so far as a doctor?
I belong to Delhi as I was born here. My parents came from Punjab and settled in Delhi. I went to Delhi Public School, Mathura Road. After that I went to Maulana Azad Medical College and did my MBBS from there. After completing my MBBS, I did MD in radio diagnosis from PGI, Chandigarh. Then came back to Delhi and worked as a senior resident doctor in AIIMS (All India Institute of Medical Sciences). Later, I got Rotary International Foundation Scholarship in 1986, which permitted me to go to the USA in 1987 to do a fellowship in MRI. There I went to MD Anderson Cancer Centre in Houston, Texas. That’s how my involvement with MRI started.
In 1987, there were very few MRI centres worldwide and in India there was none. In the end of 1987, India’s first MRI came in INMAS (Institute of Nuclear Medicine and Allied Sciences). After completing my fellowship, the idea was to join INMAS. Since INMAS was a government institution and it had its own working speed, it took nearly one year and eight months for a post which was lying vacant to be advertised and for me to ultimately join INMAS. During that time I was working as a senior resident in radiology department at RML (Ram Manohar Lohia) Hospital. Since I wasn’t sure whether I would be able to join INMAS, I started thinking of doing something of my own.
I came from a family of teachers; both my parents are teachers. Since we came from a middle-class background, my family was not sure of what I was going to do as starting this kind of business required investment of crores of rupees. During that time I found a partner who was a friend of my father and a businessman and then we set-up a small centre and started a project. In the year 1990, we got the place and ordered the machines, which were probably India’s 4th or 5th machine in MRI/Radiology. We were on the verge of starting when the gold rates went down and India’s credit rating became very low. So foreign agencies, which were doing the funding i.e. ADB (Asian Development Bank) from Philippines and KFW (German Development Bank) from Germany withdrew that for the service sector. So from 1990 to 1992 not a single letter of credit (LC) for healthcare project was started in India, which required any foreign currencies.
We had a place which was ready and we could do nothing because there was no funding for machines. During this time I joined INMAS as scientist doing CT (computed tomography) scans, MRI and everything. Things became better by the end of 1991 and we were able to establish that LC, which was through IFCI (Industrial Finance Corporation of India) and in March 1992, I resigned from INMAS and started the centre (GMR Institute of Imaging and Research), which was on Pusa Road, New Delhi.
At that time, just to put things in context, there was no MRI in most hospitals, not even in AIIMS or PGI Chandigarh. We were lucky to start it first. Since I was trained and had some experience, for the first two years we started getting cases from whole of north India — Rajasthan, Odisha, West Bengal, Bihar, UP (Uttar Pradesh), Madhya Pradesh, Punjab, Haryana etc.
That’s how this whole journey started and that’s how I became an entrepreneur out of compulsion and started something, which one would have not dreamt. If I had got job immediately after coming back, I would have become a professor in some medical college.
What made you specialize in radiology? Who inspired you?
In MBBS, you hardly get to see radiology. In 1984, when I joined radiology, it just started to develop, CT scan, ultrasound had just come and of course, it had become more than X-ray. Even though my main interest was internal medicine, I wanted to do MD in medicine and radiology was my second choice.
In PGI Chandigarh, I was first in the waiting list in medicine but I got radiology and I am glad today that I had the right choice. When I joined radiology in PGI, there was interventional radiology — a branch of radiology that uses image guidance, ultrasound guidance or fluoroscopic guidance, CT guidance to treat by putting in needles, by putting catchers; so, it was the beginning of interventional radiology in India. With this technology upgrade, apart from just doing diagnosis, we were also treating and that’s what really led me to start liking radiology. The fellowship that I went for, when I won the Rotary Foundation scholarship, was a fellowship in interventional radiology and it was a time when MRI had just started. I became very fascinated with MRI, so it was an easy switch from interventional to MRI and that’s how the whole thing happened.
While setting up the Mahajan Imaging, what sort of challenges you had to face? How did you tackle them?
The first centre, GMR, came in 1991 end, which we set up in Pusa Road. Setting up the first centre was a huge challenge because I was very fresh, had no experience of doing any kind of business venture in health care space. It was the sheer persistence and encouragement given by the chairman and general manager of ICICI (Industrial Credit and Investment Corporation of India) Bank at that time, whom we approached for loan, which helped us to get a loan to set up the centre.
MRI was so new in the country at that time that there were only one or two machines; no one had much experience in this field. Whether this kind of business would be financially viable or not was not sure. We were totally untried. But it was very exciting, though lots of challenges came in as I have told you about the credit rating of India, such a big thing affecting a small person like me! But with my partner, who was very strong and determined, and with our collective will, I think we proceeded and that’s what led to the start of our first venture.
We set up the Mahajan Imaging Centre in 1999-2000. The first project was done in Ganga Ram Hospital, where we set up a nuclear medicine unit. Then in 2001 we set up radiology department in Jaipur Golden Hospital. It was in 2004 that we stated up this venture (Mahajan Imaging) in Hauz Khas because till that time GMR was still continuing and then we parted ways after my partner’s death in 1997.
