On private practice by Doctors

Rajeev Kumar Nagotra
The recent Government warning against the private practice by HODs of the medical colleges is a bit too harsh and ungrateful gesture (pun intended). As a matter of fact it has the potential to turn counter-productive for one cannot name a single minister who is perfectly healthy and is not at the mercy of some well-known doctors. The same goes for the judges, civil servants and the police too. Everybody is lying exposed under the knife of a doctor, literally. And, it is horrifying to consider oneself under an irritated knife. This explains why private practice by the teaching faculty of government hospitals in our state has continued unabated even though it is banned in letter and spirit all over the country. The argument offered is that the medical educators in other states receive NPA (non-practice allowance) which is some percentage of their basic salary. The last NC government stopped paying NPA citing financial constraints as a reason. Incidentally, the registrars in our state continue to receive NPA and still do private practice with little fear of retribution under law. A doctor takes home Rs. 40,000-45,000 per month as gross salary at an entry level position as a faculty member. The amount goes to Rs. 80,000-1.5 lac for a full professor, the highest rank of a faculty. In addition, if one looks at how much the doctors make from the commissions from pharma companies, radiology and pathology labs, chemist shops etc. the NPA will look like chicken feed in comparison. The government must look beyond the loss the doctors will incur if the private practice is truly banned and try to mitigate the harm the practice continues to do to the healthcare services and the medical profession in general. The President, DAK (Doctors’ Association Kashmir) has already highlighted how the doctors tend to direct the patients from the government hospitals to their own private clinics and even recommend specific chemist shops and labs for their healthcare requirements. This increases the cost of healthcare manifold for the common taxpayer. One does not have to look far for these private outlets – big sign boards declaring the doctors’ visiting hours as well as affiliation to the government hospital are displayed conspicuously and proudly in the entire area surrounding the public health centers.
Apart from the disservice to the citizens, the private practice has also been causing irreparable damage to the quality of medical education being imparted in the institutions. The summer timing of the teaching faculty of the medical colleges and hospitals is 8:00AM to 2:00PM as opposed to 9:00AM to 5:00PM in the rest of the country. The consultants here hardly turn up before 9:00AM and can rarely be found after 1:00PM. In these four hours of their active presence on the campus, they are supposed to conduct classes, carry out research work, do hospital ward rounds, handle emergency cases and do surgical procedures if need be. The timing for the OPD is 8:00-11:00AM. In this tight schedule they can reasonably skip one of these responsibilities on the pretext of attending to the other. Indeed they may even skip all of these responsibilities if they have the sufficient clout and connections. The current status keeps the doctors in good humour and does not care if the general public continues to suffer. Therefore, the doctors are the last ones complaining. It is the patients and the trainees who are at the receiving end. The post graduates (PGs), some corruptible and some gullible, who do not mind getting dirty in the process cover up for the consultants in their private clinics while the latter are busy in the hospital. In return, they get exposed to three things which are detrimental to their ethical grooming – money, nepotism and indiscipline. If the private tuitions by government teachers is viewed as sinful, what makes private practice by Government doctors any different? Both the practices are equally unethical and unprofessional. A Persian proverb goes like this – if the teacher is corrupt, the world will be corrupt. Moreover, can our government allow, for example, its engineers, judges, KAS/IAS officers or police personnel to work simultaneously in private companies? No, obviously. It will be against the public interest and will jeopardize our state machinery. The private practice has likewise damaged our public health system and needs to be curbed immediately.
Those who have had a teaching experience would know that an hour long lecture in the classroom asks for at least an hour of prior preparation regardless of the teacher’s rank/experience. The author has had international teaching/research experience and has observed that even the senior most faculty in the foreign universities having two to three decades of teaching experience under their belts hold no academic or administrative meetings in the hour before their lecture just so that they can focus on teaching. In contrast, the faculty of our government hospitals have their priorities set on private clinics and nursing homes and are not available even for the emergency cases in the hospital let alone for teaching or research. The President, DAK also reminded that a government doctor is on government service 24?7 but only a conscientious doctor would care to agree to that. The pursuit of money reflects in the number and quality of research publications they produce in an academic year. Most of our teaching faculty publish their research, if at all, in an apparently low impact factor local journal called JK Science Journal of Medical Education and Research. The faculty’s contributions in the international journals are few and far in between. And, to think that they are grooming the next generation of medical practitioners for us is spine-chilling! Their PG students, who should be learning the advanced techniques of treatment and research methodologies from them are busy remembering the brand names of the different medicines and developing liaisons with the medical representatives of the pharma companies.
Another ill impact of this malpractice is that it has not allowed for the development of private sector in our state. Unlike, for example, in Delhi, a patient in Jammu sees the same consultant in the government hospital as well as in the private clinic. There has to be a clear cut policy for zero overlapping of private and public service providers in any sector to allow for a healthy competition, positive growth and public benefit. World class healthcare facilities have come up in the neighboring states of Punjab and Delhi, but Jammu continues to suffer from the same set of home-grown  doctors. The government  must make efforts to ensure that medical professionals that are trained outside of the state or the country find it lucrative to undertake private practice in J&K. This will benefit the general public immensely.
The past culture has bred the present situation and the present situation is going to shape the future of health sector in our state. It is, therefore, implored upon the government to seriously implement the ban on private practice by the teaching faculty of government medical colleges and hospitals. Even if the government has to resume the NPA policy the trade off is worth every single rupee involved. After all, the number of teaching faculty in Jammu is not more than 200 and the tax payer would rather shoulder the burden of their NPAs and receive affordable and timely medical attention at the government hospitals than get fleeced in the private clinics. And, needless to say that the ban must be absolute in nature and not confined to the HODs alone.
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