctor starts training /education to be a doctor at the age of 18 and goes on for 15 years – MBBS, MS, MD -so he is 33 years by the time he starts earning his “fees”. Yes, even before that he is paid some “stipend” – but that covers his expenses, so I would not deem it as an income.

Now, for a middle-class family, this is a HUGE RISK. The boy or girl has to be academically superior (the number of seats for upper-caste children is abysmally low), physically very fit, mentally superior, and willing to sacrifice the best 15 years of his/her life, and be willing to spend a fortune of their money. This is not easy, and neither is this compensated for.

Of course, if I were running a medical college I would be able to tell you how expensive it is to run it, and how my fees are justified. In fact, doctors pay back to society in terms of service far more than what other professionals pay. Have you heard of “community service” by lawyers, actors, chartered accountants….?

I have still not come to today’s topic. That is “pricing by hospitals”. Most of our population want 5-star service, excellent infra, trained staff. Even more importantly, doctors do not decide on the pricing in hospitals.

Here is the feedback from a doctor.

I’m sorry to make an unasked for comment. Apologies in advance if what I’ve written offends anyone’s delicate sensibilities.
I’d like to bring a few facts to public notice. Doctors do not decide the payment structure and policies of hospitals. They are paid a fixed retainer every month. The policies and the charges are decided by the corporates or the management of the hospital which might or might not consist of people who have anything to do with the medical profession directly.

I’m greatly saddened to inform you that even doctors are being exploited for our skills. The sad, slow but sure demise of private nursing homes because of political and corporate conniving has resulted in a very wide chasm between treatment rates and the man with less money hasn’t any options left. But making doctors the scapegoat is not the answer by any length of imagination.

Furthermore, more than giving moralistic lessons to doctors, my humble suggestion is that we need to focus on the things that we all are supposed to do right. And when we’re sure that there’s not A SINGLE MORE thing that we can do better/more correctly, only then can we even think about starting to delve into issues about which we have but very less knowledge. My sincere request to not propagate such blatantly misguiding material which .I’d be grateful if my request were to be heeded. Thanks. Have a good day, everyone.

One more thing I’d like to express is that it was Doctors’ day on the 1st of July. I do not know how many people were even aware of it.
We are working relentlessly in known risk scenarios. And shall keep doing so, whether we’re thanked or are beaten to a pulp even for no fault of ours. 
This just goes on to show how the corrupt media has influenced and polluted the general opinion about our fraternity. Doctors are the softest targets for extortion from all sides as they neither constitute a very large vote bank nor do they honestly know how to retaliate. The very sad fact that there is negligible unity amongst us doesn’t help much, either. 
When it comes to teaching them lessons, it’s obviously the easiest thing to do. 
Whoever has said it has said very well, “No good deed in this world goes unpunished.”

I am really very saddened that this seems, also, to be the case when it comes to the very place that I happen to stay in.

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  1. It is very true, Sir. sympathize with the state of affairs, there is a deep rot in the system. However, if someone were sick in the family, one rush to a Govt hospital or a Pvt hospital? Does one want to be treated by a general merit doctor or by a reservation doctor? I even know people who see doctor’s surname and go for treatment. On one side one wants 5 star treatment. On other hand Many aspirants want their child to be a doctor somehow. (Lalu’s daughter is rank holder in entrance 1999 – you can google it). When the ‘somehow’ has to be satisfied, the treatment is also ‘somehow’. When many ‘somehow’ exist in society, there is a parity between costs charged and quality of service rendered. It is compromised. To balance it out, everyone wants to have (e)quality treatment at low costs. Second aspect of this is ‘capacity to pay’. Not everyone can afford superior treatment, even if they wish to get quality treatment. Where will they go? cost of open-heart surgery in India is 4K$. in US it is 40K$. Likewise, all surgeries. Can India raise to 40K$? We are in different geographies and among different demography.

  2. Harikrishna Avvaru

    Excellency in any field is mostly related to academic excellence or professional excellence which really irrelevant with our current reservation system existed in our academically and also professionally. People who have used the opportunities in proper way have been successful all over the world . one cannot categorize Merit as professional excellency depends solely on individual not generalized according to categorization existed in India.Really do not like to touch this sensitive issue, unfortunately it happens only in India, like some of our friend told and differences of pay structures got established automatically as people any way attached to these models. these social Bias/parities will continue to exist as long as we have Categories exist in our academics and employments. Unless there is some pride attached to your name and to your profession , how do you establish your fame. doctors profession is mostly a name and fame game , you agree with me that some are paid/earning like film actors. you can very well count many doctors who buy degrees (donation) from Karnataka once after getting name and fame….doing well in our great nation ! Doctors profession is divine and respectful profession, only few who have passion of doing service or few for earning good pursuit it , success rate is less across all categories that existed in India. any way one should required merit.

