A Matter of Choice

A large chunk of skilled doctors today are choosing private hospitals to work with, after having sizeable amount of work experience in public hospitals. Sonal Shukla finds out why

Cardiologist and CEO of Care Group Dr Kirshna Reddy left Nizam's Institute of Medical Sciences to explore the freedom of private set-up

In the first part of this story, we profiled doctors who made a choice to continue working with public sector hospitals over the new breed of corporate hospitals coming up in Indian healthcare domain. In the second and concluding part of the story, we have tried to capture few renowned clinicians who decided to switch to private hospitals after spending some crucial years of their career working for reputed public hospitals and Government teaching institutes in India.

For some it was the dream to start on their own, for some it was the sense of dissatisfaction, for few the monetary reasons were more overpowering, some wanted to taste the challenging corporate environment and few wanted to put to use their experience gained in public sector hospitals. The varied reasons attracted these doctors to the world of private healthcare.

Corporate Calling

Having done his higher education in central institutions like PGI and GB Pant, Dr Krishna Reddy, the now Director and CEO of Care Hospitals chose to join Nizam's Institute of Medical Sciences, in his native state of Andhra Pradesh. However, being in the midst of rapid changes in medicine in general and cardiology in particular at the age of 32, along with many of his colleagues he left the institute to explore the freedom of private set-up and at the age of 36 he was amongst one of the founders of Care Hospitals.

"Initially I joined the organisation as I felt that it is an academic institution with progressive mind. However, there were few issues that discouraged my continuation with a Government hospital which included finances, lack of spirit of innovation and no scope for entrepreneurship," says Dr Reddy. Therefore, as he shares, when Dr Reddy and his group founded Care, the idea was to create an institution that has best of both worlds- professional satisfaction and intellectual stimulation of public healthcare and financial comfort, flexibility and an option to innovate which is akin to private healthcare.

Factors like lesser administrative hassles, better monetary package, all required 'working' equipment and facilities drew gastroenterologist Dr Philp Ibrahim from Mumbai's PD Hinduja Hospital to join a private hospital. "I was a die-hard full-time doctor in a public hospital and was very happy with it, till administrative hassles including clerical responsibilities, poor work conditions and, of course, low salary forced me out," shares Dr Ibrahim.

Renowned cardiologist Dr HK Bali served for over 21 years at PGIMER, Chandigarh, where he was associated as the additional professor and still had 13 working years left of his tenure prior to joining Fortis Healthcare. Dr Bali is saddened by the fact that Government hospitals today don't differentiate between achievers and non-achievers. The seniority based system where merit does not depend on performance, was the reason for him to bid adieu to his institute.

Dr Anil Bhan was working with the All India Institute of Medical Sciences, New Delhi as an Additional Professor for cardio thoracic surgery when in 2004 he resigned at the age of 45 after completing 12 years of tenure with the institute. The burning desire to start something on his own that prompted him to take the responsibility as a Director and Chief Coordinator, Cardiac Surgery at Max Devki Devi Heart & Vascular Institute after that. These are just few examples of doctors who planned to migrate to private hospitals for varied reasons.

Black and White

Having worked for Government teaching/ public and municipal hospitals for a long period of time, these doctors put forth their unbiased views on various functional issues which triggered their decisions. Lacks of basic infrastructure, operational inefficiency, and bureaucratic interference are few major drawbacks which many of them lament upon about Government hospitals.

However, it was the bureaucratic interference which made Dr Veer Mehta resign from AIIMS to join as Director Neurosciences, Paras Hospitals, Gurgaon. "For a person like me who had been working with dedication, if people sitting on top administrative posts always have upper hand and make me a scapegoat of gains for which I was not even remotely responsible, I thought it would be better to leave and join private hospital than to continue living under fear which will effect my efficiency to work," says Dr Mehta. After working for almost 30 years in AIIMS what ultimately plagued Dr Anoop Mishra was Governmental snags, lack of cleanliness, apathy of nurses and grade four employees and problems with equipment and medical technology.

Dr Vijay Kumar Garu, a General Surgeon, after passing out from Usmania Medial College in Hyderabad directly joined Nizams Institute of Medical Sciences in 1996 with a view to gain experience. However, the meager pay package and poor infrastructure soon left him with no option but to choose Yashoda Hospital to work with. "Neither good working environment nor a good pay package has become the part and parcel of public hospitals. It is the downslide from both sides," shares Dr Kumar.

