Oh, Doctor!

You might have read about how a PG seat in Radiology was sold for 1.75 crores in Navi Mumbai. Tell me, what kind of commitment can one expect towards his profession when a medical student has to pay that kind of money, except his commitment to recover the cost of his degree?

MBBS seats are sold for as much as 40-50 lakhs or more in private colleges throughout the country. Is there any wonder then that the students who manage to buy them also manage to fudge their marks to pass the exams for a few lakh rupees more? And once they get their degrees these ‘doctors’ happily play with the lives of the patients. Cases of negligence, wrong diagnosis and medication abound today. Recently one of my friends was diagnosed with ovarian cancer and put on drugs for the same till a second and third opinions proved the original one wrong. Who is going to pay for the damage caused by the highly potent medicines? And what about the mental agony? Perhaps the doctor was trying to recover the cost of his costly diagnostic equipment.

Education had become a business long ago. All one needs is to start a school or college and make enough money for several generations to come. And so today we have everyone and their doorposts starting an ‘education society’ or ‘education trust’ and fill them with their family and friends. The buildings are grand, the campuses impressive and the education just about adequate. States like Maharashtra, Karnataka and Tamil Nadu boast of engineering colleges by the hundreds!

But when it comes to medical colleges, the scenario has worsened. It is still a case of capitation fees, which is transacted under the table of course. Government medical colleges have not increased in number nor have they increased their seats commensurate with the increase in the number of students. As Dr. Devi Shetty, founder of Narayana Hrudayalaya and former member of the Medical Council of India points out, ‘We need at least 100 government medical colleges immediately. There are so many children from rural areas who want to become doctors but can’t afford to pay the fees of private medical colleges.’ Another advantage is that the selection can be done on merit, and not based on their capacity to pay capitation fee.’

Dr.Shetty opines that when a poor student is given a chance, he will have more commitment towards his profession, for he has felt the pangs of need. ‘Why should you stop students from aspiring to become doctors? Give them a chance at least!’ he urges.

It is natural that when one has to pay tens of lakhs or even crores for a medical seat, one can’t expect the doctors to be dedicated to their profession who will work for the poor and needy. Is it any wonder then that today no doctor wants to work in the rural areas and even doctors in government hospitals are running clinics on the sly to make more money.

We have something called ‘medical tourism’, where we have patients coming from developing and even developed countries for costly treatment including cardiac surgeries because it costs a fraction of what it does in developed countries. Isn’t it ironical that we have so few doctors that according to one study, there is only one doctor for nearly 2000 people in India and yet we can spare them for medical tourism?

Today only those who have money can afford quality health care in India. While this is true of private hospitals, it is power that plays a role when it comes to the premier government medical institutions like the AIIMS or the PGI. If you are a senior bureaucrat or minister or even a petty politician, you can rest assured that you will get the best possible treatment in these premier institutions. Else, you have to languish in filthy wards and suffer the indifference of the staff including the attendants whose hands don’t work unless their palms are well greased.

There is nothing like uniform treatment in hospitals – whether government or private. While charging more for those who can afford a special ward with extra facilities is fine, but giving second-grade treatment to someone in a general ward is not acceptable but is the norm. As it is, a middle-class family with a single earning member goes into heavy debts after any hospitalization and if it is a life-saving one like cardiac surgery or kidney transplant, then the situation is worse. I know of one family where the money saved to ‘buy’ a seat for the son was spent on hospital costs for the father.

Even when there is medical insurance, the costs don’t cover everything. I remember having to pay nearly 50% of the hospitalization charges when I had undergone a a major surgery several years ago, despite having medical cover. There are so many clauses and conditions in the policy that one ends up paying huge bills when getting discharged because it does not cover this, that and more — and even after discharge when one goes for reviews and follow ups.

Courtesy: Google images

All the mandatory quota of free beds in private hospitals is a big eye-wash since the other costs are so exorbitant that the patient can’t afford to pay even a fraction of it. The medicines, the nursing charges, the other facilities…The Delhi HC has ordered all the premier hospitals to give 25% OPD treatment and 10% in-patient treatment free of cost, but the beds are lying vacant as the hospitals are not willing to comply, arguing that they ‘would go bankrupt,’ if they did.

Are the hospital charges high because it has become a business like other businesses and runs purely on profit? Even hole-in-the-wall private nursing homes and clinics often have expensive diagnostic equipment to attract gullible patients who are made to undergo superfluous tests and investigations. How else would the practitioners recover the cost of the equipment and the price they paid for their medical seat?

This is similar to reserving seats for poor students in public schools in the country. How can a slum-dweller’s child compete with an industrialist’s child when it comes to meeting the other charges levied by the school in addition to the tuition fees, which has been waived off magnanimously? Is the school giving the uniforms, books and stationery free of cost? So where does that leave the poor student?

