Private practice is often cited as a cause for non-availability of doctors for government hospitals. Private practice is seen as a sure shot way to make easy money. We think it is not.
Out of the total student who joins MBBS courses in India, only one fourth to half of the students get admission to a post-graduation course. Now the question is what happens to rest of them who go to the practice (government services, private, institutional) without a postgraduate degree? Most of these graduates end up joining the government-funded primary and secondary care hospitals. Getting government jobs are not that simple either. In most of the northern India states, governments advertise vacancies one 2-4 years and an equal duration is taken to finalize interview, selection and appointment process. And those who are lucky and patient, get the job, and these are about one fifth to one-third of total applicants. Many of those who need the job, could not make it into the list of selected candidates. Many of those who do to get chosen, fail to join, as they get some better bargain while waiting for results.
Now, what are these so-called better bargains which makes an MBBS doctor refuse a government job, which the government desperately wants him/her to join? Is it some six or seven figure salary in some big corporate hospital chain? Of course not. Often these people join some private facility, at half of the wages of what government was offering, staying in a slightly less rural location as compared to a usual PHC location. So that they can stay with or close to their spouse so that children can go to a decent school and like that.
But this can be said about those who are not specialist. What about those who are a postgraduate specialist or super specialist? They must be playing in millions.
Even those who do manage to get a post-graduation degree and become a so-called specialist, they also go through almost the same cycle of career options. In cities, medical colleges and upcoming corporate hospitals do offer a reasonable carrier option. A tiny subset of who meet requirements like fellowships, publications, and connections, could get faculty/consultant positions in these medical college and corporate hospitals. Even their annual remuneration is comparable to any other government employee.
Those who cannot find a place in any of the above, are left with only one option, and that is to go to private practice. In most of the case, it starts with a table and a chair in a rented shop because that’s what a thirty-something, freshly passed out, inexperienced, married, broke and so called specialist doctor can afford. Then the daily schedule for next 5-10 years, is to run from one hospital to another, one clinic to another, to make some money, not only to meet his/her monthly expenses but also to pay for 4-5 loans, borrowed for the car, house, clinic, etc.
One-third of these which survive this ordeal for ten years or so, become the practitioner who is famous in their localities. These are the doctors who have a home more prominent than their neighbors, a flashy car and Facebook updates with photos of a foreign tour. They should not mind if people blame them for lack of doctors in the government health facilities.