SRINAGAR Sher-i-Kashmir Institute of Medical Sciences (SKIMS), a medical institute under the J&K government in Soura, a city suburb, offers solace to patients from all over Kashmir. However Kashmirs premier healthcare institute is now in crisis. There is an acute shortage of staff, as a result the serving doctors are overworked, the patients have to wait for long hours and pass through an excruciating hierarchy of the governmental structure before they are consulted by the concerned doctors.
Fayaz Ahmed Mir who belongs to Sopore in North Kashmir went to Apollo Hospital in Delhi to get a kidney transplant for his uncle in 2018. We didnt have the kind of time required by government hospitals and the private sector is too weak in Kashmir to be trusted for such a big operation, he said.
The healthcare sector in Kashmir is suffering due to the lack of Medicare facilities in private sector. Besides, there is a rising discontent among doctors serving in SKIMS owing to the long working hours and the ban on private practice, which dictates that a doctor who takes NPA (Non Practicing Allowance) is prohibited from seeing patients outside of the hospital.
Dr. Irfan Ahmad, a resident doctor at SKIMS said, “I don’t see why somebody who is getting an NPA would want to practice privately. Still, it is a personal choice and if somebody can manage to be fair to it after working hours, it really shouldn’t matter where one is seeing patients. The doctors’ goal is to see patients- in the hospital or where ever.”
A doctor earns about Rs. 10,000-15,000 on an average everyday when practicing privately, which is substantially more than the salary at SKIMS. NPA is an extra sum given to doctors to discourage private practice. It is calculated at 25% of the basic pay of an employee. It is mandatory for every doctor at SKIMS to take NPA, disallowing them legally from practicing privately.
Take the example of somebody who has come from Pahalgam or Uri to see a senior doctor, but due to the hierarchy here he will have to climb a ladder of doctors to reach the one he requires. But if the same doctor becomes available outside, it will become easier for the patient as it might mean spending a little more money, but efforts and time will be saved,” Dr. Irfan added.
Dr. Rauf Asmi, head of the Neurology department at SKIMS complained that he faces a social boycott from his neighbours and relatives as they refuse to talk to him because he doesnt see them in the capacity of a doctor outside SKIMS. We (his family) not only face a social boycott but also a security threat as once some people had started to stone my house because they were furious I didnt attend to a patient at home. But what can I do? I am scared to attend to patients outside the hospital because of the private practice ban. Whenever somebody comes to me, I tell them to come and see me at the hospital in the OPD, Dr Asmi said.
Its not that I want to practice privately at my own clinic and earn more money. I have enough money. But the upcoming generation of doctors are refusing to join us because of the ban. For them, money is a big factor. Hence, were short of staff and as the head of a department, Im overburdened with work. We cant refuse to see patients, says Dr Asmi. He revealed that nine students who had graduated from SKIMS went ahead and joined SMHS, another hospital in Srinagar where private practice is allowed.
Recently, SKIMS was in news for a sting operation through which some doctors were caught practicing privately. The ban imposed by the state high court came into effect in the year 2011. It has been up for debate ever since. A legislative committee formed in the year 2012 to examine the rise in the death toll in hospitals of Srinagar advocated for a ban on private practice owing to negligence and a “mess in healthcare”. A conversation with some doctors suggest otherwise.
Dr Umer Javed, Director of SKIMS said, “Our whole structure is by design a non-practicing (privately) institution. As an administrator, the ethical conduct is to carry on the work as per the rules of the government, which says no to private practice by doctors.”
A case of brain drain is taking place in the SKIMS as doctors are moving to other hospitals for better work conditions and option of practicing privately. A doctor who had worked at SKIMS for three years and is now working with Max in New Delhi, a private hospital, said, “I left SKIMS because the workload was extremely high. In the OPD, I used to see about a hundred patients everyday, which is three times more than my current workload. I didn’t even have time to sleep, who would think of private practice in such a scenario”. The said doctor was in the Medicine Department of SKIMS and doesn’t want to be named. “If you ban private practice altogether, you need to expand your OPD’s, lessen the workload on the doctors and make the working conditions favourable for the doctors so they aren’t unfair to their patients,” he added.
Sayantan Banerjee, a senior resident doctor at AIIMS (All India Institute of Medical Sciences) who is currently placed in Muzaffarpur to tackle the encephalitis epidemic in the state said, “I am currently in Muzaffarpur and I can clearly see the difference between us, government doctors and the local doctors here. We are highly enthusiastic while the local doctors here are responsible for so many deaths. The main difference is in the huge pay gap between us. It makes them apathetic. So the job of the government should be to ensure that a reasonable fee is given to all doctors.” He says, for a proper healthcare, government hospitals must increase the doctor-patient ratio. Private practice would mean a conflict of interest because there will be no regulation of that. Ideally, the work conditions should be such that no need arises for private practice. The doctors should be paid well and not overburdened, they should be given some bounties which result in work satisfaction and there should be enough doctors for patients so that accessibility is increased.”
Dr. Showkat Hasan, another doctor at the SKIMS Neurology Department has about 300-400 serious patients in a day. “In this department, almost every patient is severely sick. Some have dementia, some serious eye issues etc. To see each patient, we require a minimum of 30-60 minutes. Because of the high number of patients, the doctor tries to finish up fast. The diagnosis might get flawed due to the continuous flow of patients.”
“You can’t even say no to the patients as they come from far off places, they request the doctors to see them on the same day. The doctor is stuck in a vicious cycle.” Hasan added.
Dr. Farooq Jan, the Medical Superintendent of SKIMS acknowledged that there is a lack of staff in the hospital and the workload on the doctors is too much and said, Our faculty aspires to be like that of AIIMS. As part of non-monetary benefits, we allow our doctors a one year sabbatical after a term of five years. We also give our doctors a paid for fifteen day vacation in summers and a month long vacation in winters.
According to sources around 44 percent of faculty positions are vacant in the SKIMS and this not only affecting the patient care but medical education at the Institute as well.
Mansoor Ahmad, an officer at the Health Department of the Jammu and Kashmir Government said, I agree that for some doctors, private practice might be a way of helping patients but for most of them it is a business venture. The government has banned the practice with some things in mind, which are justified. On asking about the further plan of the government to tackle with the overburdening of OPDs in SKIMS, he said, There is talk going on about lessening the load in the hospital. Maybe we will construct new hospitals too.
With government planners groping in dark about a remedial measure, the discontent of doctors at SKIMS continues.