However, these clinicians also acknowledge the positive aspects of working with Government hospitals too. Almost all of them agree that especially Government teaching hospitals not just have built the strong foundation of their medical career but also have provided them satisfaction of working for the poor of the society. Freedom to pursue academics and research, fixed working hours and better clinical variety are the most prominent plus points.

Surgeon Dr Gustand Davar left as Dean of JJ Hospital to join PD Hinduja Hospital

Dr Gustad Dawar remembers the days spent in Grant Medical College & Sir J J Hospital, Mumbai as a Dean, Professor and Head Surgery. According to him, the experience was very satisfying and enriching as the phenomenal workload in the hospital gave him an opportunity to tackle a wide variety of cases and as a teaching hospital he got an opportunity to be with a lot of post-graduate students which used to keep him constantly updated on the latest in the medical world.

"Since it has a very large infrastructure, lot of acute problems and disasters can be managed better at these public hospitals," shares Dawar. Experts also agree on the point that Government hospitals provide a lot of scope for learning doctors as they can learn while they are working. Especially junior doctors get a lot of security and guidance under the wings of seniors. It also gives a lot of time to them to pick up their skills provided they are still working whereas in private hospitals one can not afford that luxury.

'Private' Matters

It is interesting to know about the challenges faced by clinician's in working for a private hospital now. Most believe that it is more challenging to work for a private hospital because the competition is more intense and career progression depends increasingly on the individual's own efforts. The responsibility of bringing patient to a private hospital lies totally with the consultant in a private hospital whereas patients are always there in a public hospital.

Thus pressure to perform is manifolds in a corporate set-up as compared to Government hospitals. Nonetheless the treatment has to be result oriented as one is critically assessed by the referring doctors. Private hospitals today provide no job security where doctors are mainly taken on contract basis, which is extended depending on their capacity to bring patients whereas in a Government set-up, once appointed they can work for the next 40 years.

Dr Anil Bhan agrees that working in a private hospital with a corporate set up is much more demanding as the ultimate responsibility is on the clinician even if he delegates responsibility among juniors. This creates tremendous pressure. Agrees Dr Ibrahim, "In a private hospital, the doctor is directly and individually responsible for every aspect of his / her patient's case. There is little that one can delegate to others. This is both challenging and rewarding."

Cardiologist Dr HK Bali left PGIMER, Chandigarh to join Fortis Healthcare

Besides, a doctor also has to change his style of working and needs to become more disciplined. Not only they need to hone their professional skills to the core, but also require polishing their managerial and administrative skills of human interaction. Doctors also echo on the fact that when it comes to the support system in the private hospital it is much better off compared to Government hospitals. "Any other problem the patient may have is attended by consultants in other specialty immediately and treated, whereas in a public hospital there is a hierarchy because of which it takes days for a senior consultant of other specialty to attend to the needy patient," says Dr CJ Hemant Kumar, Consultant Cardio Vascular Surgeon, Jaslok and Breach Candy Hospital, who has worked with KEM Hospital.

Drifting Apart

The breed of experienced doctors in Government hospitals is dying out. Most are now deciding that the sacrifices and administrative hassles are not worth the returns.

The reasons fluctuate from more monetary requirements with the increased family responsibilities, more scope for niche sub-specialties in private hospitals as well as the age factor. Joining a private hospital like Fortis Healthcare as a DM Director of Cardiology was a well thought of decision for Dr Bali, as he believed that as an interventional cardiologist, which is a very specialised area of cardiac practice, he was getting very little scope to achieve better and was not getting enough opportunities to compete with the best in the industry.

"I am an interventional cardiologist which is a specialised area of cardiac practice and in a Government hospital there is very little scope for somebody to do a sub-specialisation and achieve better. There was a feeling in me that as an interventional cardiologist I can do much better and I can plan career progression on my own terms rather than depending on the Government set-up," shares Dr Bali. Private hospitals also like to attract those specialties which are making more money for them- like cardiology, neurology and oncology, rather than internal medicine or general surgery.

Experts observe a trend where more and more young doctors are today keen on joining private hospitals over Government hospitals. One of the obvious limitations is less incentives offered by Government healthcare institutions. A good part of any pay increase is still lost in taxes, with no deductions permitted (for eg. travel, purchasing books/ equipment and attending conferences).

