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A Matter of Choice
A large chunk of skilled doctors today are choosing private
hospitals to work with, after having sizeable amount of work experience in public
hospitals. Sonal Shukla finds out why
Cardiologist and CEO of Care Group Dr Kirshna Reddy left Nizam's Institute
of Medical Sciences to explore the freedom of private set-up |
In the first part of this story, we profiled doctors who made
a choice to continue working with public sector hospitals over the new breed
of corporate hospitals coming up in Indian healthcare domain. In the second
and concluding part of the story, we have tried to capture few renowned clinicians
who decided to switch to private hospitals after spending some crucial years
of their career working for reputed public hospitals and Government teaching
institutes in India.
For some it was the dream to start on their own, for some it was the sense of
dissatisfaction, for few the monetary reasons were more overpowering, some wanted
to taste the challenging corporate environment and few wanted to put to use
their experience gained in public sector hospitals. The varied reasons attracted
these doctors to the world of private healthcare.
Corporate Calling
Having done his higher education in central institutions
like PGI and GB Pant, Dr Krishna Reddy, the now Director and CEO of Care Hospitals
chose to join Nizam's Institute of Medical Sciences, in his native state of
Andhra Pradesh. However, being in the midst of rapid changes in medicine in
general and cardiology in particular at the age of 32, along with many of his
colleagues he left the institute to explore the freedom of private set-up and
at the age of 36 he was amongst one of the founders of Care Hospitals.
"Initially I joined the organisation as I felt that it is an academic institution
with progressive mind. However, there were few issues that discouraged my continuation
with a Government hospital which included finances, lack of spirit of innovation
and no scope for entrepreneurship," says Dr Reddy. Therefore, as he shares,
when Dr Reddy and his group founded Care, the idea was to create an institution
that has best of both worlds- professional satisfaction and intellectual stimulation
of public healthcare and financial comfort, flexibility and an option to innovate
which is akin to private healthcare.
Factors like lesser administrative hassles, better monetary package, all required
'working' equipment and facilities drew gastroenterologist Dr Philp Ibrahim
from Mumbai's PD Hinduja Hospital to join a private hospital. "I was a
die-hard full-time doctor in a public hospital and was very happy with it, till
administrative hassles including clerical responsibilities, poor work conditions
and, of course, low salary forced me out," shares Dr Ibrahim.
Renowned cardiologist Dr HK Bali served for over 21 years at PGIMER, Chandigarh,
where he was associated as the additional professor and still had 13 working
years left of his tenure prior to joining Fortis Healthcare. Dr Bali is saddened
by the fact that Government hospitals today don't differentiate between achievers
and non-achievers. The seniority based system where merit does not depend on
performance, was the reason for him to bid adieu to his institute.
Dr Anil Bhan was working with the All India Institute of Medical Sciences, New
Delhi as an Additional Professor for cardio thoracic surgery when in 2004 he
resigned at the age of 45 after completing 12 years of tenure with the institute.
The burning desire to start something on his own that prompted him to take the
responsibility as a Director and Chief Coordinator, Cardiac Surgery at Max Devki
Devi Heart & Vascular Institute after that. These are just few examples
of doctors who planned to migrate to private hospitals for varied reasons.
Black and White
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Cardio Vascular Surgeon with Jaslok and Breach Candy Hospital Dr Hemant
Kumar left KEM hospital
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Having worked for Government teaching/ public and municipal
hospitals for a long period of time, these doctors put forth their unbiased
views on various functional issues which triggered their decisions. Lacks of
basic infrastructure, operational inefficiency, and bureaucratic interference
are few major drawbacks which many of them lament upon about Government hospitals.
However, it was the bureaucratic interference which made Dr Veer Mehta resign
from AIIMS to join as Director Neurosciences, Paras Hospitals, Gurgaon. "For
a person like me who had been working with dedication, if people sitting on
top administrative posts always have upper hand and make me a scapegoat of gains
for which I was not even remotely responsible, I thought it would be better
to leave and join private hospital than to continue living under fear which
will effect my efficiency to work," says Dr Mehta. After working for almost
30 years in AIIMS what ultimately plagued Dr Anoop Mishra was Governmental snags,
lack of cleanliness, apathy of nurses and grade four employees and problems
with equipment and medical technology.
Dr Vijay Kumar Garu, a General Surgeon, after passing out
from Usmania Medial College in Hyderabad directly joined Nizams Institute of
Medical Sciences in 1996 with a view to gain experience. However, the meager
pay package and poor infrastructure soon left him with no option but to choose
Yashoda Hospital to work with. "Neither good working environment nor a
good pay package has become the part and parcel of public hospitals. It is the
downslide from both sides," shares Dr Kumar.
