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Year : 1993  |  Volume : 39  |  Issue : 3  |  Page : 176

Practice makes perfect?

Dept of Gastroenterology, KEM Hospital, Parel, Bombay.

Correspondence Address:
P Abraham
Dept of Gastroenterology, KEM Hospital, Parel, Bombay.

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Source of Support: None, Conflict of Interest: None

PMID: 0008051654

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Keywords: Clinical Competence, Hospitals, Public, economics,Human, India, Medical Staff, Hospital, economics,Private Practice, economics,Salaries and Fringe Benefits,

How to cite this article:
Abraham P. Practice makes perfect?. J Postgrad Med 1993;39:176

How to cite this URL:
Abraham P. Practice makes perfect?. J Postgrad Med [serial online] 1993 [cited 2023 Oct 4];39:176. Available from:

The merits or demerits of permitting public hospital doctors after-hours private practice in the campus must be seen in the light of certain facts:

i) The present hospital pay scales are ridiculously low in comparison to what doctors in private practice earn. This wide gap is pulled further by some lop-sided tax rules, which permit a host of deductions to the self-employed (e.g. depreciation on several items, book allowance) while almost every rupee paid to public hospital doctors is taxed at a rate, which in the higher grades equals what is paid by a millionaire in India.

ii) This disparity makes it impossible for hospital doctors to maintain social standards expected of doctors, unless of course there is a significant supplemental source of income, to self or the spouse, earned or inherited. No wonder the progressive drain of talent from these hospitals - doctors who would have loved to stay back but for this depressing bread-and- butter issue.

iii) The public exchequer (which, incidentally, is bankrolled by all strata of society) cannot endlessly meet rising salaries, what with complaints even at present that employees account for 60% of the budget of the Bombay municipal corporation, for example.

iv) The is no paucity of funds (black or white) in the market today, money that is poured into private hospitals and nursing homes only because they provide more individualised attention (quality is an issue which is best left out here).

Obviously, to address the problems outlined in (i)-(iii), the logical solution would be (iv), a fact being increasingly recognised by erstwhile socialist countries. To say that this will lead to corruption or diversion of attention to the rich is begging the issue. Hospital doctors will charge rich patients for services rendered; these patients will be happy to be treated separately, and the money will benefit the doctor, the hospital and so the poor-a happy Robin Hood situation.

Secondly, corruption is not a fault of the system but of the people who misuse it for their ends. Given the same system, haven't our political leaders become corrupt today? Can we say that all the honoraries who ran our public hospitals (and taught most of us) over the decades were corrupt, or that today's fulltime staffs are all virtuous? Rules of discipline can be built into any system, and enforced if the will exists.

The question is whether we wish to continue as prisoners of our discredited big-government thinking or will accept facts of market forces and evolve the best from it. The bureaucrat will be content even if a dunce occupies a doctor's seat, so long as the muster roll is signed. But don't our poor patients deserve better talent without having to pay for it?


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Online since 12th February '04
2004 - Journal of Postgraduate Medicine
Official Publication of the Staff Society of the Seth GS Medical College and KEM Hospital, Mumbai, India
Published by Wolters Kluwer - Medknow