Friday, 25 July 2014

What Makes Doctors Greedy?

portrait of a dentist and patient
portrait of a dentist and patient (Photo credit: George Eastman House)
The one sided decree: Doctors are Corrupt!

In India, before anything against is ever proved, media comes into action and conducts a trial. Public sentiments & media 'revelations' convict the person/s in question and incarcerate them.

This is what typically happening in case of Doctors in India. Mr. Amir Khan, through 'Satyamev Jayate', tried to throw light on the darker side of the coin. People in variably agreed to what he had to say on the show. But what we have looked at is an effect of multiple causes prevalent in our society.

What makes Doctors in India greedy?

There are 2 major reasons and several minor ones.

It takes about 12 years of study & hard work for a doctor to acquire specialised qualification to practice a particular faculty of medicine/surgery.

  • Standard 11th & 12th for entrance test preparation

  • 4 years of medical school

  • 1 year internship (preparation for PG entrance test)

  • 3 years of PG

  • 1 year of internship post PG (if one has undergone PG at a Govt. Medical College)

By this time a doctor turns about 30+. Even after such a hard work, he/she is still a beginner in the career. His/her friends in other professions like engineering/management get well settled and are earning a handsome living. This puts a social pressure on them to make up for the time invested in becoming a doctor.

The need for equipment:

All surgical faculties have their specialized instruments used for performing the surgical procedure. Most of these equipments are imported and hence cost a bomb. The cheapest one costing Rs. 3,00,000/- and the expensive one can cost up to Rs. 50,00,000/-.

Now if the surgeon has to perform the surgeries, he has to be well-equipped. Since these equipments are purchased by borrowed money, they have to pay the EMIs even if they do not have any patients.

Need to look successful:

How many people will visit the doctor who doesn't drive a car or has a clinic in small lane? People perceive doctors successful if they maintain higher standards of living. They must have a car, must stay in good house, must look presentable, must wear expensive cloths, must have latest gadgets, etc, etc. 
We, the people, force them to adhere to these so called standards. So doctors borrow, they borrow from banks, credit cards & sometimes from parents. Most doctors, when they start, live hand to mouth for first 5-10 years of their practice.

Now these are the reasons why would a doctor (for that matter anybody) would be in a hurry to make money.

How Doctors in India Earn Living

Doctors make money through the following:

  1. Consulting fee charged to the patient in the clinic
  2. Consulting fee charged to the patient admitted in the hospital
  3. Surgical fee charged if the patient has undergone surgery.
  4. Share of the bill for the patient paid by the hospital
  5. Commission on pathology tests (norm is 30%, can go upto 60% of the costs patient)
  6. 'Cut' received for recommending CT/MRI Scan at a particular center. Now a days almost all centers have this practice, so matter where the patient goes, the doctor receives something.
  7. Income received from Pharmaceutical companies for using any implants made by these companies( the profit margins are huge in case of implants)
  8. Kick backs received for referring patient to other doctors/super specialists.
  9. Income received for referring patients for complex procedures like Angioplasty.
  10. Cash/kind received for prescribing the particular drug manufactured by a pharmaceutical company
  11. Margins received from 'Optional Vaccines'. Now you must have noticed that so called optional vaccines are very costly and are promoted aggressively by the manufacturing companies and Doctor alike. The only underlying reason is the high profit margins.

The kickbacks so received are so huge that sometimes they need not rely on the legitimate income they make through their consulting practice.Many a times these kickbacks are in cash and hence are never declared in the Income Tax Return.

So even if somebody becomes a BAMS/BUMS/BHMS doctor (Non MBBS) and starts practicing, in an year or so, he/she can develop a practice and can start making Rs.50,000/- per month comfortably.

Are doctors responsible for this?

There are various reasons why we can not hold doctors responsible for this. The first reason is our natural inclination for growth. If I was offered more money for what I am already doing, I would take it. That why most people change jobs, don't they? In fact any human being, would like to receive more remuneration for the work that they do. Just put yourself in a doctors shoe.

Second reason is increasing competition in Healthcare sector in India. In all big cities there are more hospitals, more diagnostic centers, more CT Scan/MRI Centers than needed. So if one center offers some percentage commission, the newer one will offer more to acquire the market share. I mean this is how the marketing works in this segment. 

When I started promoting CT/MRI services in Indore, MP, there were 6 CT scans and 2 MRI centers. In four years, the number increased 21 CT scans and 6 MRI centers. Now this level of competition will drive the doctors crazy. One marketing guy comes and offers X% commission. Next day the another guy comes and offers X+1%. Now would you dance if such lucrative offers come to you? Most people would give in to that temptation. I don't know about others, but I would.

How to minimize this practice?

There are a couple of steps we people can take:
  1. Opting for Health Insurance: Health Insurance companies (in order to reduce their claim outlay) are tightening their grips on healthcare providers. When a hospital is empaneled for cashless services with insurance provider, they bargain hard for best rates for routine surgical and medical admissions. The terms are so clear and often rigid, that hospitals can not charge a penny extra.
  2. The above mentioned option will take care of the IPD. For OPD, quite a few Health Insurance companies like Bajaj Allianz, ICICI Lombard, Reliance General Insurance, etc are experimenting with providing insurance cover for OPD level services like Doctor consultation and diagnostic services. It will take some time for these experiments to be fool proof, however, choosing such a scheme might help reducing such malpractice.
  3. The next option is fairly simple but would require some practice and negotiation. When a doctor prescribes a test, call the respective center and demand the discount on price. Most centers will ask for the doctors name. You should then make up a name of doctor from another city (my hot favorite is Dr. Subramaniam from Mumbai-as I stay in Pune). Now this guy at diagnostic center will think that since the commission is not needed to be paid to the doctor in Mumbai, he can comfortably offer you 20-25% discount. 
Now with this, we should be able to do our bit in reducing our health care bills and help reduce the prevalent malpractice. If you come across any more ways, do write to me

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