Friday, February 10, 2012

Why I no longer want to practise medicine

I recently met a classmate of mine who been practicing as an obstetrician and gynecologist in the city of Bombay. He was a bright student and had his own nursing home ; and had what I thought was quite a flourishing practice in the suburbs. However, when I met him , he told me he was planning to retire from medicine altogether. I was quite surprised , but what he told me opened my eyes . This is what he had to say.

I have been practicing as a doctor for the last 25 years , and I am proud of the fact that I provide good medical care . I enjoy taking care of my patients - and my patients love me . It's been very satisfying , but so many things have changed now , that it's just not worth the hassle to continue practicing medicine as an independent doctor in private practice in my 15-bed nursing home anymore.

For one thing , the rules and regulations have become so onerous and difficult that I seem to be spending half my life just filling up forms and doing paperwork - for renewing my registration for my nursing home ; for the insurance paperwork for the TPAs; and complying with the biomedical waste rules. I'm at the mercy of any bureaucrat or clerk who wants to come and trouble me , and there's very little I can do about it.

I used to do ultrasound scans , but now I have stopped doing them. Every time I do an ultrasound scan , because of the PNDT Act, I have to fill up the form which says I have not disclosed the sex of the fetus. Why can't people just accept the fact that doctors are respectable citizens ; and that it's not good for our self-respect to be treated as crooks and criminals .

I no longer have the autonomy which I used to have . A lot of my patients have insurance ; and filling up their paperwork ; getting pre-authorisation; and following up with the insurance companies for my payments has become such a pain , that I no longer have the energy to do it .

Finally, I don't think my patients respect me as much as they used to. They no longer treat me as a trusted a professional. They think I am mercenary ; and often challenge my recommendations . Medicine is no longer considered to be a very respectable profession , and I'm pretty much fed up , which is why I want to retire. It's because we have not stood up for each other that doctors like us have contributed to this decline - we only have ourselves to blame !

What will you do in that case ? You are only 50 !

That's not a problem at all . I own my own nursing home ; and given the astronomical real estate rates in Bombay today , I will get a huge amount of money by selling it . Even if I just park this in a fixed deposit , the interest I get will actually earn me much more than what I'm getting from my medical fees right now ! I'll be quite happy and contented - and don't forget I'm a Doctor , which means I am smart. I'm sure I'll find something to do without having to deal with all the daily hassles I have to put up with today.

It is a shame and tragedy that things have come to this pass. We don't realize how much harm we do by pushing doctors against the wall . Some of this damage has already happened in the US , where primary care physicians no longer want to take on new patients , because they are fed up of the restrictions which are being placed on them. Sadly , the Indian medical system seems to have imported all the bad bits and bobs of the West; and sooner or later , we're all going to pay the price. Most doctors no longer want their children to become doctors anymore , so that the profession which used to attract the best and the brightest is no longer seen as being desirable . This is one of the reasons why we have all these private medical colleges which charge huge tuition fees - and we are now producing a new generation of doctors, which is more focused on the bottom line rather than being focused on providing good patient care. I dread the day when I become older and fall ill !

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  1. Anonymous5:09 PM

    Dear Dr,

    Eventhough I am not a doctor shall I suggest pills for your depressed friend (?!)? As per my judgement-based medicine he must 1) immediately go on a vacation for atleast a week 2) watch Laurel and Hardy every day for an hour ;) 3) Meditation :) 4) Read serenity prayer morning, afternoon and evening and 5) spend time with the company of good friends and 6) he needs lots of love, care and pampering 7) If possible he must go and treat patients from the most backward areas of India and not just the creamy layer in a private practice in Mumbai. Then his pains will appear a lot lesser :). I think most men (especially men who lead their life with high principles and aims) pass through this phase of depression at 50+ irrespective of their profession :). Perhaps a doctor in his 30s would have very positive view of the entire (present) situation than your 50+ friend :)

    I live in a country which has one of the best health care systems in the world. We pay health insurance depending on our income. People who earn more pay more. People who earn less (for example students) pay very, very less). But everyone gets the same quality healthcare. When we see a doctor we have to pay a fixed consultation fee (approx.600 Indian rupees) and this consultation fee is valid for 3 months irrespective of how many times you visit the same doctor or any other specialist. That’s the only amount we pay to the doctor and all other expenses are covered by the insurance (medicine costs and surgery costs). No one can stay in the country without health insurance because for obtaining your job contract to student admission card you need to show them the proof that you are insured with a health insurance company.

    I did talk to my boss who is a clinician too about how the entire health care system works? Are doctors happy with it? etc. He did say that the doctors here are also forced to do lots of paperwork for claiming money form the insurance companies for the treatment they provide for the patient. He said they also face lots of bureaucracy issues in the process. But when I asked him whether he is unhappy he said “it is difficult sometimes but I realize that there should be a control as doctors are also humans and are prone to do mistakes”. He continued saying that “medical care has become a business, so there should be a controlling body and if there is a controlling authority all kinds of bureaucratic things has to be dealt with and there is no escape” and he also said “I could not think of a better system than this and we have to put up with this if we like it or not. Since medical care has become a business, naturally the customers (patients) take an upper hand and their rights are much protected than that of the health care provider”.

  2. Anonymous5:09 PM

    I agree that filling up the form to say that “I haven’t disclosed the sex of the baby” is ridiculous but how could doctors just expect that people should believe them and accept the fact that doctors are respectable citizens? Can just education and intelligence level enough to brand someone as a respectable and responsible citizen? Actually more intelligent a human being more crooked he can think. Haven’t you heard horror stories about irresponsible doctors? How can a society brand a person good and responsible just because he is a doctor? Not every doctor will use the autonomy given to him in a good way. If filling up forms and facing bureaucratic issue is difficult for an affluent doctor have you ever thought of poor patients suffering with their illness as well as illiteracy and money issues? I have seen doctors prescribe their poor, illiterate patients a long list of medicine most of which are totally useless in treating their condition. I know doctors who do so in order to enjoy all the physical comforts provided to them by pharmaceutical companies. How to control such doctors? Should doctors be given complete autonomy?

    There are doctors who are mercenaries and not all of them. But patients are very intelligent. They do easily understand their doctor. A good doctor will always get the utmost respect from his/her patients. No other profession can be as satisfying as that of a good doctor. Thanks to information therapy we have got enough knowledge to challenge a doctor’s recommendation :) and a doctor should take it in the most positive way.

    Oh great! So he just will sell his nursing home and then make a FD of the money and live happily with more money than he could earn as a doctor without any hassles!!! Does this mean that the entire hard feeling he has ultimately boils down to that fact that he can’t earn more money without any disturbance? Sorry, the particular paragraph sounds like that.

    Doctor, when you do not like this particular system a better alternative than venting is to propose a system which can do justice to both doctors and patients. As a very intelligent physician you have the capability to do so. Will it be accepted or not is the next question? Sometimes there is no immediate way out. Only by continuous, concentrated efforts changes in any system can be obtained. Persistence pays, quitting is not always a wise option.

    I thought most of the private medical college seats are occupied by doctor’s sons or daughters who don’t have enough cut-off marks but are forced to study medicine in order to inherit their parent’s private practice :). Who is having enough money in our society other than doctors and politicians to make their young ones study medicine in a private medical college? (Of course actors but they want their children to inherit acting :)).

    I am sure when you fall ill (I pray God that it should never happen and that He gives you eternal health and happiness) you will for sure find many good doctors as YOU to take care of your needs !


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