Should full-time staff doctors be allowed private practice?

SV Parulekar 
 Dept of Obstet and Gynaecology, KEM Hospital, Parel, Bombay.

Correspondence Address:
S V Parulekar
Dept of Obstet and Gynaecology, KEM Hospital, Parel, Bombay.

Full Text



This issue has been the subject of a great controversy for a long time. The reason has been that everyone has been looking at it from a very personal point of view. The answer is a strong "yes" from a full-timer's point of view, because it would permit him to improve his income. In fact it would be far better than private practice alone, since it combines the benefits, and eliminates the disadvantages of both the systems. Psychological satisfaction of assured fixed income, facilities to admit nonaffording private patients, job satisfaction, teaching (where applicable), and a prestigious position in an institute, combined with possibility of huge income and tax benefits of private practice, would leave out practically nothing that one would wish to have professionally.

But is it feasible? Would seven or eight hours of full time job leave sufficient time and more important, sufficient energy for private practice? Barring very few exceptions, the majority would find it impossible to manage both well. And no doctor would willingly neglect any part of his work, institutional or private. Another issue of importance is that should such a doctor be called to attend to some private patients during his full time job hours, would he be able to leave his work and go? And if he were, would he be allowed to do so by his employers? If not, he would be obliged to take leave and go, and would soon run out of all concessions and leave. Another option would be to go away for a while without any notice to the office of the employers, which no conscientious doctor could manage. And either way, it would be gross injustice to the colleagues of such a full timer, because they would have to look after his work while he was away making money, just so that the poor patients did not suffer.

Let us look at it from the employers' point of view. By allowing full timers to practice, they could cut down their remuneration, and save a little money. But then, it cannot be done at the cost of a compromise of the health care given to the patients, for whom these institutes are run, using money of the tax-payers. A better option would be to have a number of full timers to offer the routine health care, and have a few honoraries of extraordinary merit, whose knowledge and expertise are not needed seven hours a day, six days a week. A fallacy of this option is that such extraordinary persons are found one in a million. There is probably no need to change the system and employ a number of doctors on honorary basis, just so as to be able to get a rare genius, who anyway might be a dedicated worker, and accept a full time job without wanting permission to do private practice.

The issue being discussed is not whether full timers need better income. They possibly do. But the solution to that problem is not to allow them private practice. Those who feel they need more money can leave their jobs and start practice. It is wrong to believe that all good doctors will leave, because it is wrong to believe that there can be bad doctors. There cannot be bad doctors, as the examinations they pass are quite rigourous. So let the extraordinary ones leave the institutes, if they must. The loss for the institutes will be much less than that from allowing private practice to full time doctors.