Ban on private practice: How myth weighs against reality

Ban on private practice: How myth weighs against reality

As soon as the PDP-BJP government took shape, Mufti Muhammad Sayeed announced a closer watch on SKIMS doctors and issued a warning to its doctors doing private practice.

SKIMS Medical College had advertised various faculty positions in 2013. The positions were re-advertised; this time to be filled on the basis of ‘academic arrangement’, reportedly due to no applications being received. The positions wherein no applicant was available were Professor and Associate Professor in Paediatrics and Radiology, Professor in Dermatology and Professor and Assistant Professor in chest medicine.

Sources in SKIMS said, “There are a few departments which are under the threat of de-recognition if even one faculty member chooses to leave.”

In the other tertiary care hospitals under the ambit of GMC, private practice was banned in January 2013. However, this ban was confined to Heads of the departments (HODs) in GMC, Associated Hospitals and Dental Colleges of the State. Legal suits followed and the High Court dismissed the petitions in August 2014 and noted that ‘the Government may extend such restrictions to any other post specified by it from time to time’ in view of the patient interest.

PATCHY VS BLANKET BAN:

A senior physician in SKIMS said, “There is no homegenity in the rules. If doctors in SKIMS are banned from private practice in the interest of patient care, how does the government justify private practice of doctors in other hospitals?”

He added, “Pay and perks is a secondary question. But first of all, governments must come clear on why something is being made illegal.” He further asked, “If there are justifications of the ban, and I am not saying there would not be any, then it needs to be extended to all doctors in all hospitals.”

Another physician in SMHS Hospital said, “Doctors of SKIMS and other teaching hospitals have to be available full time for patients for which they are highest paid lot in public sector of state.” He added that there needs to be a blanket ban on private practice as the duality of rules results in confusion, inefficiency and paves way for other ill-practices in the health sector.

‘SELL APPLES BUT DON’T PRACTICE’:

Many doctors demand that they be given the right to decide how they wish to utilize their time. AnHoD of Medicine in SKIMS said, “If I sell apples after hospital hours, it is not illegal. But if I decide to do what I have skills and qualification to do, that is see a sick person and prescribe medicines, I am a criminal.”

He questioned the logic of making private practice a criminal activity. “No doctor will stay in hospital 24×7. The institute has right over his time in the designated office hours. Beyond that, how he chooses to use his time must be his own discretion,” he said.

A senior neuro surgeon at SKIMS demanded that the label of ‘criminal act’ on doctors found practicing be taken off. “It is an offence, a disobedience, not a crime,” he said.

WHAT IS PLAN B?

Experts feel that the governments must decide the course of action based on the prevalent scenario, rather than ‘disposition’. They argue that any decision must be backed by provisions and arrangements that enhance the patient care in the state.

“The shortage of doctors is a reality, not a myth,” a senior dermatologist at SMHS Hospital said. “If they implement a policy where no doctor is allowed to practice in private clinics, they need to ensure that government hospitals do not collapse due to the influx of patients that were being catered to in private sector.”

On the similar thought, a senior gynecologist said, “Doctors who leave hospital for private practice have a better life, more income and smaller work hours.” She gave a comparison of the earnings of doctors in the ‘few evening private clinic hours’ and the month in hospital.

A senior surgeon of SKIMS said, “Quite a few doctors are actually mulling resignation from SKIMS. How will the government handle the hospitals without these senior specialists?”

SAILING IN TWO BOATS:

Some doctors feel that SKIMS doctors are trying to ‘sail in two boats’. A retired pediatrician from GMC said, “People who had joined SKIMS years ago were tempted by the prospects of quicker promotions. They knew that they would not be allowed to practice but opted because they want to climb the hierarchy faster.” He added that those who opted for GMC wanted to be allowed to do private practice.

He asked, “They knew what they were getting into, now they want to twist the arm of the government with their projections and threats.”

There are also growing voices opposing government doctors doing private practice. “Private sector in Kashmir is still in its infancy. It will not grow till senior government doctors stop using their ‘titles’ such as ‘associate professor’, ‘professor’ etc. to show down other doctors without a position in government hospital,” a private hospital surgeon having worked abroad said.

He added that it is not a healthy scenario that even in private clinics, one has to wait for the doctor to arrive from government hospital. “Healthcare has to be efficient, 24×7 service, government as well as private,” he concluded.

LET THE GOVERNMENT DECIDE:

Many people feel that it should be the prerogative of the government to decide policy matters. “If the courts have banned private practice, it must be for the patients’ good only,” Zameer Ahmed, a software engineer said.

Courts have banned private practice by doctors in many hospitals in the past. The doctors under West Bengal Medical Education Services were banned from indulging in private practice. Delhi government hospital doctors are also not allowed to practice.

However, some argue that these states have a booming private sector to cater to patient needs.

“The debate surrounding private practice ban is useless. If the government cannot ensure the presence and availability of specialist and senior doctor in hospital, the whole purpose is lost,” Sajjad Mir, an attendant at GB Pant Hospital said.