Target practice takes its toll
Last year, a 38-year-old doctor was shattered when he got a circular from a prominent city hospital he was working with, terminating his contract with them. “Our association with you has not been fruitful over the last two years,” the letter stated.mumbai Updated: Nov 21, 2011 01:46 IST
Last year, a 38-year-old doctor was shattered when he got a circular from a prominent city hospital he was working with, terminating his contract with them. “Our association with you has not been fruitful over the last two years,” the letter stated.
This was the second hospital, after his earlier one, another prominent city hospital, that was terminating the doctor’s contract in the last two years for not achieving targets set for doctors engaged as consultants with the hospital.
‘Target’, a marketing term, refers to achieving a certain number of sales in a month or year. With the advent of corporate hospitals across the city in the last two decades, the terminology has crept into the parlance of doctors.
“I have been working for more than 10 years now. Ours is not a target-oriented profession. How can anyone say we should do a certain amount of work? Only the experience and work on the professional front should matter,” said the exasperated doctor, adding that the hospital expected him to get at least five to ten patients admitted every month.
The doctor’s removal for “non-performance” is not an isolated case. Most private hospitals in the city audit their doctors to see if they are meeting the required targets.
Corporate hospitals, which thrive on targets, have two systems to generate income for the hospital. One involves salaried doctors, who work full-time with the hospital. Here the marketing team is responsible for bringing in patients. This system is followed by many high-profile hospitals in the city.
The second system involves allowing doctors to have attachments with the hospital. In this system, the doctors are asked to give a certain amount of their fees as affiliation fee to the hospital.
Here the hospital management expects consultant doctors to bring in a good number of patients or conduct adequate procedures on patients. The doctor is allowed to keep about 20 % of the total bill raised from the patients they treat.
The second system gets murky given that most doctors have attachments with at least two hospitals. If the doctor does not generate the required income, he is removed from the hospital. In cases of salaried doctors, the salaries of ‘non-performing doctors’ could be slashed, sources said.
Dr Sujit Chatterjee, chief executive officer (CEO) of LH Hiranandani Hospital said, “We have our targets set internally but it is never passed on to the doctor as their focus changes.”
Marketing teams of most private hospitals set a target of 20 admissions a day, said industry sources. Some set targets of Rs 70,000 a bed, a day. This would necessarily mean the procedure performed on the patient admitted has to be major one.
While older doctors who are established in the profession have little trouble getting patients, the younger ones find it difficult to meet targets. “Some doctors indulge in malpractices to
meet their targets, a senior doctor alleged.
“There is too much pressure particularly on younger doctors. A lot of un-indicated surgeries (conditions where surgeries are not necessary) take place, particularly in cases of angioplasties and orthopaedic surgeries which bring in a lot of revenue for thehospital,” said a senior neurosurgeon attached to corporate hospitals in south Mumbai on condition of anonymity.
“In the US and UK, there are established protocols for a procedure or a surgery that’s documented. This is followed by both doctors and insurance companies. There is no such protocol in India that is widely accepted by doctors. This gives rise to un-indicated surgeries and procedures. The difficulty here is that we cannot prove un-indicated surgery,” said a senior official from an insurance company on condition of anonymity.
“We come across a lot of cases where angioplasties are done on patients with just 40% block in one vessel of the heart, which many doctors believe is not necessary and can be cured with medicine and a better lifestyle. The doctors scare the patients so much that they undergo the procedure,” said Jagdish Katira, an insurance and investment advisor.
The targets fixed are not restricted to the number of patients and surgeries. Many hospitals compel the doctors to get investigations (laboratory testing such as blood reports, X-Rays, CT scans) done at the hospital.
Saifee Hospital gives incentives to its doctors for every patient, procedure or investigation that is done in the hospital. (See box on ‘Saifee Hospital docs follow points system’).
Doctors who cross their targets for the year are awarded suitably by the hospitals, said sources.
“They can get a hefty bonus as high as Rs 5 crore or can negotiate to increase their share of the total bill from 20 % to about 25 %,” said a source.
A senior doctor in-charge of the administration of Saifee Hospital didn’t seem to think there was anything amiss in the practice of removing doctors from the hospital if they do not generate revenue.
“We usually call the doctor and ask why he is not bringing us patients while he is getting patients for other hospitals. We try finding out his problem and try to solve it. If it is not working out for us, we remove the doctor,” he said on condition of anonymity.