Is there Physician burnout in India ?

(I  was  asked  this  question  recently  and  I  answered  it  as  below)

I can answer it because I am one such case. 31 years ago when I started my private practice I was very aggressive in my choice of patients and procedures. I transitioned from diagnostic to interventional GI Endoscopy and went on to do procedures which were cutting edge and evolving in the medical field. I used to go for training, conferences and workshops to learn about new techniques and procedures. I used to conduct CME programs did indirect marketing in day and age when it was unheard of. I have sat outside offices of IAS officials for empanelments in various organizations.

We had an excellent surgeon and a small 4 bedded nursing home in which even prior to year 2000 we had done cervical laminectomy, Side to Side Linorenal shunt, Trans hiatal Esophageal replacement, Intra operative enteroscopy, laprotomies under local anesthesia in patients not fit for GA, besides routine cesarean, laproscopic cholecystectomies, hysterectomies, sclerotherapy, Variceal band ligations, foreign body removals, polypectomies and cysto gastrostomy. After that I built a larger nursing home and remained as aggressive for another 10 years or so despite suffering 2 heart attacks (MI). I took nearly 40 odd loans during my career for various things ranging from cars, equipment, house, nursing home etc. I was active in IMA as secretary , President and numerous other posts.

I stopped taking emergency patients in 2012 and all patients approaching us at night would be told Dr is not available or out of station. I started referring all high risk procedures which so far I was doing in large numbers to tertiary institutes. I gradually shifted my wife to a corporate hospital and stopped her obstetric & Gynae work in our nursing home and finally sold the nursing home.

Today I do consultations and elective diagnostic UGI and LGI endoscopies for limited hours only. I have totally stopped ERCP, and am no longer running an operation theater even though I still have all the equipment. I would love to retire totally and spend my days writing or swimming but my wife and children do not wish that I retire completely lest I become cranky. I simply do not have the desire or the drive in me anymore for clinical medicine. I would probably not mind giving free services to poor but unfortunately even that comes under various Regulations , Acts and Laws in India.

As regards the reason, though I give my reason as being “medical” but I know it is not that. I feel disheartened by the changing attitude of my patients, the thankless ness, the attitude of having bought my services and the increasing litigations. In face of judicial over reach, bureaucratic meddling, intrusion by insurance companies and unmanageable compliances the bond I had with my patients is broken. I view each patient with suspicion and each official and inspector barging into my clinic with disgust. The demands of politicians, judiciary, the IAS, IPS, IRS, their drivers, their clerks and families is something I can do without. I would prefer not to work rather than to have to submit and demean myself.

I am not alone and know many senior doctors who have mid career shifted their profession or simply retired. The profession in India was been deprived of its autonomy and if I cannot be a medical entrepreneur free from unreasonable shackles then I do not wish to practice medicine. I will probably survive on my savings and investments but feel guilty also for depriving many who could benefit from my expertise. Instead of a clinician I am now more of a medical activist cum student of medical law as it is evolving in India a work which I have been doing for 27 years but the proportion of my time devoted to this has now increased tremendously.

Dr  Neeraj Nagpal                                                                                                                                          Convenor MLAG  9316517176