A couple of decades ago, the number of seats in engineering colleges were limited and many of these institutions gave admission based on the ‘capitation fee’ system. Today there are so many engineering colleges countrywide that even your doodhwala might have one and give your child admission if you paid the fees! True, it might not be the best college, but that hardly matters because the job market is on the upswing and one is assured of a job anyway. Isn’t that’s a good thing?

Likewise, if we have more medical colleges, we can create more doctors, which will reduce the doctor patient ratio and thereby reduce the medical costs too. The need of the hour then is to create more medical seats with affordable fees to enable students from smaller towns and rural areas to get admission. Coming from deprived backgrounds would also make them more committed towards their profession, don’t you agree?

Today, when everything can be bought for a price, is it any wonder that we ‘buy’ education, including life-saving ones like a medical seat/degree?

The words of the season being democracy and constitution do I hear someone say that in a democracy it is unconstitutional to interfere with someone’s fundamental right to sell or buy a seat?

I would love to hear your views on this.

40 comments

  1. […] Related post: Oh, Doctor! […]

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  2. Sad, sad state. You raise some pertinent points and valid questions. Wish we could do more than just debate :(.

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  3. Since you have already read my post on a similar topic, you already know my views. I think what our people need, more than anything else is: Hope. What Hope can you expect them to have when they don’t have a chance to have quality education without paying underhand; when they cannot become a doctor without paying likewise; when they can’t get healthcare without facing same music…and so on. On the flip side are the rich and the upper middle class. My cousin runs a hospital in Punjab. He has patients coming who demand MRI as if demanding a car or fridge or TV! Anyway, shall be reading your blog regularly

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    1. I agree with the flip side you have mentioned. MRI, CAT scans and the like have become status symbols for the rich and the poor think it is the best diagnostic tool and they should have it too! Truly, we seem to be becoming a country which can offer little hope to our people education wise, healthcare wise and a lot of ‘wises’ besides. Thanks for visiting. Visit again 🙂

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  4. Zephyr,
    Your post is more than an eye-opener. Unfortunately the source of our many problems is indeed corruption. I am sure many would agree to it. I believe that medical profession today is nothing more than a bulletin board where doctors read (I am sorry misread the patient most of the time!). Sometimes it seems there is no respect left for the profession and it is a money minting business. More than the doctors, it is the hospital staff and administration that are rude and cheeky. They often will give you that look as if you were being treated ‘free of cost’ or were ‘solely at their mercy.’ Ridiculous! I am asking myself -where did the bedside manner go?
    We probably need more Anna Hazares to battle corruption that is anywhere and everywhere.
    Barkha Dhar

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    1. Bedside manner vanished with the high-sounding medical degrees that make specialists. Leave alone bedside manner, there is no reassuring smile either. Sometimes one is scared to visit a doctor for the prognosis and diagnosis delivered in the most scary tones and words.

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  5. I agree to the last punctuation. Education and Health have become a Mafia. But do we need an Anna Hazare to start protesting?

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    1. But are we protesting or just going along because it is the easy way out? A known devil and all that…

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  6. Thank you so much for your condolences and prayers during our time of grief.

    The term medical tourism itself indicates the mercenary attitude of the medical fraternity.
    We need more Devi Shettys for the good health of the medical profession.

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    1. Any time Deepak. It is at such times that you need friends.

      The interesting thing about Dr.Shetty is that he wants hospitals to reduce their costs by increasing the number of surgeries — economies of scale! That’s what he does in his hospitals.

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  7. you’re absolutely right… it is the shortage of seats in govt medical colleges which allowed the private colleges to flourish and demand anything they feel like. The 1.7 crore seat was new depths to which we have fallen. You have to consider that will be just the donation – fees will be around 6.5 lakhs a year..which makes the final seat worth nearly 2 crores.

    Even with so many medical colleges, theres still such a huge shortage of doctors:population. There is news that from next year, there will be a common entrance for all the students of india rather than the separate ones in each private medical college ( which can be faked and seats bought )… but i doubt whethr the pvt colleges will allow it to pass. They stand to lose in crores every year by accepting these demands and after all, the main idea behind these institutions is to be a profit making business.