  3. I work in a high volume not for profit hospital as a senior consultant. I am also involved in administration and decision making. Though the doctors salaries is one of the lowest and by the end of the year there is no profit generated, the running costs are quite high, to give quality care. If we choose safe and superior equipment, they are disproportionately more expensive, with limited life span and high maintenance cost. Costs involved in keeping up with mandatory requirements – quality control, asepsis, NABH requirements, PF compliance, minimum wages compliance, fire safety, consumables bought in Euros and Dollars, number of staff of various technical expertise required etc add to the bill significantly.

    When most patients get admitted, the relatives wish to go all out. They say don’t bother about the cost. Talking about money at that time is considered inhuman. But on the other hand, once the treatment is started, several relatives keep disappearing from the scene and bills mount up. If the outcome is adverse in spite of the best efforts, again the dialogue is “Anyway you didn’t manage to save the patient; why ask for payment?”. The price cap for ICUs by several Governments defy the logic and any basis of costing, especially with the cost of oxygen, antibiotics and expenses involved. If these are not appropriately addressed, even well meaning institutions will find it difficult to cope with the demand and unrealistic expectations, to keep running the services.

  4. politicians promote and feed on reservation.. general merit guys hates reserved as it is considered as undeserving gratification and vice versa reserved see themselves as victims of oppression. This itself divides people. Moreover, The benefit is not enjoyed by people whom it is meant for either.. Even after 75 years of independence if you are not able to uplift through policy, it means policy is not working, isn’t it?.. india is 1/6th of world population, extremely talented.. yet when politicians/filmstars/ultra rich get cancer or something they fly abroad for treatment. That means you yourself trust treatment from outside. Is it not a failure of system ?

  5. @C Singh, The motive for which your business is opened: if “service for no profit” OR “profit making objective”. If (1) then you should be ready to bear the costs involved without complaints. It also means you have deep pockets and you are dedicated to humanity. If (2) business objective, then the cost-benefit analysis is not done correctly. In case of (2) you have only a couple of things to think of (i) Make in India should kick-off in theory and in practice. Then you wouldn’t have to pay $ and euros to secure medical equipment. I dont know conceptually why we still have to depend on firangi-maal. Yes agreed, only they are manufacturing (+ our failure).. (ii) Analyze the paying capacity of crowd for whom you are procuring the machines and their willingness to pay. You may chose to allocate a quota for charity. But not all. On emotional side, a person who has facilities and knowledge to treat other person, but who refuses to do so (for the want of covering costs, personal effort and time) and turns the patient away is always pictured as a blood sucker villian, no matter what your justifications are.

  6. @SS, the objective is clear – not for profit but unless the costs are covered, we can’t survive to treat the next patient. As you have rightly mentioned, only they are manufacturing the cutting edge equipment. Ventilators for example, for someone who has breathing arrest due to snake bite or pesticide poisoning, ordinary machines to pump oxygen are enough. There are dime a dozen made in India. For COVID, fine adjustments are required to make a life or death difference. If I ever need to be on a ventilator, I would like to be on a ventilator which has fine features and not one which I know for sure I won’t make it. If my intention is to be showing to be doing something knowing very well the patient won’t survive, the first one is enough but it is a long way before the second one will be made in India.And I believe in doing unto others what I would have others do unto me.
    The last point you mentioned is very true. But our Indian community has money for festival celebrations, marriages, tours and the like. But when it comes to their health, they expect someone else to spend. The Government also spends a very small portion for health. So if one truly wishes to serve, give high quality care, expect to break even, the only way is to over charge another one to subsidize the first who has spent all the money for marriage and numerous other functions!

  7. @c singh, the points you mentioned are valid. You are following model (1), then it matters how much scaled up is the organization. The high scales up orgs register themselves as charitable trusts, approach government for tax breaks, solicit donations from people and also tie up with companies like a partnership for the co’s mandatory CSR activities. A very significant fund raising and cost coverage is done this manner I believe. However if you are scaled down then you cannot dream of procuring multi speciality equipments and run at zero costs. It will surely burn up all cash at fast pace, no matter how much good your intentions may be to render service. You may want to check with some cost accountant and work out sustained operations.
    In india people spend on festivals,tour etc etc… by their own wish and enjoyment. No one goes to doctor by their own wish. They are forced to by the ailment. Thus reluctance to spend and a psychological feeling of money drained on (seemingly) unproductive task. What do you think? 🙂

