When doctors become employees, what do patients do?

We’ve all seen it happen. The friendly neighborhood doctor who had a great practice is suddenly less available. He suddenly seems to be associated with one (or many) of the corporate hospital chains springing up around town. He now has a ‘roving practice’ where he is available at different locations throughout the day – sometimes as many as four locations in the same day. Certain days of the week, he is with one specialist hospital in one part of town. Certain others, he is dedicated to another hospital elsewhere. While he begins to visibly thrive, his once loyal patient base needs to follow him wherever he goes.

A slow but steady ill has been seeping through the healthcare industry in India. Increasingly, more and more doctors are ditching their private practice to become employees of corporate hospital chains. The economics of the decision are fairly sound. Why spend money they can ill-afford at the beginning of their careers on setting up a private practice - painfully waiting to grow a clientele, depending on the vagaries of patients for a steady income and maintaining a staff and equipment at their own costs – when a corporate hospital chain offers them steady employment, good remuneration, a readymade set of patients, marketing and sales machinery to generate leads etc? Clearly one option is far superior to the other.

However, that is but one side of the story. For patients, healthcare is suddenly a precious commodity – to be traded for money. When Corporate entities begin to determine how patients are treated, personalized treatment goes completely out of the window. The corporate entity is only interested in making profits, the sooner the better. So patients who enter these places are treated pretty much the way Henry Ford revolutionized the automobile industry – like an assembly line.

Think about it. Patients, even prospective ones need to schedule an appointment. They are then given a 15 minute consultation by the allocated physician. Post this they face a barrage of ‘recommended’ tests; preferably at the hospital where the physician has a tie-up. Reports from elsewhere will simply be dis-regarded. Another consultation after an appointment and treatment begins. The consulting physician refers the patient to a specialist physician depending on the nature of the diagnosis. The specialist needs another appointment and may entail further tests. Finally the problem is diagnosed. Treatment can then begin.

The trouble scarcely ends there. After this comes choice of hospital, choice of accommodation, choice of diet, choice of medication – all of which are determined by the consulting physician. Typically, these are all at one of the associated hospitals. Not that anyone is blaming the physicians of having an ulterior motive. They simply need to meet their monthly quotas. Unless they do so, they won’t get the ‘performance bonus’ component of their remuneration, which can be substantial. The hospital rakes in the moolah, the physician meets her/his quota and the economy grows at a frenetic pace. For everyone except the patient, that is.

This is a far cry from the days when the physician took time and energy to understand the patient. Over time, they actually became trusted healthcare advisors. Keeping the specific information about the patients, their families and even their affordability, the physician would recommend the best course of action. Tests were not a mandate. In a lot of cases, they were skipped in preference of careful examination. Time spent was not a criterion for consultation fee; outcome typically was.

However all that is nothing more than a distant memory nowadays. The Corporate Hospitals, Insurance Companies, ‘Consulting Physicians’ and their ilk have changed the very dynamics of the industry. And definitely not for the better! When doctors become employees, the corporate guidelines take precedence over the Hippocratic oath. Mammon becomes more powerful than patient health. Care decisions; formerly taken by the doctors themselves, are not centrally made by committees which may or may not have patient outcomes as the primary goal. Treatment options, once personalized and customized to individual patient lifestyles and financial status, may become more cookie-cutter in approach with a one-size-fits-all mentality. Sure, physicians and doctors may still play the role of an advocate. However, it is safe to say that they will have to keep the health of the corporate entity – meaning money-making potential – paramount in their practice.

All is not bad though. Being a part of a corporate healthcare facility may give the physician better and more easy access to specialists and expensive equipment. They also have access to quality and reliable healthcare reports. Facilities, otherwise unavailable become more accessible. Their patients can thus benefit from better care. But all of this comes at a premium. Money becomes the primary consideration.