How Goliaths are killing the Davids!

Dr David is a NRI doctor who completed his higher surgical training a few years ago in the UK. He then worked as a consultant orthopaedic surgeon in a large district general hospital in the south of England. He is married, with a wife who works in the IT sector and two kids - a girl, 14 and a boy, 10. He had some compelling reasons to return to India, most of them personal. But, he also harboured a desire to improve the quality of care and increase patient information /awareness. He did his homework prior to relocation, and targeted a few large corporate hospitals - Goliath-1, Goliath-2 and Goliath-3 were the most popular in the city. The reason for choosing to join a corporate hospital was that he was offered a reasonable retainer; something that will keep him & his family comfortably fed, clothed and the children schooled whilst he established his reputation and practice. Despite a lower salary, he chose Goliath-3 as he felt that it had the best infrastructure, a good set of colleagues in other departments as well as his own.

Dr David started getting disillusioned after a few months. He had been promised incentives - a percentage of earnings / revenue generated above his retainer level - after a 6 month period, depending on his turnover of patients and in turn, revenue. Within 4 months he had broken the retainer barrier and was generating sheer earnings in terms of surgeon's fees of at least twice that of what was being paid (as retainer). He discussed this a few times with management, who kind of promised him that it will be reviewed soon. 

Almost 18 months had passed when Dr David started realising that he was being taken for a solid ride. He started looking at options in Goliath-1 and Goliath-2 - the two other major players in the city. 

Goliath-1 was a well established brand that was notorious for it's unethical (mal)practices. Although, the revenue generated would be very good, Dr David was not comfortable with their practices; plus, the operating theatre availability was limited and there was a lot of internal politics. He didn't want to get mired in this. 

Goliath-3 was better in the latter aspects, but was run by a neurotic/psychotic. Dr David, again felt uncomfortable even thinking about moving there. There were, of course, certain other 2nd level corporate houses that did not have this retainer culture, but he found out that they lacked culture, period! Also, they did not have any of the equipments / instruments required for the kind of specialised work that he did; other consultants were bringing in their own instruments to work and were charging the hospital for it.

So, nearly two years following his relocation to India, Dr David was at a crossroad - he could either swallow things and maintain status quo, or start visiting several hospitals and collect a fee for service, or build / establish his own nursing home / hospital. With the fee for service model, he found that most hospitals levy a 15-20% service charge on the surgeon's fee (in addition to the tax deducted at source). Dr David was beginning to feel a sense of strangulation - the Goliaths had perfected the art of strangulation whilst he had been away from the country. It was their way or the highway.

Dr David is now seriously contemplating returning to the UK. He has looked at other options like the Middle East, Australia and New Zealand.

Dr David's case is just one example of many well trained NRI doctors who return to India with visions of making things better only to be completely disillusioned. Losing one's vision is easy if one is not lion hearted and perseverant. 

In recent years the government has  relaxed a few regulations to encourage more NRI doctors to return but clearly this has been a half-hearted stab - most NRI doctors tend to specialise in their respective fields, whereas the current regulations do not allow accreditation of the specialist qualifications (for example, whilst FRCS is recognised as a 'higher' qualification, FRCS (Urol) is not!!). My take on this is that this was probably done to protect the turf of the 'locals'. I mean, who is the loser? The poor Indian patient, of course.

There are several doctors who have trained exclusively in India doing a fantastic job - be it the quality of their service, their communication skills or maintenance of ethics. I do not say this in a patronising or condescending fashion; because, there are quite a few who practise medicine in the worst possible way - full of avarice, unethical, uncaring and extremely condescending to their patients.

The combination of economical disillusionment, lack of public infrastructure, power outages, lack of common courtesy and civility, the need to 'put up' with unethical practices (since this is almost systematised, just like corruption) is enough to make someone who is used to a different way of life to pack their bags and head back to sanity.

The hangers on are brave indeed!