Bombay Hospital was the first private hospital in Mumbai, which got University recognition in Post-Graduate studies and thus started getting a better class of doctors rendering better care to the patients. In the city of Mumbai, Bombay Hospital has set up a very good example by making 300 free beds available to non-affording patients. Vice versa, every speciality, which could be extremely expensive, is now available to the rich affording masses of Mumbai. Since Mumbai has a population of more than 13 million, we thought it worthwhile to bring out a Special Issue on “Scope of Private Practice in Mumbai”.

Population explosion in Mumbai has resulted in rampant land development leading to emergence of dozens of suburbs (located over the Eastern and Western sectors), each having a population of more than one lakh. Thus the scope of private practice in Mumbai has become decentralised and fragmented.

In the earlier days, private practitioners preferred to locate themselves in South Mumbai, as it was the hub of the city. Nowadays even small localities have many GPs and even specialists. Also with time, the demand for specialists has increased. People often prefer to go to the doctors specialising in the particular branch of medicine. In the current issue, we have included the thoughts of some leading doctors on the topic of “Scope of Private Practice in Mumbai”.

First of all, I would like to commend the work of three rather accomplished doctors, who according to me, are pioneers in their own fields and whose accomplishments will remain a landmark in the city of Mumbai. In future, it will be next to impossible for anyone else to reach this pedestal, in view of this decentralisation of private practice in Mumbai. I am referring to Sushil K Shah, S Natarajan and BK Goyal. These gentlemen have done incredible phenomenal work and have also lent their knowledge to achieve medical landmarks.

It would be highly appropriate to begin with the veteran Bombay Hospital cardiologist BK Goyal, who has been awarded with the prestigious Padmashree, Padmabhushan and Padmavibhushan titles, for his invaluable service to the medical fraternity. He has had an illustrious career, which includes a plethora of awards and eminent positions. He is also a well-known medical educationist and social activist. His achievements are lofty and in future, possibly cannot be reached by anyone.

S Natarajan, a leading ophthalmologist is the man behind the much-acclaimed Aditya Jyot Eye Hospital. He is the recipient of many a reputed awards, from the Indira Gandhi Sadbhavana Award conferred by the Global Economic Council to the Gusi Peace Prize - 2005 for outstanding contribution in the field of Ophthalmology. He is known for his untiring efforts to reach out to the people. He started his career at Chennai’s prestigious Shankar Nethralaya. Bombay Hospital brought him fame and was a stepping stone to his success. His hard work and perseverance have yielded him his current stature. Aditya Jyot Eye Hospital has also started the Aditya Jyot Artificial Retinal Lab that may, one day, develop artificial retina!

Last but definitely not the least is Sushil Shah, the brain behind the Metropolis Health Services. He is a pathologist, who promoted his faculty with his business acumen. Metropolis was the first one-of-its-kind centre with state-of-the-art facilities. Sushil Shah has been involved in many noteworthy activities like introducing the first HIV test and successfully helping the obstetricians to help deliver a test tube baby using IVF treatment.

These men are legends. We don’t make these kinds nowadays. It is our pleasure that we have lived around them and have been exposed to their knowledge.

Once more I would like to stress that, considering the fact that the scope of private practice is getting more and more convoluted, it would be very difficult for anyone in future in Mumbai to reach the heights these able doctors have achieved.

The Challenges of Healthcare as vividly discussed in a brilliant article by LH Hiranandani, on page 54, hopefully will soon be practiced by the doctors of the city of Mumbai.

In this city of Mumbai, where nearly every alternate person carries a mobile, spends heavily on seeing the latest Bollywood movies as early as possible after release and does not work on nearly 100 days a year when cricket matches are being played, Deepak Jumani represents the role model of a modern family physician. In his article on page 65, he discusses the role of computers, Mediclaim and telemedicine, which can be practised in this city by many Family Physicians.

Medical tourism, according to many authors, including P Madhok, a man of vision (on page 69), has already touched such heights that in a recent newspaper the list of the countries all over the world sending their blood samples to Mumbai had been mentioned. Also mentioned are the patients of osteoarthritis needing joint replacement, or patient needing heart surgery coming to this city.

