The dilemma that Indian doctors face today is that their profession is based on principles of morality, ethics and Hippocratic oath whereas accountability is based on consumer laws, RTI and Laws of tort. He is confused about the realities of his own practice. Out-of-hours duty and worsening work-life balance is the new normal. Unsafe working conditions, increasing incidence of patients attacking doctors and medico-legal debacle are now everyday news.
Since I started my private practice as dermatologist 10 years back, I have witnessed a decline in students opting for medicine as a career. Amazingly, this decline is counterintuitive to laws of demand and supply. According to MCI, India has one doctor for every 1722 people. Compare it to 1:714 in China and 1:384 in the US. This fall of interest in medicine can be attributed to several reasons: lower salaries for doctors, a longer curriculum of 5.5 years, limited PG seats, and a mandatory one-year rural posting. A country where onions are priced by market forces, members of parliament want to cap the doctor’s consultation fee. These decision makers seem to be unaware that for every 100 rupee that a patient spends on his health, not more than 10 rupees reaches the doctor. Rest 90 rupees are devoured by pharma, medical device and corporate hospital nexus.
Government plans to establish some 200 new medical colleges in the next 10 years to address the shortage of 600000 doctors. Unfortunately, there is no plan to improve the quality of medical education in existing colleges. Government colleges suffer from inadequate infrastructure and facilities where private medical colleges in India are run by profit seeking crony capitalists. Policies give undue importance to quantity over quality.
Forced by perverse acts and regulations, ever increasing time/cost of establishing the practice and economic pressures, doctors have lost their independent professional medical judgment, and their integrity. Most doctors have lost their autonomy for the life of a shift-working hospital employee. While the profession is on this ill fated journey, the condition of patients has gone even worse. The healthcare ecosystem has been engineered to incentivize the profit motives of the middleman who is neither doctor nor patient. And at the end, doctors have to take all the blame.
Medicine used to be a noble profession … not anymore. The physics of radioactive half life has taken over the physiology of medical profession. It suffers from an exponential decay over time.
All these developments might sound pessimistic but I am also a firm believer that there must be a way out. I must remind all my colleagues that there is no change that happens on its own. There must be a change agent for any revolution. As practitioners of medicine, only we can rescue our revered profession.
Its David vs. Goliath !
I hope that as a doctor your conscience will resonate with some of my feelings. If yes, I invite your suggestions to resusciate our profession.