Feature

Defying the Mirror

While our 'family doctor' is getting older, he is still far away from giving up work. How true does the notion of 'doctors do not retire' hold relevance in today's times, when everyone is gung ho about the 'young India?' Nancy Singh seeks some answers

Doctors and teachers never retire. This is what we have been hearing since our childhood. That was 20 years ago when a 'family doctor' was actually a part of all our families. His word was 'the' final word when it came to medicine. Call it ignorance or innocence, but it was almost 'criminal' to doubt his/ her supremacy or diagnosis, and the best part of it all, our 'family doctor' was just a phone call away. Well, enter 2009. The concept of 'family doctor' has become quite redundant and thanks to the well-informed patient, he/ she enters the GP with dollops of confidence and razor sharp attitude that screams — If anything goes wrong, I'm gonna sue this doctor.

In such changing times, it is important to ask whether a doctor ever retires. As a matter of fact, the healthcare sector is inundated with professionals who are above 60 and doing extremely well also. There is no way that their popularity has gone down or patients have stopped flocking to them. Just that they have slowed down. And some not even that. Take for instance, Dr KM Cherian, Chairman and MD, Frontier Lifeline Hospital, Chennai. His energy, enthusiasm and the busy schedule across the world can embarrass many youngsters! "I can't sit idle at any place. It is a profession where your experience is your biggest treasure, and it is also the demand and loyalty of the patient that keeps you going. Today, if I just stop working, I am quite sure that my patients will not allow me to. And even today, people travel from across the world just to get their hearts operated by me," shares Dr Cherian. He makes it a point to operate at least one surgery per day whenever he is in India.

While on one side you have the young, spirited CEOs who all are aggressive about numbers, future plans, facilities and qualities, you will see an equal number of administrators who are successful doctors and their hospital is running just because of their name and popularity. So, you see, there exists a fine balance amongst them in our country.

Defying the Mirror

No denying of the fact that healthcare adores, loves , respects the senior-most crowd of this coveted industry, but no ignoring the fact either that with ageing, problems of old age start creeping in, even for practicing doctors. Feels Dr P Madhok, Consultant Paediatric Surgeon and former surgeon at Wadia Hospital; Arogyanidhi Hospital and BARC Hospital, Mumbai says, "Dimness of vision because of developing cataracts, hearing problems and joint pains are a common feature. Some develop hypertension and diabetes. Others may have digestive disturbances. Remembering names of patients and even drugs can cost an effort. Certain amount of cerebral atrophy is associated with old age, which may translate into learning difficulties for the doctor for newer techniques and methods of investigations. Science is advancing so fast that unless one keeps up with CME, library and/or internet, he will only become a back number." Times are changing indeed. "The other problem of advancing age is losing friends and colleagues to death, disease and infirmity. For those doctors who are still upright, the question is to retire or to go on?" questions Dr Madhok.

But What After Retiring?

Another issue is that even if the doctor wants to retire, there are not many options left for him henceforth. There is a huge fear of boredom that exists and top of that most of these doctors have not been good financial planners in their hey days too.

Agrees Dr R Bhalerao, Director of Medical Planning and Projects and a Consultant of Gastroenterology and Liver Diseases at Mumbai's PD Hinduja Hospital, "After working for more than half of your life, emptiness can be a huge factor, that leads to doctors continuing to work." Currently running at 75, Dr Bhalerao was sure that he will stop practicing actively in PD Hinduja Hospital after the age of 65. But even the hospital did not let him go! Hence, he is still practising. His work has shifted more from clinical to administrative, with him handling a lot of projects at the planning stage. Believes Anirrudh Kunte, Deputy HR, PD Hinduja Hospital, "We have many senior doctors working as consultants here. There are many advantages to that. Firstly, they have something called as attachment and bonding to the organisation and exude a lot of sincerity and loyalty in whatever they do. The focus at their age is of giving back to the society unlike the younger lot who are busy to climb the success ladder. And undoubtedly you cannot match their experience."

Even if the doctor retires, or slows down, in India, unfortunately he does not have many recreation facilities to go around. Agrees Dr Madhok, "In the West, the options are easier. Being welfare states, retirement brings in rich benefits, a handsome pension, old peoples clubs and promotion of hobbies. In India, unless doctor has made himself secure, options are fewer. Besides, the savings might not be commensurate with the rising price index. Joint family systems are dying out and nuclear families are the in-thing. Many old couples live alone because children have gone abroad. So passing time alone in the house may be a problem."

