Saturday, 25 November 2017

Who wants to be a doctor (in Karnataka)?

So the dust from the recent doctors' strike has settled, and the diluted KPME Act has been enacted quietly.

But Karnataka has got to be the worst place for a medical practitioner.  And the KPME Act has nothing to do with this.

The KPMEA is only the latest in a long list of insults that have been meted out towards the practitioners of the 'noble profession.'

As though the tough-as-nails medical course were not enough, each of us doctors has been through hell and high water to try and eke out a living.

Find that hard to believe?  I don't blame you; especially in these times when news channels proclaim striking doctors to be 'Yama's agents.'  

Consider the odds stacked against us: difficult course that one manages to scrape through; even more difficult PG entrance exams; bottle-neck in the form of dime-a-dozen medical UG colleges, but not enough PG seats; capitation fees to get into UG and PG courses; sleepless on-call nights; dog's work in the wards/OTs/OPDs; climbing mountains to establish oneself as a sought-out doctor, assaults on doctors, non-recognition of foreign PG degrees, etc, etc. 

During all this, family/social life goes for a toss and you can pretty much forget about hobbies, alternative interests, and life outside the daily medical grind.  By the time you get round to your hobbies and interests again, you are well past your prime. 

One can't even change jobs like those in technical professions can.  Once a doctor, always a doctor.  You got to struggle on endlessly, even if you earn a pittance in comparison to the IT-BT lot who easily earn twice or thrice as much. 

It is a strange dilemma that a doctor finds him/herself in: deficiency in the midst of plenty.  Indian economy is up and running, but the healthcare professional strangely finds him/herself left out of the Indian success story.  

Setting up a private practice is a case of hit or miss.  You may or may not click with the patients, who can be rather fickle when it comes to following up with you, and loath to pay consultation charges.  It takes years in any case to make a name for yourself. 

In the hospital set up, you need to tow the line of the management, and accept a pre-set salary or 'cuts' from the consultation charges, which are rather like seedless peanuts!

So you are left with a job that you do not enjoy, and that does not provide you with anything substantial to set up home and raise a family.  This is especially true if you happen to live in a high-cost city, such as Bengaluru. 

The effect of all this?  Disillusionment; burn out and drop outs.  I have seen many doctor friends leaving the country in search of a better deal.  Some have altogether dropped out of the profession and started business ventures.  Some have contemplated suicide.

Yes, we have encountered and are still putting up with many 'KPMEA's in our lives as doctors. 

Basically, the recent fiasco from the state government has highlighted three issues, as I see it:
  1. the general public wants first-class service at the lowest cost, preferably free of cost
  2. the doctors want a fulfilling career that provides them with financial security on par with other vocations
  3. the government (in the ideal world) would want a seamless primary and secondary care service that satisfies both stakeholders; public and healthcare professionals
At the moment, none of these three issues are being addressed, even with the implementation of the KPMEA. How can one put a cap on healthcare services without capping other non-essential services that are being allowed to jack up prices wantonly.  Go, for example, to a multiplex and see for yourself how much you have to shell out for the ticket and food. 

What is the solution?  There is none that is perfect, but we are looking at a scenario where the medical service is free to the public, but at the same time, the hospital and the healthcare providers are compensated suitably.

The state owned NHS of UK (even though many in that country find faults with it) comes to mind as a service that achieves just this.  Free healthcare funded for by the taxpayers' money that is deducted at source.  

On the other side of the pond, the US healthcare is largely privately provided, with insurance system covering the cost for the patient.

We need to look at these and other models to decide the best suitable healthcare delivery system that can be adapted to our conditions.  Mindlessly capping fees and charges in an increasingly capitalized and corporatized society is not going to cut it.

Somehow, I cannot see the present government of Karnataka making any thoughtful, pragmatic changes in this regard, given the fact that it has its eyes set on the upcoming state elections.

So, dreadful, populist measures such as Indira Canteen and KPME Act will continue to be inflicted on the unsuspecting populace, as this government attempts to revive the dynasty that has clearly done its time.  

Governments will come and go.  The doctor in Karnataka will continue to suffer.

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