Doctors versus managers in Indian hospitals

Doctors are having a hard time surviving. Even though small 20-bed doctor-run nursing homes are the most cost effective way of delivering medical care for common problems ( such as elective surgery and childbirth) , it's getting harder and harder for doctors to start a nursing home in India because of the license raj and government bureaucracy. Most doctors are being forced to join corporate hospitals, where they are extremely unhappy because they are exploited and ill-treated by the management.

Why are doctors so unhappy in many corporate hospitals ? Doctors have a bottom up approach. They have been trained to be patient advocates and do everything they can to help their patient to get better. This is their primary professional focus - and this is what makes them special. This is what patients expect from them and doctors take pride in their ability to provide the best possible medical care for their patient – and they will move heaven and earth to do so. They are so focused on each individual patient’s well-being , that they will often not consider extraneous factors such as the patient’s ability to pay.

The management’s world view is very different. From their point of view, the hospital is another business – and the bottomline comes first. They understand that until they continue to remain profitable, they will not be able to survive – and if they do not survive, how will doctors be able to provide care to their patients ?

Both these approaches are perfectly valid and sound – and usually there’s no conflict. Most of the time, it is possible to provide cost effective care profitably to patients, and everyone is
happy ! However , there are times when financial considerations and medical priorities do clash. This is when the divide starts.

Bad hospitals focus only on financials . They reward doctors based on their turnover and throughput – and do not care about the quality of their care. They pressurize doctors into doing unnecessary procedures; micromanage doctors; and their primary focus is on paperwork and forms. The management often treats doctors disrespectfully; hires and fires at will; and skimps on the amount of money they pay to their doctors. Good doctors will often walk out of such hospitals when they are treated badly – and this demoralizes the rest of the staff.

Good hospitals , on the other hand, understand that their interests are aligned with those of their medical staff. They involve doctors in important managerial decisions; provide doctors with staff, tools and technology to help them to improve their productivity; treat them as important team players; and provide interested doctors with training in business management . They invest in their doctors and try to create a life long bond with them !

Doctors also come in different flavours ! Bad doctors are good at playing games of one-upmanship. They may be medically incompetent, but they are very politically savvy – and will suck up to the management to try to keep one step ahead of the other doctors, whom they treat as competitors, rather than as colleagues !

Good doctors focus on the well-being of their patients. They will not sell themselves short; and take pride in their professionalism. They expect to be treated with respect and dignity; and try to understand the basics of how the hospital runs, so they can provide constructive inputs

We need to allow doctors to get on with their job of providing good care to their patients. The only reason a hospital exists is to take care of patients – and they can only do this is they have motivated doctors, who feel they have the support of the management.

The sufferers as a result of this divide is the poor patient, who feels neglected and uncared for, even though he is paying an arm and a leg through his nose for the 5-star ambience of a brand name hospital !