Is this exploitation??

I have recently joined a hospital as an orthopaedic surgeon which is run by a charitable organization which has many branches in India and overseas and is an eminently respectable organization of monks. I am also working in a hospital that was established by a monk but is run by a governing body whose members are very honourable and distinguished citizens. Both these hospitals are non profit NGO’s. They provide in their hospitals treatment for patients in the out patient department for a paltry sum of money and the cost of the investigations vis-à-vis haematology, biochemistry and pathology is about 50% of the standard rates of private laboratories. They also provide radiology including x-rays in both the hospitals and CT scan and MRI scan in one centre at a rate that is at 60 % of the standard market rates. They are therefore able to draw a huge amount of patients because of the initial cheap rates in the OPD and for investigations.

However I would like to point out that when it comes to indoor treatment services the rates are not so attractive. The bed charges are just slightly cheaper than most nursing homes but the OT charge, medicine cost and the cost of accessories is the same or more. They are able to provide treatment at competitive market rates because they pay less to the doctors and it is this area I would like to draw the attention of all my colleagues.

Most of the doctors who join do so with the expectation that their private practice will increase as more patients get to know them. Some doctors join with a genuine intention of serving the suffering humanity and the poor. We will leave the second group out of monetary considerations of this discussion. 

In the OPD the doctors are paid as a per patient basis or given a allowance that is fixed irrespective of the number of patients. In either case the amount is just enough to cover the travelling/fuel cost and maybe a packet of cigarettes. In the indoor physicians are paid per visit and the surgeons are paid according to the operations to be performed. There is a list of procedures categorized into minor, intermediate or major and the surgeons are paid accordingly. It goes without saying that I am embarrassed to receive these fees. 

Now, the point I wish to draw attention to is the fact that Consultants working in these hospitals are working at a nominal remuneration. The consultant physicians are charging a fee that is a fraction of their regular visit/ consultation fees and the surgeons likewise get a fraction of their regular fees for operating. These amounts are usually decided by the governing bodies of these charitable hospitals. It therefore follows that the medical officers/ RMO working there do not command the salary that their counterparts do either in government service or in the private setup. It therefore follows again that, since the medical officers/RMO are working for a pittance, the nurses and the ancillary staff gets paid less. I can personally vouch for the fact that one charitable organization pays its RMO Rs 8000/- monthly for working 6 days a week for 8 hours per day.

Please consider the situation that follows. This poor fellow who has a MBBS degree is earning a pittance through his profession but he is also a man whose IQ is more that average as proven by the fact that he has a degree which as all of us know is not the easiest to get. He must therefore find or make other channels for earning money. But he does not have to look very far because there is a whole bunch of private entrepreneurs who are catering to just this class of doctors. These are the people who have started a diagnostic centre or a nursing home. This poorly paid doctor soon finds out that there are incentives offered for catering to these business houses and  he starts to augment is inadequate salary. There is nothing illegal or wrong about this except perhaps morally but that is stretching the point a bit too thin. What is this fresh graduate to do when he is put in a situation where he is paid a very meager amount that does not correspond to his education level?

And more importantly who are the persons responsible for this state of affairs?

Is it the charitable hospitals that are the culprits?  I would very strongly refute this point by giving the example of one such hospital on the outskirts of Bangalore that does not charge their patients a single rupee but their doctors are very well paid. This hospital is run by Sri Satha Sai Baba Trust and it does not have a cash counter. The facilities and the treatment provided there is at par with the very best in India. And I repeat that it is all completely free. So if one hospital can do it, why not the hospitals here in Kolkata?

The blame lies, in my opinion, fairly and squarely on the consultants themselves. If their services are offered cheap then the consequences reflect very poorly for the juniors. Not only do they not get paid well, they are also not in a position to demand more. In one line the seniors are choking the juniors. It is very difficult to see the consequences of ones actions until pointed out or seen in retrospect. What can the seniors do that will let the junior doctors and fresh graduates live a better professional life and not have to restore to immoral means of earning money?

However these charitable hospitals do not ask or force us to do charity for them. They have a fixed payment schedule depending on fixed rates and a doctor may choose to work there if he desires. This is where the second group of doctors who actually wish to serve the poor masses becomes important. If one group of doctors works for nearly nothing then it is not possible for another group to ask for their regular fees and consequently we have to continue at status quo. As a result our juniors will continue to be in the same situation. What should the seniors in this senario do to look after the freshers?

In these days of litigations against doctors through CPA it is our duty to provide the best services to the patients, which can be enforced if we work in a professional manner and make sure our juniors do so as well.

In my honest opinion if you are paid well you have the drive and the interest to work hard. 

Given the current situation, a whole generation of doctors are going down the drain in West Bengal.