`Hospitals should make doctors stakeholders to ensure success’

Soumya Viswanathan - Mumbai

In healthcare, it is always the doctor-patient relationship that is most talked about. A more important one, that between hospital and doctor has never been paid heed to. The bad blood prevailing in this relation is acknowledged and accepted.

Medicos say that hospitals and doctors have always been adversaries. And they will continue to be, if hospitals do not change. The main reason for this hostility is that the goals of the hospitals and the doctors’ personal ambitions don’t match completely. Simply put, what frustrates the doctors is that hospitals are only interested in money. Doctors say that a medico should be earning or learning. “Both are not happening,” remarks a consultant.

Doctors complain that after leveraging on them to reap profits, hospitals do not offer a fair remuneration. This is more pronounced in Mumbai where doctors have multiple attachments and at each hospital they suffer a 30 per cent cut in fees.

Says Dr Ketan Parekh, president, Association of Medical Consultants (AMC), “Hospitals take 20-30 per cent of the doctors’ bill as service charge. This is not justified.” Agrees Dr Sangeeta Pikale, consultant gynaecologist, “The 30 per cent taken from us does not go back to the department in any form and is not accounted for.” It is this pay disparity that has led to under the table practices and hostility say doctors.

Says another consultant, “The so-called charitable hospitals in Mumbai earn enough through their departments like pharmacy and lab. The charity is finally done by doctors.”

Doctors also allege that hospitals pressurise doctors to bring more work and more money paying no attention to quality of work. Hire and fire policy has become commonplace. Dr S V Nadkarni, ex-dean strongly condemns this. “The performance of doctor is judged by the accounts department of the hospital. Hospital does not see how a doctor manages a patient or the ALOS.”

“We must realise that this relation can affect quality of care,” says Dr Parekh. Explains Dr Tarun Sahni, senior consultant, internal medicine, Indraprastha Apollo Hospitals opines, “The treatment of the patient has to take into account the management guidelines and how they perceive the relationship with the patient. The approach the doctor may have towards a patient may differ from the approach the managment may desire. This leads to mismatch and the reason why many doctors drift away to create institutions on their own so that they can “run it their way “.

Doctors also grouse that there are minor issues like equipment upgradation, investment in new facilities, selection of residents, where they are not consulted.

Experts feel that lack of proactive marketing on the part of hospitals is a reason why doctors are forced to promote themselves and “get revenue” for the hospitals. “If hospitals market themselves, they can run even with middle level doctors.”

Suggests Dr R V Karanjekar, medical director, Fortis, “Doctors are the integral part of the medical system and must be involved in decision-making. This will help the growth of the hospital. Ideally, they should be made partners in equity.”

Dr Sahni feels that good administration can bridge the gaping gap in interests of hospitals and doctors. Says Dr Karanjekar, “The problem is more with non-medical persons running the hospital. They must understand that doctors must not be caged and treated like other staff. They are a productive group and must be treated that way.”

That again brings into question — who is better poised to understand the doctor? Experts also feel that doctors, especially senior doctors exhibit a rare ego and arrogance towards the non-medical administrators; however, a medical administrator may contain these traits and take the medical fraternity along with him.

Says Dr Sahni, “The ideal situation is to have a perfect blend of managment and doctors and to induct doctors who have a frail for managment into managing institutions.