However, these clinicians also acknowledge the positive aspects
of working with Government hospitals too. Almost all of them agree that especially
Government teaching hospitals not just have built the strong foundation of their
medical career but also have provided them satisfaction of working for the poor
of the society. Freedom to pursue academics and research, fixed working hours
and better clinical variety are the most prominent plus points.
Surgeon Dr Gustand Davar left as Dean of JJ Hospital to join PD Hinduja
Hospital |
Dr Gustad Dawar remembers the days spent in Grant Medical
College & Sir J J Hospital, Mumbai as a Dean, Professor and Head Surgery.
According to him, the experience was very satisfying and enriching as the phenomenal
workload in the hospital gave him an opportunity to tackle a wide variety of
cases and as a teaching hospital he got an opportunity to be with a lot of post-graduate
students which used to keep him constantly updated on the latest in the medical
world.
"Since it has a very large infrastructure, lot of acute problems and disasters
can be managed better at these public hospitals," shares Dawar. Experts
also agree on the point that Government hospitals provide a lot of scope for
learning doctors as they can learn while they are working. Especially junior
doctors get a lot of security and guidance under the wings of seniors. It also
gives a lot of time to them to pick up their skills provided they are still
working whereas in private hospitals one can not afford that luxury.
'Private' Matters
It is interesting to know about the challenges faced by clinician's in working
for a private hospital now. Most believe that it is more challenging to work
for a private hospital because the competition is more intense and career progression
depends increasingly on the individual's own efforts. The responsibility of
bringing patient to a private hospital lies totally with the consultant in a
private hospital whereas patients are always there in a public hospital.
Thus pressure to perform is manifolds in a corporate set-up as compared to Government
hospitals. Nonetheless the treatment has to be result oriented as one is critically
assessed by the referring doctors. Private hospitals today provide no job security
where doctors are mainly taken on contract basis, which is extended depending
on their capacity to bring patients whereas in a Government set-up, once appointed
they can work for the next 40 years.
Dr Anil Bhan agrees that working in a private hospital with
a corporate set up is much more demanding as the ultimate responsibility is
on the clinician even if he delegates responsibility among juniors. This creates
tremendous pressure. Agrees Dr Ibrahim, "In a private hospital, the doctor
is directly and individually responsible for every aspect of his / her patient's
case. There is little that one can delegate to others. This is both challenging
and rewarding."
Cardiologist Dr HK Bali left PGIMER, Chandigarh to join Fortis Healthcare |
Besides, a doctor also has to change his style of working
and needs to become more disciplined. Not only they need to hone their professional
skills to the core, but also require polishing their managerial and administrative
skills of human interaction. Doctors also echo on the fact that when it comes
to the support system in the private hospital it is much better off compared
to Government hospitals. "Any other problem the patient may have is attended
by consultants in other specialty immediately and treated, whereas in a public
hospital there is a hierarchy because of which it takes days for a senior consultant
of other specialty to attend to the needy patient," says Dr CJ Hemant Kumar,
Consultant Cardio Vascular Surgeon, Jaslok and Breach Candy Hospital, who has
worked with KEM Hospital.
Drifting Apart
The breed of experienced doctors in Government hospitals is dying out. Most
are now deciding that the sacrifices and administrative hassles are not worth
the returns.
The reasons fluctuate from more monetary requirements with the increased family
responsibilities, more scope for niche sub-specialties in private hospitals
as well as the age factor. Joining a private hospital like Fortis Healthcare
as a DM Director of Cardiology was a well thought of decision for Dr Bali, as
he believed that as an interventional cardiologist, which is a very specialised
area of cardiac practice, he was getting very little scope to achieve better
and was not getting enough opportunities to compete with the best in the industry.
"I am an interventional cardiologist which is a specialised area of cardiac
practice and in a Government hospital there is very little scope for somebody
to do a sub-specialisation and achieve better. There was a feeling in me that
as an interventional cardiologist I can do much better and I can plan career
progression on my own terms rather than depending on the Government set-up,"
shares Dr Bali. Private hospitals also like to attract those specialties which
are making more money for them- like cardiology, neurology and oncology, rather
than internal medicine or general surgery.
Experts observe a trend where more and more young doctors are today keen on
joining private hospitals over Government hospitals. One of the obvious limitations
is less incentives offered by Government healthcare institutions. A good part
of any pay increase is still lost in taxes, with no deductions permitted (for
eg. travel, purchasing books/ equipment and attending conferences).
