Ban on Private practice

Dr Rajive Gupta
With the abrogation of Article 370 and establishment of Union Territory of Jammu and Kashmir more than one year back, every now and then we hear that all the rules and regulations of Union Territories of India shall also be enforced in Jammu and Kashmir including halt in the private practice by the Government doctors, though the long delay in implementation has taken place due to COVID – 19 pandemic.
In almost all the Union Territories of the country, Government doctors are not allowed to do private practice and the delivery of health care system is excellent there.
A large number of MBBS and specialist doctors are unemployed in the union territory of Jammu and Kashmir.They do not get an opportunity to establish in private because their share in the private market is also grabbed by the Government doctors, thus adding to their hardships inspite of high level of studies and ultimately, they are compelled to leave for other States and countries in search of job.
The teaching of MBBS and post graduate students by the faculty in the Government Medical Colleges of Jammu and Kashmir and the quality of patient care has deteriorated due to their main interest in private practice.
It is ironic that full-time Government doctors are allowed to run private clinics depriving poor and underprivileged of essential health care in the Union Territory. The Government doctors are paid handsome salary and they need to devote to the patient care in the Government hospitals than in their private clinics and nursing homes. Private practice is taking a heavy toll on the poor patients and has eaten away health institutions in the Union Territory. Doctors spend most of the time in their private clinics and are not available for patients in the Government hospitals. Their attention and time is directed towards their private clinics. They misuse hospital facilities for their private patients at the cost of poor patients who have no resources to attend private clinics. The dual practice creates a perversive incentive for doctors to increase waiting time in government hospitals so that patients are forced to go to private clinics. If a doctor entertains a huge number of patients in morning and evening at his private clinic, with tired mind what justice he can deliver to patients at hospital. It is no denying that tradition of diverting the patients from Government hospitals to the private clinics is prevalent in Jammu and Kashmir since decades and the basic fault lies in allowing private practice by the Government doctors. It is also true that doctors use public hospitals as recruiting grounds for private practice. Patients in government hospitals are left at the mercy of resident doctors and trainees who lack expertise to handle complicated cases and some patients die of misdiagnosis or delayed intervention due to non availability of senior doctors who most of the time are in their private clinics.
The employment and public facilities are being used by many of the Government doctors for building private practice leading to commercial exploitation.
There has been mushrooming of private hospitals and nursing homes in Jammu and Kashmir over the last three decades. Except trauma and emergency cases, most of the patients including the poor ones straight away go to private nursing homes for getting instant treatment than to line up in long queues and getting dates of surgery months ahead in Government hospitals. If analyzed, more number of patients are undergoing elective surgeries in private nursing homes of Jammu and Kashmir than in the Government hospitals where crores of rupees are being spent for equipment, staff, salary, construction and maintenance of buildings, etc and irony of the situation is that it is mostly the Government employed doctors who are operating them in the private hospitals. At an average, a consultant in Government Medical College of the Union Territory operates just once in a week and carries out only 2-3 operations and may do 8-10 operations in private hospitals in a week. This malpractice can only be overcome by putting a halt in the private practice by Government doctors and by increasing the number of their OPD and OT days so that more number of patients can be accommodated.
The previous attempts to ban private practice have been stalled by a strong lobby and they have misled past regimens on the issue. To start with Government should immediately put a strict ban on the private practice of the doctors in the Government Medical Colleges of the Union Territory and this will definitely improve the teaching of the medical students and patient care in Government Medical Colleges. There may be a fake apprehension that some of the doctors in faculty will resign from the Government job if there is ban on the private practice and it will become difficult for the authorities to run the Medical Colleges in the Union Territory due to deficiency of faculty. Be assured none will quit the Government job because of handsome salary along with the position they are provided in Medical Colleges. If the Government takes stand by initially announcing ban on the private practice of Faculty of government Medical Colleges in the Union Territory of Jammu and Kashmir with the instructions that anyone who is interested to quit the Government job can do with prior three months notice and with simultaneous advertisement of filling up all the faculty posts if left vacant by the lateral entry and giving opportunity to the more skilled and dedicated doctors from the Union Territory and outside to take the faculty position thereby streamlining the whole system. Moreover, there has been standing instructions from the Hon’ble Supreme court of India that Government teachers can’t be allowed to teach in private institutions in the interest of the students and Government doctors can’t be allowed to do private practice in the interest of the patients. Though the private teaching by the Government teachers have been banned by the Government of Jammu and Kashmir, but the order of ban on the private practice by the Government doctors has not been yet implemented in Jammu and Kashmir. It is high time for the administration to put a halt in the private practice by Government doctors in the Union Territory of Jammu and Kashmir like other Union Territories of the country and this will definitely streamline the working and patient care as well as teaching in Government Medical Colleges in UT in the long run. It is better to treat the trouble at the source to avoid a bigger or more difficult mess. In other words, the crux of the situation in the local language is “na rahega baans, na bajegi baansuri“. To improve the functioning of Government hospitals and Medical Colleges across the Union Territory and for making doctors more accessible for the patients, it is important to put a blanket ban on the private practice by the Government doctors especially that of Government Medical Colleges in the first instance.
(The author is a Senior Laparoscopic Surgeon in Jammu)