Trending migration of trained physicians, nurses, and other healthcare professionals (HCPs) to the private sector is affecting public healthcare systems and may pose a major threat in future to the achievement of health equity in low-income states like ours. What makes doctors work in Government hospitals? Is it passion to serve society, a secure job, recognition in the society or lack of opportunity in the private sector? Should an Indian HCP choose a Government job over a corporate job? Is India’s private healthcare sector treating care providers and receivers as revenue generators? This write-up is not intended to argue on moral standings focuses on creative policy approaches required to balance from a human rights perspective and to ensure that the individual rights of health professionals do not compromise the societal right to health, and how Government hospitals can improve the working environment for their existing staff, making it more attractive and reducing the urge for them to seek employment in the private sector.
Crossing Over to the Private Fold from Public Hospitals is always a major career decision depending on the individual’s preferences, goals, and values. HCPs, like any other professionals, have the freedom to change jobs if they wish to seek better career prospects (compensation and benefits). Higher salaries are the main driving force behind this exodus.
Public hospitals are unable to provide high emoluments due to budgetary constraints on the other hand many private hospitals offer lucrative packages and performance-based incentives to HCPs based on their productivity (profitability) contributing to business or other measurable criteria. The explanations could be broadly categorised into: ‘higher salary’, ‘life in public hospitals’, ‘decision-making’, ‘life in the private hospitals’, ‘better infrastructure/ resources’, ‘future plans’ and ‘values and beliefs’.
Though the replies are consistent with individual priorities and preferences, the majority show that job satisfaction and demographic factors play significant roles in the decision for relocation.
Government hospital staff was found to have significantly higher emotional exhaustion and depersonalization as compared to their counterparts working in private with more flexible working hours, allowing care providers to have better control over their schedules and work-life balance care without burn out.
Professional development opportunities are a hallmark of corporate hospitals actively engaging in upgrading and innovation, allowing HCPs to participate in cutting-edge medical advancements and specialized training through expensive training programs to enhance their business.
Career growth and advancement through time bound selections, and promotions in Government institutions are marred with stagnation while private hospitals usually have well-defined career paths with better opportunities for promotions, leadership roles, and academic positions. Professional satisfaction in personalized and patient-centric care is prioritised in Private setups, giving doctors the chance to provide more individual attention and tailored treatment plans to excel professionally.
Impact of Exodus on Public Hospitals: Healthcare system relies on a balance of skilled professionals to meet the needs of the population. Skilled HCPs possess extensive knowledge, and expertise in specific areas of medicine.
For accurate diagnoses, effective treatments, and compassionate care when known experienced practitioners leave public hospitals, may lead to a shortage of qualified staff to provide high-quality services in speciality areas which increase workload on remaining staff to handle a higher number of patients, resulting in longer wait times to access specialized care within their local healthcare system affecting thoroughness of examinations, reduced consultation durations and limited attention for each individual.
Thus, a loss of trust and dissatisfaction with the level of care provided compounds to the negative perception of overall standard of care provided in Government hospitals. Patients may need to travel long distances even out of state to seek care in private healthcare facilities, which can be more expensive. Experienced doctors, nurses often play a crucial role in mentoring and teaching. Their exodus can have long-term consequences for medical education, teaching, and training programs.
India needs incentivising Care providers working at Government hospitals to attract and retain skilled staff by enhancing the working environment ,ensuring better infrastructure and processes (E filing, digital tools, QR coding), modern medical equipment, adequate resources , EBM protocols ,clean and well-maintained workspace .
Offer competitive salaries and benefits in Government hospitals to make their salaries and benefits comparable to those in the private sector who might otherwise be enticed by higher salaries in private hospitals. Establish programs for continuous professional development through higher training, skill enhancement workshops, seminars, refreshing courses, and conferences to keep them updated with the latest medical advancements.
Recognize and appreciate their contributions through hard work through awards, promotions, and additional benefits based on their achievements and service quality. Implementing performance-based incentives and rewards for HCPs can be any reward, program, or recognition in the workplace that helps to motivate employees to do more and help in their retention. Simplify administrative procedures and reduce bureaucratic red tape to avoid stagnation at positions, enhance opportunities for selection and promotions to carry out their duties with a hope of futuristic careers.
Establish effective mechanisms for HCPS to address their grievances and concerns. Encourage open communication channels, establish feedback mechanisms, and address issues related to emoluments, workload, workplace safety, and job satisfaction.
Retaining Doctors in Public Service is balancing human rights and societal needs in the twenty-first century. The shortage of skilled HCPs in public hospitals in our state may be worsened by their exodus to private hospitals. State has invested heavily on their education, trainings. Serving a certain period in Government jobs after completing their undergraduate, postgraduate or post-doctoral training, or faculty appointments commonly known as a bond service or mandatory service, is a strategy implemented by some states to prevent brain drain, especially in underserved areas.
Regarding this we need a balanced approach: One of the primary goals of implementing bond service is to ensure that HCPs who have received subsidized education or other benefits from the state, contribute to public healthcare services. By requiring HCPs to serve in Government jobs for a specific period, states aim to retain trained medical professionals in the public sector, where they are most needed to provide essential healthcare services to underserved communities.
It is important to understand from the perspective of health care providers the reasons affecting their decision to stay or leave a public hospital. The results have relevance for healthcare policy (decision) makers and hospital management regarding strategies to consider when addressing the issues of staff retention and recruitment.
Is there anything wrong with changing the place of work? In my opinion, NO. What I feel challenging is, to maintain morality when private hospitals in India pay HCPs hefty sums and give them unethical monetary targets to achieve to justify their salary.
Is that why doctors recommend patients to retake tests in their hospitals and sometimes advise surgeries if it may not be required? The reply of Dr. Meera (name changed) potential migrant on unethical revenue targets is shared here with Biblical quote, “Although tempted, a person may contemplate a wrong action and then dismiss it. That is temptation, but it is not sinning”. Meera states, quote” Sir, this might be a difficult question to answer (the most attractive candidates are the ones who have a job), but with the right mindset, you can turn it around to your Truth”.
DR FIAZ FAZILI is a Certified Qualified Professional in Quality Healthcare Policy Planning and has worked as Director Total Quality management, Clinical auditor & Team leader with many national and international accreditation Bodies like JCI- CBAH_ NABH: GE healthcare international can be reached at drfiazfazili@gmail.com)
DISCLAIMER: The views and opinions expressed in this article are the personal opinions of the author.
The facts, analysis, assumptions and perspective appearing in the article do not reflect the views of GK.