The case in point is Dr Kumar, Cardio Vascular Surgeon, joined Mumbai based
renouned municipal hospital KEM in 1978 as the hospital is well known for its
cardiac care treatment. He left the hospital in 1994 from the post of associate
professor at the salary of Rs 10,000. "With the amount I was earning after
being highly qualified, it was not possible to lead a decent life. Owning a
house, educating the children is not possible with the Government pay scale,"
shares Dr Hemant Kumar.
Wear and Tear
Orthopaedic surgeon Dr PK Dave accepted the Chairmanship of Rockland Hospital
after retiring from AIIMS as Director |
The motives, age and posts of those doctors migrating from
public to private hospitals is wide-ranging. However, most of them believe that
it is the middle level of doctors who tend to drift the most, though some feel
that today it has penetrated in each and every level in Government hospitals
today.
At an average age of 35 -40 is mostly when doctors tend to
think of joining private hospitals as by then they gain enough exposure in teaching,
research and experience. On the other hand, doctors holding the higher posts
like HODs might not take the idea of switching over to private hospital very
kindly.
"Age is the main constraint at this juncture. They also don't want to loose
pension benefits. And what if they don't live up to their image and expectations?
This question might bug them," believes Dr Bhan.
But there are few exceptions like Dr Ashok Mahashur and Dr Gustad Davar. Before
joining Mumbai's P D Hinduja Hospital as a Consultant Chest Physician and Head,
Department of Respiratory Diseases, Dr Mahashur worked as Professor and Head
of Department of Chest Medicine at GS Medical College and KEM Hospital. After
working with KEM Hospital for 25 years, he took a voluntary retirement. The
long stint itself became a reason for Dr Mahashur to think of switching to private
healthcare. HOD is the highest academic position in a municipal teaching hospital
after which follows the Deanship which is a non-clinical and non-teaching post.
"There is stagnation if you are at the position of HOD for a long time.
I decided to opt out after holding this position for 10 years, before it is
too late to go out because going out also has a time period," shares Dr
Mahashur.
For Dr Dawar, the opportunity to work as a Director and a surgeon in a well
organised tertiary care set up was reason enough to take voluntary retirement
as Dean, Professor and Head Surgery from Grant Medical College & Sir J J
Hospital, Mumbai and join PD Hinduja Hospital.
Experts today observe a trend where reputed private hospital usually do not
prefer hiring doctors who are above 58 which is a retirement age. But again
there are exceptions. Renowned orthopaedic surgeon Dr PK Dave accepted the Chairmanship
of Delhi-based Rockland Hospital after retiring from AIIMS as a Director. For
this orthopaedic surgeon, the sheer motive behind joining a private hospital
was to remain active in his own field.
Returning back?
They spent sizeable time with either Government teaching or public hospitals.
Today, they are successfully managing their careers in private hospitals. But,
at present, if given a choice, would those doctors like to return back to the
Government hospitals? The replies have been interesting. Dr Reddy would prefer
to go back, provided there is a quantum shift in operational freedom and efficiency
even if he gets half of his present compensation. Dr Bhan is happy with his
career at this juncture where he is associated with Dr Naresh Trehan's mega
medicity project with his team of 34 clinicians. Dr Hemant Kumar would like
to go back, not as a full timer, but as an honorary because he feels that this
way he will be able to get the best of both worlds.
There are doctors like Dr Dave who still miss the challenge of working for a
hospital like AIIMS where he was managing almost 6,500 staff under his guidance,
unlike today where he has to deal with not more than 250-300 people. "The
position I had in AIIMS had various facets of working. It was a challenge and
a good activity and occasionally I do miss that challenge," avers Dr Dave.
Future
The future may have more doctors joining private hospitals early in their career,
unlike in the past when they preferred to spend a few years in Government hospitals.
Young doctors, who prefer to go abroad after returning back, prefer to join
private hospitals. Nevertheless, few doctors are still hopeful that with the
sixth pay commission's recommendation to increase the salaries of doctors working
in Government hospitals will reduce the attrition considerably in Government
hospitals.
Others feel that even the sixth pay commission recommendations cannot match
the earnings of a doctor in the private sector. A doctor in a Government hospital
performs double duty that of teaching as well as management of patients, and
for the number of years he has put in to acquire the skill, he is not adequately
paid amongst the employees in the Government sector. Other contributing factors
like lack of basic infrastructure along with lack of freedom and administrative
hassles are other deterrents. "Sixth pay commission did well to correct
the growing disparity between public and private servants. However, it will
be meaningless, if it is not coupled with accountability and performance,"
concludes Dr Reddy. Just as they say, there are two sides to a coin, there are
pros and cons of both private and Govern-ment hospitals. But ultimately it is
the sound work-life balance and professional satisfaction that these experts
aspire for at the end of the day.
sonal.shukla@expressindia.com
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