The real growth of Mahajan Imaging Centre started from the year 2004 as an individual company and with having full control and full decision making capabilities.
What sets Mahajan Imaging apart?
We have the best equipments and many add-ons of these equipments, which are available at extra price (varying from Rs 10 lakh to Rs 15 lakh each piece). We continuously upgrade our equipments, which is not in the case of any businessman. Many businessmen do not want to invest in continuous up-gradation because they want money to come out whereas we have been going on reinvesting in technology.
In the last eight years the MRI scanner that we have here has been upgraded three times and at one time it was such a heavy duty upgrade that it took 14 days of machine down time and cost nearly Rs 2 crore. The business fraternity is not so keen and as a professional, as a radiologist, I have no constraints in getting the best equipments and that is what we have been doing. Recently, we have got world’s best CT scanner, which is a dual imaging scanner with spectral imaging capabilities and is the first to come into this part of the world.
Though we have best CT scanner, still I urge to have better, to upgrade my equipment continuously. I actually believe in the words of Jack Welch, CEO of GE Healthcare, “You change before you have to.” So, we change and keep upgrading that gives us pleasure; it gives doctors and patients the best technology possible. Here what we have in comparison to what we had earlier is that we have all radiology modernity under one roof. We have high field MRI system, we have a standing MRI system, two MRIs in this centre and we have dual energy high spectrum CT scanner, two digital X-rays etc.
The other way in which we are apart is that we are into a lot of pure and applied research apart from clinical research. We have research tie-ups with IIT (Indian Institute of Technology) Delhi, IIMS, MIT (Massachusetts Institute of Technology) in Boston, US with whom we are doing some collaborative work on functional imaging of the brain and brain plasticity in studying blind children whose sight has been restored and it’s a path breaking study which will soon get published. It is not like that we are here only to do scan and MRI…we are looking beyond it.
Also there are lots of humanness and lots of sympathy that we give to our patients here. It’s not like you come here and get your scan done and that’s it. Right throughout in my career, I have believed that rich must subsidize poor in health care so that poor can also get best treatment. The poor patients who come here, we give them all kinds of concessions including free scans. We are able to do it free of cost because rich pay the market rate. This works very well and this is the part of our ethos and our thinking. It’s not our corporate social responsibility; we do not look at it like this. We do it as a part of our being because that is what we believe in and that’s what I was taught as a child and what my children have been brought up thinking; we continue that thinking.
Despite being spending money on free scans or subsidized treatment, we are still able to run our business. I believe the blessing, which we get form our patients, is much more than the money we could have charged. I truly believe that a large part of our success is because of the blessings that we got from unknown people.
What it takes for a doctor to become an entrepreneur? Do you see yourself more as an entrepreneur or a radiologist?
A doctor never changes, only exceptional doctors change. I am in no way a businessman; I am still a doctor, a radiologist. I still do sit on machines and do the scan myself, still do my reporting. It gives me more pleasure; it’s like a de-stress… doing your own radiological work is like doing meditation. Having to do business is a compulsion and I can tell you this is very tough and there are many things that we ignore that a good businessman would not ignore.
I believe many doctors who become entrepreneurs still remain doctors. My focus is still on my patients, on their scans, on talking to them, on talking to physicians, surgeons. I also do believe that since we are always being at the cutting edge of technology, the onus is on us to also teach physicians as well as the society at large about the new technology that are coming and about how they can help in day to day diagnosis and treatment. I always go around the country, out of the country to lecture on these newer technologies, on usefulness of the newer technologies and on how the application of these technologies is changing the way we diagnose, changing the way we treat.
How your entrepreneurial journey has transformed you as a radiologist?
I would say my core competence still remains radiology. It’s not like we never think how we will achieve break-even or we don’t think how profits will come from. Our equipments are very costly, very capital intensive and the payback time range to nearly seven years. One has to run a tight shift but if you do a good job, if you are honest to yourself, your patient, to the doctors who refer to you then still you can have a profitable venture without having to focus too hard on profitability. Your honesty and your humanness are transparent to all over the world and they are able to see that which translates it into a profitable venture. Of course, sometime you have to be mean with the companies, which sell the equipments as they have only profit motive at heart. We always hope that we are able to get a good deal and they convince you every time that you have got a good deal, but one never knows how true this is. I have more or less stuck to one company for these 22 years i.e. GE Healthcare. Only recently I have bought some product from Philips Healthcare. I think once you develop relationship, the company also stands by you.
What’s been the most important change since you joined the medical profession?
The major change since I joined this profession is that radiology is no more a dark room radiology. It has emerged from the dark edges and moved in to the forefront of the medical world. Nowadays, medical graduates have to work hard to choose radiology as career option because it is impossible for anyone who is not in top one per cent of his class to get radiology. Today, radiology has become most sought after branch of medicine, may be because of the glamour associated with the big machines or may be because its ever changing, newer and newer technologies are coming into it which fascinate people and also because of the fact that without radiology no treatment is initiated today.