The case in point is Dr Kumar, Cardio Vascular Surgeon, joined Mumbai based renouned municipal hospital KEM in 1978 as the hospital is well known for its cardiac care treatment. He left the hospital in 1994 from the post of associate professor at the salary of Rs 10,000. "With the amount I was earning after being highly qualified, it was not possible to lead a decent life. Owning a house, educating the children is not possible with the Government pay scale," shares Dr Hemant Kumar.

Wear and Tear

Orthopaedic surgeon Dr PK Dave accepted the Chairmanship of Rockland Hospital after retiring from AIIMS as Director

The motives, age and posts of those doctors migrating from public to private hospitals is wide-ranging. However, most of them believe that it is the middle level of doctors who tend to drift the most, though some feel that today it has penetrated in each and every level in Government hospitals today.

At an average age of 35 -40 is mostly when doctors tend to think of joining private hospitals as by then they gain enough exposure in teaching, research and experience. On the other hand, doctors holding the higher posts like HODs might not take the idea of switching over to private hospital very kindly.

"Age is the main constraint at this juncture. They also don't want to loose pension benefits. And what if they don't live up to their image and expectations? This question might bug them," believes Dr Bhan.

But there are few exceptions like Dr Ashok Mahashur and Dr Gustad Davar. Before joining Mumbai's P D Hinduja Hospital as a Consultant Chest Physician and Head, Department of Respiratory Diseases, Dr Mahashur worked as Professor and Head of Department of Chest Medicine at GS Medical College and KEM Hospital. After working with KEM Hospital for 25 years, he took a voluntary retirement. The long stint itself became a reason for Dr Mahashur to think of switching to private healthcare. HOD is the highest academic position in a municipal teaching hospital after which follows the Deanship which is a non-clinical and non-teaching post. "There is stagnation if you are at the position of HOD for a long time. I decided to opt out after holding this position for 10 years, before it is too late to go out because going out also has a time period," shares Dr Mahashur.

For Dr Dawar, the opportunity to work as a Director and a surgeon in a well organised tertiary care set up was reason enough to take voluntary retirement as Dean, Professor and Head Surgery from Grant Medical College & Sir J J Hospital, Mumbai and join PD Hinduja Hospital.

Experts today observe a trend where reputed private hospital usually do not prefer hiring doctors who are above 58 which is a retirement age. But again there are exceptions. Renowned orthopaedic surgeon Dr PK Dave accepted the Chairmanship of Delhi-based Rockland Hospital after retiring from AIIMS as a Director. For this orthopaedic surgeon, the sheer motive behind joining a private hospital was to remain active in his own field.

Returning back?

They spent sizeable time with either Government teaching or public hospitals. Today, they are successfully managing their careers in private hospitals. But, at present, if given a choice, would those doctors like to return back to the Government hospitals? The replies have been interesting. Dr Reddy would prefer to go back, provided there is a quantum shift in operational freedom and efficiency even if he gets half of his present compensation. Dr Bhan is happy with his career at this juncture where he is associated with Dr Naresh Trehan's mega medicity project with his team of 34 clinicians. Dr Hemant Kumar would like to go back, not as a full timer, but as an honorary because he feels that this way he will be able to get the best of both worlds.

There are doctors like Dr Dave who still miss the challenge of working for a hospital like AIIMS where he was managing almost 6,500 staff under his guidance, unlike today where he has to deal with not more than 250-300 people. "The position I had in AIIMS had various facets of working. It was a challenge and a good activity and occasionally I do miss that challenge," avers Dr Dave.

Future

The future may have more doctors joining private hospitals early in their career, unlike in the past when they preferred to spend a few years in Government hospitals. Young doctors, who prefer to go abroad after returning back, prefer to join private hospitals. Nevertheless, few doctors are still hopeful that with the sixth pay commission's recommendation to increase the salaries of doctors working in Government hospitals will reduce the attrition considerably in Government hospitals.

Others feel that even the sixth pay commission recommendations cannot match the earnings of a doctor in the private sector. A doctor in a Government hospital performs double duty that of teaching as well as management of patients, and for the number of years he has put in to acquire the skill, he is not adequately paid amongst the employees in the Government sector. Other contributing factors like lack of basic infrastructure along with lack of freedom and administrative hassles are other deterrents. "Sixth pay commission did well to correct the growing disparity between public and private servants. However, it will be meaningless, if it is not coupled with accountability and performance," concludes Dr Reddy. Just as they say, there are two sides to a coin, there are pros and cons of both private and Govern-ment hospitals. But ultimately it is the sound work-life balance and professional satisfaction that these experts aspire for at the end of the day.

sonal.shukla@expressindia.com