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    1. Ooh! That high fees? Is it only in private medical colleges or in Govt. ones too? I think the aspirants must be thinking of the capitation fee and tuition fees as ‘investment’ for their business. Of course the colleges will oppose any such move and a weak and corrupt govt will bow to them.

      btw., I didn’t know you were an anesthetist. I have great respect for your fraternity — been under your care for half a dozen times and come out unscathed 🙂

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      1. these fees are in private sector … and yes, everyone sees it as investment only. And once more u r right. I doubt if any private maedical college will let the govt kill their goose which lays the golden egg…

        Its sad really. I work in a medical college so I’m used to seeing major operations being done at 10% of the price and even free .. but not everyone wants to go to a medical college. And as u said, in a private setup, the rates are all cutthroat which maybe ok for the well-to-do, but not for the middle class families.

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        1. Oh no! The well-heeled go to medical colleges for treatment and avail of the low cost but get VIP treatment. It is the poor who suffer there too. But when they do go there, they get good treatment, is what I have heard, not maybe in the premier institutes of the country, but in state medical colleges.

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  8. Ha,I think it is prevalent in all countries.Yesterday,I went to see a doc because of migraine.She gave me 7 different medicines.3 for headache,1 for sore throat and 3 other to counteract the side effects of the above.Duh!

    And 1.75cr for a PG seat? So even if you score only 50% in exam you can get into a med school if your dad is a rich man.Is that student worthy of the seat?Will he/she be able to do a good job?Being a doctor is a very responsible job,I wonder whether the “capitation fee payer” student can do justice to the profession
    Please do watch first half of “Aarakshan”.

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    1. That is exactly the point here. How will someone who pays for his seat be a committed doctor? your experience with docs is nothing new. I never go to them either. One migraine medicine actually increased the frequency! It is a side effect and the doctor didn’t warn me, nor did the leaflet. I found out from the net! I still suffer from migraines — have been suffering for the last 4 decades!

      I didn’t watch the movie because I heard it had said nothing new and the title was just a teaser.

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  9. Great post- and hard-hitting too. A PG seat sold for 1.75 crores? Unbelievable!

    I agree that more seats and affordable fees would ease the problem. It would probably not be as easy as increasing seats in Engineering colleges. Medical colleges have to be attached to hopitals, etc. But it would be worth it if the govt made the effort.

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    1. I think all the big corporate hospitals can afford to open medical colleges and so should the government. When you are spending crores on useless things like security to terrorists, I think you can spend a few thousand crores to build medical colleges and hospitals, don’t you? But the govt. has better things to do like protecting the corrupt.

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  10. Oh yaa..this is so so true….I went to a gynac who is from the old school during my pregnancy…he took only ONE scan in the whole 9 months I was in Mumbai and I had a superb pregnancy..super nice okie?…I went to Baroda and since my parents really dont know any gynacs (Bro and me were born in calcutta, so ma didnt really have a gynac here) the doctor made me go through 5 scans in a span of 15 days!!! and then on May 30th, she told me the baby will be born after June 2nd..and R was born at 12 in teh afternoon on May 31st and I dont even want to go through the birth story again..it gives me jitters…in short, it was lacerations all through my vagina, 22 external stiches, in numerable internal stiches, collapse of the wall which seperates the vagina from the rectum, and now for the past three years I suffer from fissure problems in the rectum..and this is only because the doctor miscalculated R’s birth timing..she said 7 in the evening when she checked me at 10 and R was born at 12 in the afternoon..so there..this is what the new age doctors do 😦

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    1. It would have been better had you been able to continue with your gynaec through the delivery. your gyneac was only two days off. I know of cases when they are 15 days or more off the due date. Your certainly sounds like a horror story. The thing is that we don’t take action against such doctors and let them get away. Today doctors ask the girls if they want a normal delivery or C section and you know many girls choose the latter! Oh joy to the doctor who is richer by nearly a lakh!

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  11. Appalling as it might be, but education has become a business today ! Everyone’s starting either a school, college, management institute, medical or dental college, no matter the quality of education that’s being imparted ! They’re all sure of making pots of money which is their one and only intention !
    Just the other day we were discussing the good old neighborhood GP giving us those awful mixture in bottles(ugh !!) with that dosage stickers…. all made inhouse by the ‘compounder’ ! Couldn’t help laughing when I read your apt description of it !
    Today of course every doc opens a ‘multi speciality’ clinic !

    That sure is a superb post and I agree wholeheartedly !

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    1. You should see the schools and colleges today — they are posher than a five-star hotel and as you rightly point out, with dubious quality of education.
      Oh yes, I forgot the ubiquitous compounder! and even with the multi-speciality clinics they can’t diagnose anything and will refer you to a specialist 🙂

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  12. I was appalled by the news.And did anyone do anything about it? Was any action taken against those who took the hefty sum? Most unfortunate is that we all are aware of the malpractices but nothing is done to curb and punish the guilty.