  8. @ss, I work in a very large scale organization. The tax breaks that existed earlier have been taken away! We had VAT exemption but now we are killed by GST with no exemptions! Even for the drugs that are distributed free, it is considered “promotional expenses” and any input tax credit availed needs to be paid back! Most large companies with CSR shut the door telling they have donated to PM cares fund and other Government projects that show case national integrity. We do get a trickle but the needs are huge. Exemptions for excise duty and import taxes are tagged with unrealistic clauses. I wish some sympathetic consideration will be given by the Government for genuine institutions willing to undergo required scruitiny.
    I agree, people spend on things by their wish and enjoyment. But in addition, when they come to health care facilities with no money, their expectations are sky high, top of the line, with no potential risk (which necessitates some very expensive imported equipment) and the last thing they wish to talk about is the expense involved. They think it is not their head ache!

  9. @C Singh, Are you sure? I think the IT u/s12AA has been made more stringent. Charity institutions have to comply with the additional requirements is understandable from Govt perspective, because there was lot of hawala and black money flowing in the viens of NGOs earlier. The verification for Govt is an overhead and so they are bit cautious. But, large scale orgs the finance sheets would be generally clear and AO will not be pick it up for petty disputes. If you are non-profit, from tax angle you dont have any tax. (There is no income exceeding expenses, hence no tax). You need to have bills and verifiable modes of income and expenditure.

    We cant pin people. It is like rule of the game in charity institutions. Illustrating: if you were to walk down the road imagine you find some 10 hungry ducks caged in a farm. You feel sorry for the ducks and decide to feed them, and so strike a deal with them. You have 50 Rs in pocket and decide to buy them bread. You decide to charge 6 Rs (6×10=60) thinking, suppose 2 ducks default, still your 50 Rs is more or less covered. They seem to agree. You go and buy bread and throw the bread crumbs at the ducks. Ducks eat the crumbs happily. They dont pay up! You lost 50 Rs but you cannot say a thing! In this story, ducks are acting perfectly normal. On the other hand you are acting abnormal, ducks are birds and they will not pay. That is rule of the game, like snake and ladder you cannot go up a snake, like in chess, rook will not move diagonal. You have to rely on others in framework to cover costs. No other go.

  10. @SS, actually there is a slight twist to the story! The happiness you get when you see the hungry ducks feed, is far more than what 50 rupees can buy. That is why working in not for profit organizations one has more to gain, though not monetarily. The only challenge is when you run out of the 50 rupees, you are helpless when you see the next bunch of hungry ducks. You only wish there is some way to feed them, when the rest of the world is unable to help!

  11. @C Singh, Leaving the emotional aspect aside and focusing on money aspect in this blog.. So we agree that:
    1. There is always a next bunch of ducks. That is unlimited. But 50 Rs in the pocket is limited.
    2. If you procure bread making machine for the ducks. You do not expect the ducks to pay, do you ?
    3. 50% of ducks may give you egg in return. But others are males 🙂 You think, if they give, okay, else other sources.

  12. The only solution here is to:
    1. Make public servants (ministers, bureaucrats) avail Rx in India itself – if they wish to avail foreign Rx, they must pay from pocket, not out of taxpayer’s pockets
    2. Codify the medical education system – make it more practical and skills-oriented
    3. Empower and train nurses to play a more important role. Currently, the entire responsibility of a patient’s health is on the shoulder of a single Dr. Modern medicine is a team effort, with each member playing almost an equal role.

    I trained at an institute of repute (double digit rank in national exam , both MBBS and PG) Trained in Intensive Care – worked in NGO hospital for several years – burnt out by 70 hour weeks and being on call – moved to another country because I felt that my physical and mental wellbeing is more important than romantic notions of ‘service’. Even the best Dr is minutes away from losing a patient and getting thrashed by relatives.
    Service can wait. I would rather earn more money abroad, and donate a sizable %age to charity !!

  13. I did not know our MBBS was valid outside India. @BS, Barring few and south Asian countries, other countries do not accept it, they require some Licencing tests (like USMLE) to be cracked before you can practice there. Cracking these is a steep climb.. Curious to know the country and what the exams are. Is it NZ? By the time you complete the course work a good amount of your time is lost. In other countries, relatives may not thrash, but if (and only if) there is medical negligence, one could end up in jail for life or pay hefty compensations. I think a large sum of payments to hospitals and doctors come mediclaim-cards from medical insurance cos (rather than individual pocket) so the capacity to pay is high. ‘romantic notions of service :)’ good one… It is hard in India and laws are soft, some people are illiterate and loss leads to hooliganism.

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