Economic Times
22 March 2011
By Gauri Kamath
Mumbai, India

In 2008, after 14 years of studying and practising medicine in the UK, Hemant Vadeyar and wife Shantala wanted to head home to Mumbai. Despite their impeccable qualifications, Vadeyar, a hepato–pancreato–biliary and liver transplant surgeon and his gyanecologist–obstetrician wife were "apprehensive".

They knew most of the city’s leading hospitals preferred 'star doctors' – people who had, over the years, built up a reputation. They also realised they would likely have to juggle multiple 'attachments' to hospitals all over Mumbai, besides trying to set up their own consulting room or surgery centre. The experience would be virtually entrepreneurial – far removed from the salaried employment at hospitals of the UK's National Health System, which they were used to. "It was a daunting prospect," says Vadeyar.

Luckily for the couple, Kokilaben Dhirubhai Ambani Hospital (KDAH), in Andheri, was looking for staff for its new, tertiary–care wing. More importantly, KDAH officials made it very clear they wanted to be the first in Mumbai to employ only salaried, full–timers . This, instead of visiting doctors who are usually attached to multiple hospitals and bill patients directly if they so wish.

The Vadeyars became among over 120 doctors hired by KDAH. "Fulltime doctors become partners of the institution, helping both grow," says Ram Narain, CEO at KDAH. "In a visiting–consultant model, the doctor simply uses the hospital as a facility." Increased corporate investment in healthcare is influencing private hospitals' engagement with doctors. While nascent in Mumbai, having a full–time doctor on the rolls – as opposed to one who is affiliated to several hospitals at the same time – is a trend gathering pace in places like Chennai, Bangalore and New Delhi . Healthcare experts say it will accelerate, and hold potential benefits for quality care and clinical outcome, as well as longterm returns for hospitals.

Legacy Issues
Historically, India's private hospitals have comprised smaller, doctor–led nursing homes with under 50 beds. These, typically, "did not have the volumes to have full–timers" says Ratan Jalan , founder, Medium Healthcare Consulting . "A surgeon would have to affiliate with four or five other centres for adequate financial compensation." The large, trust–run tertiarycare hospitals in cities like Mumbai, relied heavily on doctors to canvas for patients.

In exchange, doctors billed patients at their discretion. Over time, as the city expanded, patients preferred doctors to be close to them, cementing the model of multiple affiliations. Even government hospitals allowed their doctors to pursue private practice as a retention tool. As a result, "doctors who came into corporate hospitals, continued, on that understanding," says a healthcare industry veteran.