Satish Khadilkar from Bombay Hospital, writes on page 70, that the neurological diagnosis has become much easier in Mumbai with the help of imaging machines and electrophysiological studies. He is right in mentioning that the number of CT and MRI machines in Mumbai are more than those in the whole of England, Scotland and Wales put together.

Doctors in Mumbai are under a lot of stress and are busy attending patients round the clock, and making money. But alas! Their future in terms of health and domestic life is bleak, unless as suggested by Maheshwari et al from Bombay Hospital, on page 72, they go for group practice as is being done in USA. This is definitely possible if like-minded doctors, whose chemistry matches, join together and start practising as a group.

Patients of infertility look out for IVF treatment, as discussed by Satish Tibrewala on page 76, which though very costly is affordable only to affluent patients of Mumbai. This treatment now draws infertile couples from many parts of world to this city after they have surfed the net for cost effective options.

Sangeeta Agarwal from Bombay Hospital, has said in her communication, on page 87, that in this cosmopolitan city of Mumbai, the physical appearance of the doctor itself can contribute to achieve the required status. Famous Farokh Udwadia appears to be a tailor made physician for aristocratic Breach Candy Hospital patients. The top most politicians including the Prime Minister of India, businessmen and Bollywood personalities are his patients and one has to see and hear him talking to believe how he could be the personal physician of Mr. Amitabh Bachchan, who has been rated as the Number 1 Indian for the year 2005. As compared to Big B, Farokh Udwadia, who is 13 years older than him, has no baldness or wrinkles on the face and without any make up exudes a radiant glow, which enhances when he is talking to the patient. Vice versa, Mumbai has a very large population living in the slum areas and every such area has a poorly qualified or even non qualified doctor, whose dress and appearance, as well as the local language spoken by him, matches so much with the local population, that he is considered a ‘hero’ doctor. There are hundreds of such doctors in Mumbai, who are grossly overworked and are minting money, which even a highly qualified physician in downtown South Mumbai may not be able to make.

Soon Mumbai’s cosmetic surgeons and specialists will be attracting people from abroad though they are already very busy with the people of Mumbai, who have become very conscious of their looks and physical appearance.

Genetic studies, discussed by BN Apte from Bombay Hospital, on page 93, though not freely available in many laboratories in Mumbai, are very costly, but when done can answer many queries of the patients and the doctors.

Thirty per cent of the population in USA is following alternative medicine (for which the government and Life Insurance Companies are now reimbursing). Vaidya Chaturvedi from Bombay Hospital, in his article on page 104, is not wrong when he says that there is a very large scope for Ayurveda, and for that matter any alternative medicine in the city of Mumbai, where there are different types of people willing to spend any amount of money because they are afraid of side-effects of allopathic medicines.

In short, in my opinion Mumbai is the only city in India and possibly in the whole world, where sky is the limit to achieve name, fame and prosperity.
A few years back, it was published that one of the leading Cardiac surgeons’ (at that time) income was Rupees 1 lakh per day, while the top most Bollywood actor (at that time) was also earning that much money. This statement may not be applicable now because of dilution and fragmentation of medical practice. As against that, fancy prices are being commanded by the popular Bollywood actors of today.

Finally, I have still not discussed the role of private hospitals, which are multiplying. More private hospitals like LH Hiranandani’s (Hiranandani Hospital), KR Shetty’s (Cumballa Hill Hospital), Mr Khorakiwalla’s (Wockhardt), Panda’s (Asian Heart Institute) are going to set a new trend in private practice in Mumbai because these hospitals are investing a lot of money on the infrastructure and the latest machinery. I can foresee that in future new super specialities like that of foetal 2 D Echo Cardiography, “Revision” Arthroplasty, “Revision” Coronary Angioplasty, Endosonography and many others are likely to be promoted. We are already having orthopaedic surgeons specialised in only shoulder, spine or ‘Reconstructive’ microsurgery of limbs. KR Shetty from Cumballa Hill Hospital, on page 79, rightly points out that private hospitals are definitely responsible for every aspect of private practice in Mumbai mentioned above namely the earnings, the spread of super-specialities, the easy use of mediclaim (specially cashless), the practice of telemedicine and are going to help us in increasing medical tourism, where doctors will be earning a large revenue for the Government of India.