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CAREER CONTRAST : 'EMPLOYED BY A HOSPITAL' OR 'SELF-EMPLOYED AS A PRIVATE MEDICAL PRACTITIONER'
OP Kapoor*, Sanjiv Amin**
Ex. Hon. Physician, Jaslok Hospital and Bombay Hospital, Mumbai, Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital, Mumbai 400 008.
The career options for a graduated resident Indian medical student planning to settle in his home country are few. Two foremost ones are either seek employment in an established hospital or clinic, or enter private practice. Consequently, the Indian clinicians are divided in these two large categories.The Hospital Employed Doctor
1.The 'Trust' or 'Corporate' hospitals "hire" doctors whereas the Municipal and Government hospitals "employ" those recruited usually through a public service commission or recruitment committee. A fundamental difference between being "hired" and "employed" is the fragility of employment (low in Trust or Corporate setting and high in Municipal or Government institutions) and accountability of the doctor to the institute (high in Trust or Corporate setting and low on Municipal and Government setting). Understandably, fragility versus accountability take reciprocal positions.
2.These doctors typically encounter patients who seek health-care from the hospital or clinic for an acute illness. The patient and their family members usually have little time to solicit recommendations and the hospital or clinic selection is based on the proximity to the house, commuting convenience and appearance of the buildings.
3.The 'employed' or 'hired' doctor usually responds to patients characteristically. A defensive, safe and academic approach to the patient is typical that necessitates investigations without much consideration (or pretended ignorance) of his or her financial resources. A firm direction to attain an accurate diagnosis and complete recovery of the patient is followed so that the patient goes back home safe. The approach to the patient is usually 'firm' with a few words conversation, except if recommended from the Hospital Manager or Trustee. The doctor remembers the patient as bed number 1207 or 858 etc., and finds it difficult to cope with remembering the names. The patient too may fail to remember the name(s) of the treating doctor(s). The doctor is contented as long as he is paid for his services and gets professional satisfaction.
4.Academic updating is essential, more in the fragile and accountable setting, and even for promotions in the safe and less accountable employment. Attending conferences is a lot easier as it is organized and paid for by the employers.
5.The doctor could enjoy a regular 9 am to 5 pm type life on majority of weekdays and not have to struggle to get the patients. Holidays are planned according to convenience of the family members and vacation days of children.
6.The fees are collected by the hospital staff irrespective of whether the patient is a relation of a doctor or can afford or not. A hefty deposit is taken in advance and balance often refunded a few days after discharge from the hospital.
7.All taxes must be paid as they are usually de ducted at source.
The Self-employed Private Practitioner
1.After many months of frustration arising out of inadequate number of patients, the private practitioner's practice begins to stabilize and grow. Different methods of soliciting work are employed during the early months and he or she usually realizes the "word by mouth" spread of his or her name and fame by treated patients is the singular and most worthy method of gaining practice. This is typically realized after at least 5 years. Market driven forces prevail for accomplishing good practice, and those who deliver quality care to patients do better than others.
2.The patient is usually 'recommended' to the family physician by some of his friends, colleagues or relatives as the right doctor. Thus the doctor is 'chosen'. The common ailments managed are infection induced fevers, diarrhoea, cough, skin rashes, or those needing prolonged or lifetime follow up, e.g. diabetes mellitus, hypertension, arthritis, asthma etc.
3.The family physician's patient has immense faith that accounts for more than half the recovery. The approach of the doctor is gentle and "sweet" and investigation are in accordance with the purse of the patient. Every question of the patient is answered to satisfaction. A part of the conversation on each occasion would include inquiries of the spouse, parents, children and business or employment.
4.The family physician can practice for life time with a limited knowledge with possibly some "CME programmes" every year. Finance for attending a conferences or symposium is to be generated from the practice earnings or 'begged' from a pharmaceutical firm.
5.The patients expect 24 hours availability. Locum service arrangements are often necessary to maintain the busy practice. Holidays are fewer and mainly in 'slack practice' season.
6.A private practitioner should be ready to see the following (which may be in dozens) patients free for their lifetime. Brothers and sisters of the spouse. In-laws and the in-laws of brothers and sisters and of their spouses. Neighbours in the residence and clinic buildings. Relations of neighbours. Servants of own household and of in-laws, neighbours and the clinic. Club workers and their relatives if a member of any club, Income tax officers, custom officers, police officers, politicians and their relatives. Patients who say that they have not brought any money or cannot afford. The family friends and their relatives. Teachers and their relations. Medical students and their relatives. Doctor colleagues and their relatives. (The list can be very long and don't be upset, if once in a way, on a particular day, a quarter of the patients seen did not pay!!!)
7.Tax payments can suit individual requirements and can vary from year to year.
My personal views of the respective doctors are expressed above, that I reckon majority of readers will agree, and they may form the basis of selection of either career for a fresh graduate seeking settlement.
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