This is the age of evidence-based medicines and doctors as well as patients do not accept treatment based on just one’s own clinical acumen or thought process; they want to see the evidence. Thus we see the radiology at the forefront. Radiology helps detect all body parts — right from head to toe… each and every organ and each and every part we have to know all and that’s why there is variety. Also, there are huge variety of equipments such as X-rays, MRI, CT scan, interventional radiology… so there is a lot that a radiologist can choose from and that’s why I think radiology has come from bottom right to the top.
How has the field of radiology developed in India?
In India, radiology has developed very rapidly. Nowadays MRI, CT scans are available in small towns; PET scans, which we started around five years ago at Mahajan Imaging Centre at Ganga Ram Hospital, was the 7th or 8th in the country at that time, now there are more than 80 in India. Technology has also evolved, you are getting better and better technology, the spectral CT is the case in front and so I can say that radiology in India is blossoming, it’s growing at a rapid pace.
Unfortunately, the growth of the radiologist and trained technologist is not keeping pace with the growth of the number of machines and centres that are coming in the country. I think this is going to be a concern, which can hamper the growth of radiology. I think the onus is on the imaging centres like us to also come into teaching and training, which we do. We are trying to do our bit but there needs to be a change in thinking of the government that private set-ups and private doctors have to be incorporated as teachers — may be in the form of part time teachers — as used to happen in the past, as honorary professors, so they can also contribute to the teaching and training in India because without trained manpower we are not going to meet the goal of health care for all which we have set for our country.
Are you happy with the quality of doctors coming out of the medical colleges and the role being played by the MCI to maintain that?
Both in private and government medical colleges there are those who are good, those who generate very high quality not only radiologists but also specialists, physicians, surgeons. There are also students who are medium level and there are also who are not up to the mark. I think it’s up to the MCI (Medical Council of India), to set at least minimum standard above which everyone should be. In our country, there is quite variation in the teaching and training in both government as well as private medical colleges which varies from state to state and also within state.
What measures should be taken by the government to bridge the gap between the demand and supply of radiologists?
The government is already trying to increase the manpower. The government has increased or say doubled the number of seats for MD, MS in different medical colleges. They have, to some extent, diluted the number of professors needed for the number of students that can be there. Also, through Diplomate National Board (DNB) of examination, the private set-ups are also having been brought into the ambit but I feel that they need to loosen up even more. We cannot compromise in quality anyway but once minimum standard is set by MCI or DNB then even private medical centres, especially in radiology, which may not be attached with a hospital can do the maximum work and great variety of work. Earlier, they used to be allowed to have DNB students but somehow in the last few years they have stopped this and this needs to be revived otherwise we will have great shortage of manpower.
As the president of Indian Radiological and Imaging Association (IRIA), what major initiatives you have taken so far for the progress and well-being of the association members?
We have taken great initiative into academic. We have made the annual radiology conference more like a radiology PG course. It is very academically oriented. In every state, multiple courses are being organized, multiple conferences, seminars are being organized. We are encouraging them and we are even funding them through our central IRIA. Through the Indian College of Radiology much more emphasis is given on teaching and training. Through these central organizations, we are giving traveling fellowship, giving money up to Rs 50,000 to those who can go abroad to deliver a talk or for a fellowship. We have tied up with the European Society of Radiology, with the Korean Society of Radiology, with the Chinese Society of Radiology and several other societies where young Indian radiologists can go and train free of cost. In fact, the Korean Society has been good enough to even give them stipend and give them a place to live where they can spend anywhere from 4 to 12 weeks during this course free of charge, to and fro are also paid. So, our effort is mainly on teaching and training and academics and also on trying to bring the entire organization close together so that we can learn from each other’s experiences.
What are some of the major problems that the association members are facing currently?
Actually, we have quite a cohesive organization and officers there as well as members at large are very supportive of the people who run it and there is an annual election which is held. So, it’s a very broad based representation that this organization has and from the running of the organization for last nine months or so where I have been in the helm of affair we have not faced any difficulties.
What’s the most difficult personnel decision you have made so far in your career?
The toughest decision, which I have made, was choosing radiology when I could have waited to get MD in medicine. But God has his own way and probably he is the one who made me choose the right one. The other thing I think was parting with my previous partners. Though father had died but his sons were my partners. So, that was the tough decision but circumstances compelled me to take that decision. Because, according to our way of thinking, when you enter into a partnership it is for life. Beyond that I guess you are engrossed and happy doing your work that it is only have been happy and happy kind.
What’s your message to the budding radiologists?
One thing that I have done always and also as president of Indian Radiological Society is to encourage young radiologists to become entrepreneur. I tell them to see my example, who comes from a middle-class background, whose parents are teachers and if I could do something and become an entrepreneur — maybe I was forced to become — why can’t others do it. Youngster have much more knowledge, they have much more capability and grapes of reality.
I encourage everyone to become an entrepreneur because if a radiologist or a doctor can become entrepreneur he would, I feel, be much more humane in his approach, as compared to a businessman doing the same because a businessman’s pleasure is in making money, our pleasure is in diagnosis, treating or curing, that gives us more pleasure than the money that we can get out of it. This will also help in improving the standard of health care across the country.