An Individual Choice

"Doctors should not retire but be there for second opinion when they are seniors. Youngsters should be given a chance too" - Dr R Bhalerao Consultant of Gastroenterology and Liver Diseases PD Hinduja Hospital Mumbai

"It is the patient loyalty and demand that keeps you going. Anyways, I can't even imagine sitting idle too!" - Dr KM Cherian Chairman Frontier Lifeline Hospital Chennai

Many feel that it is entirely a personal choice and there need not be too many perceptions about it. After all, this is not the only industry where post 60 people are working. Very strongly agrees Dr (Prof) OP Kapoor, Ex Hon Physician Jaslok Hospital and Bombay Hospital and former Prof. of Medicine in Grant Medical College and JJ Hospital, "I feel those doctors who can work, should work. They need not work 'centre stage' but accept a less stressful life style. The topmost industrialists of the world are above 75 years of age and yet, as directors of companies, they make accurate decisions. Birlas, Tatas are such examples, as are heads of many other business houses. Coming to professionals like solicitors and physicians, most of them are in demand at that age. People go to them because of their vast experience and wisdom and for sure, most of them get better opinions."

Aged 77-years, he has authored as many as 600 publications to his credit and he has also authored 12 books. Nowadays, he is mostly found passionately conducting lectures on medicine in fully packed auditorium. He has been doing this free of cost since the past 55 years. Whenever there exists a 'difference of opinion' in diagnosis, the patient always prefers to consult a senior physician. "Although I do not agree with this approach, it will take a couple of years for the people to realise that a young super-specialist who has seen many more patients with that particular problem, is, any day better equipped to handle the case. But, what happens when two leading cardiologists differ in their opinion, and choice exists between coronary angioplasty and bypass surgery? In such cases, the patient would then depend on the opinion of the senior-most doctor," feels Dr Kapoor.

Give Young Chaps a Chance

With all the richness of experience and first hand practical knowledge after handling so many patients, there is also a side which feels that because of the senior brigade, the youngsters do not get a chance to go up and on the same side there are many leaders today who prefer having younger physicians as they can be moulded as per the organisation's changing culture unlike the rigidity of senior lot and also the fact that the youth is very open to new technology and usage of IT. Take for instance, Deenanath Mangeshkar Hospital, Pune which is led by Dr Dhananjay Kelkar, who is of the firm belief that senior doctors come with a huge burden of ego and rigid mind which cannot go well with the vision of the hospital. When he took over a sick hospital and also when he started leading Deenanath, he ensured that the 'crowd' is below 40 across all spectrum. "Because of the openness of the youth to new ideas, I was able to turn-around a sick hospital and attain a breakeven within three months," shares Dr Kelkar.

Human Resource Crunch

Retire or don't retire. After all it is a personal choice. But a deeper question is where are the people? Imagine, if suddenly all the senior lot hang up their boots, are there enough 'younger substitutes'? The answer is no. And this is not an Indian phenomena per se, but it's worldwide. There is a huge manpower crunch and in fact many countries are worried that after the 'baby boomer' generation completely goes away, the Gen X is not sufficient to fill in all the gaps.

And it is not a 'future tense' situation. The problem of shortage of enough manpower in healthcare is pinching all the countries. For instance in the US, according to the Association of American Medical Colleges (AAMC), a 'perfect storm' is forming for shortage of doctors and surgeons for the reason that the time it takes to train doctors —typically three to seven years — and the fact that the count of senior citizens in the US is growing rapidly. With 79 million baby boomers beginning to enter their retirement age, so are their doctors. So, from 1985 to 2006, the proportion of doctors aged 55 and above have risen from 27 to 34 per cent.

The AAMC in its 2006 goes on to report that the people belonging to this category - which is roughly around 2,50,000 active physicians - will all retire by 2020. The impact is said to be more in the case of rural America, wherein out of 2,11,908 only 9,334 physicians are general surgeons, as per the American Medical Association data. As a matter of fact, the US has increased the retirement age upto 75, experts inform.

Also, interestingly the groups of GPs who worked for fewer hours in 2001 compared to what they did in 1986, the 'Gen X GPs' were working for fewer hours than the baby boomers when they were at the same age. Coming home to India, the Government extended the retirement age from 62 to 65 for AIIMS doctors, due the existing shortage. Even Bihar decided to increase the retirement age from 60 to 62 as earlier the doctors were retiring at the rate of 50 doctors every month and such a pace could not be substituted with younger physicians who in any case prefer proving their mettle in big corporate hospitals. So you see, it's not a question of whether a doctor should or should not. The bigger picture is that can India afford or cannot? Well, as far as the demographics show, it indeed cannot.

Dr Kapoor concludes saying, "India is a country, where faith plays a very important role in the relief of symptoms. The patient feels much better when they consult an elderly physician, who can clear their doubts and remove any suspicions from their mind. Even our people can identify a young physician in his 60s who is so slow that he is worse than a doctor in seventies. And yet a doctor in his seventies, who is very busy talking, examining and discussing can pass off, in the minds of the people as the one in sixties. What is important is that when a patient takes an appointment, he does not ask for the age of the doctor!

healthcare@expressindia.com