To ban or not to ban private practice by government doctors? The question is back in play in Karnataka with a government-appointed commission rooting for a ban.
The Karnataka Administrative Reforms Commission, headed by former chief secretary TM Vijay Bhaskar, has observed that a large number of doctors in government health centres indulge in private practice after official duty hours and has recommended a “ban (on) private practice by government doctors in all departments”.
The commission — which submitted its recommendations to the government on Friday, 3 February — noted that the ban on private practice will help the state start evening Out Patient Departments (OPDs) in government hospitals.
“If doctors are barred from the private practice they may be more willing to put in extra hours to make up for vacant posts. It would also be easier to ensure their attendance in government hospitals during duty hours if there is no pull of private practice,” the commission’s report stated.
Backing a ban
The commission noted that the state government gives an option to medical doctors to take up private practice or receive a Non Practising Allowance (NPA). But as there are a large number of corporate hospitals and nursing homes in urban areas, there are ample opportunities for government doctors to take up private practice.
Arguing against private practice, the commission said there were an adequate number of doctors in Karnataka — in fact, better than the norms set by WHO — and there are enough private doctors and private medical establishments to cater to the public that can afford to pay private fees.
“So far, about 20 States have banned private practice. It is also banned in GoI (Government of India) medical institutes and in Central Health Service Rules. It is therefore recommended that Government of Karnataka consider banning private practice by all Government doctors of all departments in the interest of ensuring better medical care to patients in Government hospitals. DME and HFW department may move a proposal in this regard,” it said.
Also, similarly placed government teachers and lecturers are barred from taking private tuitions, the commission noted.
What do doctors say?
When South First spoke to few government doctors, there were mixed responses to the commission’s recommendation.
One senior doctor at one of the reputed medical colleges in Bengaluru said the issue of banning private practice has been discussed time and again, but it has never been implemented.
“The main objective is to prevent government doctors from taking up private practice during office hours. This can be ensured by regular/surprise checks and appropriate punishments,” the senior doctor said.
He contended that banning private practice by experienced government doctors will affect a lot of the rural population and inhabitants of smaller towns — as they will have to seek medical advice from private doctors.
“It is not fair to restrict the optimal utilisation of a medical professional’s expertise. If they practice, it will help the common man as they will be available once the OPDs in the government set-up closes and emergency services are non-existent at PHCs and sub-centre levels,” he added.
However, another doctor, a nephrologist from one of the district hospitals, said government patients would definitely benefit from the move.
“The government is planning evening practice in government hospitals by giving incentives to doctors. This will be good for government doctors. This is a win-win situation for both government doctors and patients coming to government hospitals,” he said.
However, Dr Manjunath CN, director, Jayadeva Institute of Cardiovascular Disease Research Hospital, said this experiment has been tried many times in many states, ultimately it is going to be a futile exercise.
He called it a double-edged decision. According to him, many specialists might opt to exit from government hospitals, resulting in shortage of faculty, especially in rural, semi-urban and district-level hospitals, thus affecting patient care.
He argued for the creation of a conducive working environment with proper facilities and leadership so that quality and timely treatment is provided within working hours.
“Decentralisation and delegation within hospitals is equally important. Attendance does not necessarily mean attention,” he added.