harish natarajan pepperwellness

Only dreamers can be doctors

If there is one thing I regret in life, it is not studying to be a doctor. I am not usually the regretting kind—but I have enormous respect for those that heeded to the calling and chose this profession.

There are a number of reasons I could possibly give for my not choosing to be a doctor—but below all that is a lack of courage. I simply lacked the courage to withstand the trauma and the gore; I lacked the commitment it takes to work endless hours. I doubted my ability to go those long hours without sleep and still be available, when needed, to address the next, inevitable, crisis. I wasn’t sure that I could cope with the expectations—and be that model citizen who is expected to unselfishly put others’ interests ahead of his/her own.

Twelve years ago, I made amends in a small way, by committing myself to a career in healthcare—to support these wonderful people in their quest to keep people healthy.

A few years ago, I was discussing a mutual passion in music with a doctor friend. The conversation veered to affordable player options and I talked about my latest acquisition, a Bose Sound Dock. My friend laughed and said, “Rs 13,500 isn’t a small sum of money on an associate professor’s salary, Harish”. I came out of the room very embarrassed by my lack of sensitivity and suitably chastised. The incident also got me reflecting on the cost economics of becoming a doctor.

A little known fact is that a professor in a Government Academic Centre of Excellence takes home a salary comparable to that of the Medical Representative across the table hoping for a favorable prescription from him. This figure could multiply multi-fold if they choose to move to the private sector. This begs the question, “Why do these doyen of the medical profession choose to stick to their academic careers?” “What gives them the strength to resist the large financial incentives to jump ship?” and “Is this a sustainable situation?”

Medicine is amongst the most expensive educations one can pursue. Even in a relatively less expensive country like India, the cost of qualifying as a doctor can top Rs 1 crore – in terms of facilities, equipment, teaching faculty and support staff. It also takes significantly longer to qualify – there is the 4 year undergraduate course, residency and a possible 3 year post graduation.

Doctors often earn their first salaries when other professionals have bought a car and are planning their first child. The starting salary for a General Practitioner would average about Rs 6 lac per year. This is only marginally higher than that of an office assistant—and significantly lower than an executive’s starting pay. Most start as duty doctors manning the toughest shifts and the worst timings—or are left to fend for themselves in the uncertain world of private practice.

Layer on top of this the huge gap in the availability of qualified doctors to manage the health of a population as large as ours. The WHO norm is 2.5 doctors per 1000 population—a number that several developed nations have reached and exceeded. China and Brazil have 1.8 doctors per 1000 population. The corresponding figure in India is 0.7 doctors per 1000. Given the amazing range of professional choices available to an aspiring youngster in our country, will this gap ever be covered? I, for one, have my serious doubts.

What, then, is the recourse available to us? How do we continue as a country to march towards Universal Healthcare, the Millennium Development Goals and delivering on the promises an “emerged” nation needs to make to its citizens. I have listed out my “must do’s” below:

  1.  Value our doctors—they chose to be where they are so they can serve us. Value their time and respect their inputs.
  2.  Support every healthcare professional to work at their highest capability level.
  3.  Use technology to free up precious doctor time.
  4.  Empower patients to take care of themselves.
  5.  Focus on prevention and early intervention.

Each of these is a complex problem in its own right – and each deserves to be dealt with in detail as I hope to do in my future writings.

For the moment, though—I would like to end with a salute to our doctors. You are truly an inspiration. We might not always show our appreciation but we depend on you to keep us healthy and happy!

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