MUMBAI: Cardiac surgeon Ramakant Panda’s advertisement on referral commissions has triggered a heated debate in the healthcare community. Some doctors have come out in support, but a large section has criticised the campaign. Dr. Panda spoke to The Hindu about what led him to take up the cause. Excerpts.
What prompted you to start this campaign?
When I started my medical career, about 35 years ago, not even 5% doctors knew about the cut practice. Those who did were looked down upon. Also, the practice existed in very few pockets of the country. But today, more than 50% doctors offer cuts, in some places it is even 80% of the fraternity. Those who don’t give cuts are now looked down upon and victimised. It is that bad.
When I came back to India in 1993, I hated it here. I promised myself that I would never get into [commissions], and survive. I was vehemently against it.
In the last few years, there have been several articles in newspapers and medical journals, but it has never been started as a movement. I wanted to start this campaign at the right time.
Suddenly, healthcare has come to the consciousness of people. They are looking at it as an area where the cost is very high, and they cannot afford it. In the last six months, there have been lot of efforts in cutting down healthcare costs. By putting an end to the cut practice, one can drastically cut down the unnecessary treatment that is indirectly also a cause for costly healthcare. As much as 25% of the treatment done in the country is over-treatment or unnecessary treatment, and commercial motives are the reason behind it.
With all the buzz around the capping of stent pricing, I felt this was the best time to bring it to public notice and sustain the campaign. I am clear that we won’t be able to completely eliminate the practice, but will definitely try to bring it down.
Why a hoarding?
Once you put up a hoarding, it remains there for a month or two and people notice it. We chose the prominent location near the airport where people are travelling from all over the country: it is not only for Mumbai; we want the message to spread and people from all over to notice it.
We had a long debate on whether we should put the message of ‘no commissions’ directly. But I felt that if you write something indirectly, the public may not understand. So we decided to put the hard facts. We wanted people to react. If they don’t react, it all fizzles out.
Did it work?
It did. Soon after we put up the hoarding, the State has formed a committee to make a law against the cut practice.
The genuinely honest doctors are supporting us. Doctors who are most dishonest came out vehemently against us but now they are changing their tune. They want to sabotage by joining us.
The Indian Medical Association’s president-elect sent me a message saying that it was unethical to put such hoardings. What is more unethical? Taking money from your colleagues or coming out against the practice? I want the IMA to show me one doctor that they have penalised in the past five years.
Many doctors say it is nothing but a marketing gimmick by AHI…
If that was the case, then I would have just done it and forgotten about it. I would have just focused on Bombay and then left it there. Why would I reach out to people all over India?
Doctors say that you are washing dirty linen in the public…
The linen is so dirty. How are you ever going to clean it? The moment you start, it is going to stink. Since 80% of the doctors are
into this, they are simply hiding this dirty linen. And now it is stinking all over the place.
AHI is known for aggressive marketing and overpricing as well. Many feel that this crusade is a bit odd.
We are not overpriced. We are absolutely transparent, unlike other hospitals who hide 70 % of the expenses. We do it the other way around. We bill each patient in such a way that the estimate we give and the final bill is the same in 95% of patients. No hospital in the country does that. In other hospitals, the bill is very different from what is quoted. That’s why we look expensive.
Again, it is not a marketing gimmick. If it was, I would not have taken it to the government level.
Isn’t it indirectly helping the branding of AHI?
No. We are getting everyone involved. We will be more than happy to put everyone’s name out there.
One hospital from south Mumbai wanted to join us. I told them, please do, the more hospitals we get, the better it will be. The only condition is they have to strictly ensure that they do not follow the cut practice.
You started AHI when the practice was already prevalent. How do you ensure your doctors don't take cuts?
People kept asking for cuts, but we strictly said no. Gradually, the message went out.
When we hire doctors, we give them a code of conduct that spells out two things boldly: no cuts, and no cash should be collected from patients. In 2005, we terminated three well-known doctors as they collected cash from patients.
Also, we have been selective about our hiring. We did not take doctors infamous for taking and giving cuts.
How did you resist when you started out?
I tried to establish myself by offering a type of cardiac surgery that no one was offering, and by taking up highly complex cases. For such cases, doctors didn't have a choice but to send patients to me. If they wanted money, I would say no.
I started offering the total arterial bypass technique (taking two arteries from chest wall and one from hand if needed) that no one was practicing in the country. My first patient was one with merely 20% heart pumping. No one would operate such patients. So after a few cases, everyone knew my skills.
I used to tell doctors that I won’t be able to offer any money, but send me your bad cases. That was my cut.
Did your practice suffer initially?
It took time for my practice to pick up. In the first year, I did only about 10 or 15 cases. In the second year, I did 100, and third year about 200. It was in the fourth year that I actually settled down, with about 400 cases. Had I been giving cuts, I would have settled down in the first year itself.
I had a select group of doctors who knew I did complicated cases and gave best results. They would send me patients.
What do you think is the root cause?
Two sectors are aggressively driving the cut practice: general physicians and private hospitals. It has become a systematic, organised structure, institutionalised over a period of time.
[In private hospitals,] 10% to 25% of a patient’s bill is paid to the referring GP. The moment you pay this much money, your focus automatically is not on treating the patient but to see how much you can extract from him.
There are two other reasons.
One is the high cost of medical education. By the time a student completes the MBBS, the parents have spent at least a crore or more. It all stems from there.
The other is greed.
Can the nexus be broken?
It is a five to ten-year-long affair. Nothing will happen overnight.
New ways are devised to make it work [when crackdowns happen]. I am told corporate hospitals today have agents who go out distributing the money. We need to put down a legislation and give exemplary punishments.
