Tuesday, December 15, 2009

How doctors in India are getting squeezed !

Consultants practising in Mumbai have a hard time getting patients.

It has now become practially compulsory for all new young specialists to have to give the family physicians who refer patients to them a hefty proportion of their fees as a commision for sending patients to them . While corporate hospitals are more refined and refer to this fee as a referral fee, the fact remains that this is a kickback - and can be as high as 50% ! Not only does this make the practise of medicine unethical, it causes young doctors to become cynical and disillusioned. They are often forced to toe the family doctor's line , and in order to generate more revenue for themselves, resort to unnecessary medical testing and surgery. The tragedy is that this corruption has spread throughout most Indian cities and is now rampant. Since the most corrupt doctors win, even the honest and straightforward ones soon fall into line very quickly, when they see what their seniors and peers are doing.

However, this is not the only area where doctors take a beating. Government rules are becoming increasingly onerous - and like any bureaucracy, the government only understands paperwork. As long as this is done properly, nothing else matters. The problem is that doctors then end up spending more time on the paperwork, rather than their patients !

Corporate hospitals are another major source of concern. These are large for-profit institutes, who have excellent marketing skills and huge budgets. Most doctors are defenceless against this kind of corporate competition, and quickly end up losing patients to these hospitals. Just like the Walmarts drove the mom-and-pop corner store out of business, these hospitals skim off the cream of patients, and will drive many independent young consultants out of business.

Finally , the last straw seems to be the entry of medical insurance into India. Medical insurance companies are hard bargainers - and today, if you want to be on the medical panel of an insurance company, you need to bribe the TPA ( Third Party Administrator) to allow you to serve on their panel ! If you don't do this, all the patients who have medical insurance will go to your competitor down the street !

Who ends up paying for all these kickbacks and the bribes ? You , the patient, that's who. The doctor simply builds in all these "costs of doing business" into the medical bill which he presents to you !

The only solution for the consultant who wants to survive is to cut out all these middlemen ! It's only when specialists will be able to reach out to patients directly that all this rubbish will stop. While senior consultants do not have a problem, thanks to their reputation, and the fact that most of their patients come to them through word of mouth, what is the junior consultant who is full of ideals going to do ?

He will have to use the web to reach out to patients directly ! This is the most cost effective medium to practise medicine ethically - and it will soon become an essential tool for most specialists !

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