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    1. We don’t have the laws to do that and when we do, the ones who have to do it can easily be bribed. That is the reality today Alka, like it or not. Mostly, these things don’t come in the open like the time a close relative had paid nearly 5 lakhs for an engineering seat in Chennai in the late 90s since they were FC (forward caste) and so had no seats on the merit quota. She told me about how she had to wait a whole week with her heart in her mouth and an indecipherably scribbled 2″ square paper for a ‘receipt.’ reporting such cases would mean no seat and harassment from the authorities too. But when you buy a medical seat, you have to worry about the quality of the doctors who have done it. How can you trust your life to them?

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  13. well said..myself a medical graduate studying for pg entrance..appreciate yu for this brave post…rightly said too…

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    1. Hope fervently you don’t need to pay capitation fee and even if you need to, you don’t! All the best for your success in the exam. Visit again 🙂

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  14. agree with you…if they are paying so much to get in, they can pay a bit more to get it…and they will definitely want all that money, plus more, back when they have it..unless of course he is a saint…
    like Purba, going to doc is my last resort…we lost the faith and respect we once had for them…

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    1. It is the sad story everywhere Sub. You pay money to get a teacher’s job, policeman’s job, even a peon’s job in MCD and what do they do to recover the money? take tuition, bribes on the road and from the common man to move your file, respectively. Doctors and hospitals are for emergencies and there too they squeeze the money and sometimes even life out of you 😦

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  15. I just got a medical insurance done for me and my family. And struggled to get one for my healthy mom who just turned 60, because she is on the wrong side of age.
    Zephyr – it would be very interesting to find how many medical and engineering colleges in this country are being run / owned by political bigwigs. The connection is obvious.

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    1. Like Purba pointed out, medical insurance is only for the healthy and the fit. I will have to start undergoing the harrowing thing from this year since I have passed the mandatory age for ‘no medical test’ for women, which is 55. It is no secret — these professional colleges are either owned by politicians or corporate hospitals themselves. As for engineering colleges, as I said in the post, even a chaiwala can have one if he has the money and the local Corporator or MLA’s support.

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  16. ZM, lovely post and agree totally on the stand that “buying” of medical seats will cause a conflict of interest. Only one bone to pick with you (and many others actually). I agree doctors and medical practitioners work directly to save lives but why doesn’t anybody consider the engineering sciences life saving? The poor guys build machines that help doctors and God forbid they build a bad bridge or building or railroad and there’s going to be a whole lot of business for the docs!

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    1. Maybe the engineers and docs are in collusion there!! But seriously, who says bridges don’t collapse? Of course that is also due to corruption — mixing 10 parts of sand to 1 part of cement 😀 Opps, I should be discussing this in Parliament, not on my blog perhaps?

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      1. Pratibha · · Reply

        I remember, when Siddharth was taking admission in Engineering College, we were asked to ‘pay’ 3 lacs. He told us to start a grocery shop for him, with that money,instead of paying and getting him a seat.

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        1. Good thinking on the boy’s part 🙂 and he has done great in life too!

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  17. delhizen · · Reply

    chithi,a hard hitting post and since i have worked with many ‘brand hospitals’ i know exactly what happens in there… as far as buying seats or reservations are concerned its a menace… I have suffered the brunt and like me many lakh have.

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    1. Leave alone brand hospitals, what about the neighbourhood GP? He/she has an arrangement with diagnostic labs and so routinely send people for all kinds of investigations like they have asked my maid to get a CT for a headache. she told me that they haven’t prescribed any medicine, nothing, but to get the CT!

      By increasing the number of medical colleges and seats, the menace of capitation fees can reduce, as it has reduced in the case of engineering.

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  18. A visit to the Doctor is always the last resort for me – I’d rather bear the pain and let my body heal naturally. And when I do have to make the mandatory visit, I fear incompetence coupled with high handedness.

    And then there are specialists for each body part and no one is willing to risk a diagnosis till you undergo a plethora of medical tests.

    Sadly Hospitals are now run like commercial establishments and medical insurance is only given to the fit and healthy.

    Buying a medical seat..paying capitation fees is corruption in my eyes. You are denying a worthy candidate his rightful seat.

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    1. It is more than just high-handedness. They don’t tell you anything. I used to be mad at first till I realised they don’t know anything themselves! I remember grilling my surgeon when I had to undergo a surgery to remove a tumor near my ear. He was a sport and even answered the question of his success rate! You feel like trusting such doctors, but they can be so confident only when they are competent.

      Of course buying and selling a college seat is corruption. And when it is a medical seat, it is a criminal offence — it should be made at least now into one!

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  19. 🙂 i know what incited this post….

    🙂

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    1. It did make me complete and publish it quickly, but this post has been in the pipeline for some time now. Take care.

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