Daybreak - The death of the independent doctor

Episode Date: March 3, 2025

Young independent doctors in India are stuck between a rock and a hard place. Take F M, a 32-year-old psychiatrist who has a clinic in South Mumbai. She’s spent a third of her life slogging through medical schools and internships to finally earn her super-specialised degree. But two years into her private practice in a posh South Mumbai area, she wonders if being a doctor is really worth it.Nearly 50% of the total medical seats in India are in private and deemed medical colleges, which don’t come cheap. Sheetal Shrigiri, gynecologist and counselor at a coaching center for medical-entrance exams told The Ken an MBBS degree at a private college costs anything between Rs 50 lakh and Rs 1 crore.Apart from the financial burden of the degree itself, once they become doctors, there is increasing competition from hospital chains and also the pressure of having a social media presence and to deal with.Tune in.*This episode was first published on September 30, 2024Daybreak is produced from the newsroom of The Ken, India’s first subscriber-only business news platform. Subscribe for more exclusive, deeply-reported, and analytical business stories.

Hi, this is Rohan Dharma Kumar. If you've heard any of the Ken's podcast, you've probably heard me. My interruptions, my analogies and my contrarian takes on most topics. And you might rightly be wondering why am I interrupting this episode too. It's for a special announcement. For the last few months, I and Sita Raman Ganeshan, my colleague and the Ken's deputy editor, have been working on an ambitious new podcast. It's called Intermission.

We want to tell the secret source stories of India's greatest companies. Stories of how they were born, how they fought to survive, how they build their organizations and culture, how they manage to innovate and thrive over decades, and most importantly, how they're poised today. To do that, Sita and I have been reading books, poring over reports, going through financial statements, digging up archives, and talking to dozens of people. And if that wasn't enough, we also decided to throw in video into the mix. Yes, you heard that right. Intermission has also had to find its footing in the world of multi-camera shoots in professional studios, laborious editing and extensive post-production.

Sita and I are still reeling from the intensity of our first studio recording. Intermission launches on March 23rd. To get alert, as soon as we release our first video. episode, please follow intermission on Spotify and Apple Podcast or subscribe to the Ken's YouTube channel. You can find all of the links at the ken.com slash I am. With that, back to your episode. It's hard to believe this, but gone are those days when becoming a doctor, a medical doctor, meant that you're sorted for life in India. Take FM, a 32-year-old psychiatrist, for example. She spent a third of her life slogging through medical schools and internships and then finally she got her super specialised degree.

But two years into her private practice in a Porsche South Mumbai area and she is wondering if being a doctor one of the most sought after careers globally is really worth it. She charges a consultation fee of $3,000 which is sort of low by big city standards. Initially, she didn't even get a lot of patients. Her monthly overheads are modest for a small clinic in a shared setup with another doctor. And though she didn't share the actual figures with the Ken reporter Lifia Khan, she told her that her best month didn't even cover the salary of her kid's nanny. Now, if you take into account the number of years and the kind of money that these young doctors have to spend on their degree, it's turning out to be quite a financial burden for that.

them. For context, nearly half of the total medical seats in India are in private and deemed medical colleges, which do not come cheap. Sheetal Shrigiri, a gynecologist and a counsellor at a coaching centre for medical entrance exams, told us that an MBBS degree at a private college costs anything between 50 lakh rupees to one crore. Apart from the financial burden of the degree itself, once these people become doctors, there is increasing competition from hospital chains and also the pressure of having a social media presence to deal with. Young doctors in India are stuck between a rock and a hard place. Welcome to Daybreak, a business podcast from the Ken. I'm your host, Nick Das Sharma, and I don't chase the news cycle. Instead, every day of the week,

my colleague Rahel Philipos and I will come to you with one business story that is worth understanding and worth your time. Young doctors in India with less than five years of experience are really struggling to set up an independent practice. And like that wasn't enough, they're often having to forego ethics just to stay afloat, like cutting practice, which is when doctors receive kickbacks for referring patients to other doctors or hospitals. And then, like Olivia points out, there is an added cost of playing the new age game,

which is marketing, online listings and maintaining a presence on platforms. Things that doctors didn't have to bother with just a decade ago. Also, let's not forget the NEET scandal. The country's national eligibility come entrance test for entry into medical colleges is dealing with allegations of paper leaks. Unfortunately now, the ordeal doesn't end for aspiring students when they get through these exams. It has reached a point where the Indian medical medical medical medical system, Association, or IMA, which is a national voluntary organization of modern medicine doctors,

launched a web portal to help young doctors find jobs within the country. This was just two weeks ago. The association also has plans to help doctors get employment abroad, which, by the way, is going to further damage India's doctor shortage. But what else can they do when there are no other good options? Plus, these moves are just not going to cut it. For young doctors who are struggling with low patient turnouts, no ties to hospitals, and competition from private equity-funded chains, these things don't really make much of a difference.

To give you a better understanding of just what's in for them, let's talk about what they have to deal with before they even begin their practice. India offers a total of little more than 1,000-1-100 medical seats. Out of these, half are in government colleges, so they are affordable. But, as you know, getting through them is super, super difficult. For example, in Maharashtra, an MBBAs from Grand Government Medical College, which is among the top 10 institutions in India, costs about 1 lakh rupees per year. The same degree in a private medical college costs between 7 to 16 lakh rupees.

And at deemed universities, it is more than 25 lakh rupees per year. Now, even if you manage to get an MBBS somehow, it's still. won't be enough. You need another sub-specialty, like an MD. A doctor at a Pune Hospital told us that it is difficult to land a decent consulting job at a private hospital or even set up your own practice without it. And this will cost you another two to two and a half crore rupees in a private medical college, including fees and other costs. Now say you got lucky and you managed to do this as well. What next? You'll want to set up your own practice, right? But for that to work, you'll have to be able to offer the latest treatments with the latest

equipment if you want patients to choose you over corporate hospitals or other doctors. Take a dermatology clinic, for example. A doctor told us that it takes anything between 40 to 50 lakh rupees to start a good one. But how will you be able to do it if you have the burden of a massive student loan? It doesn't just end here. Stay tuned. The thing with running an independent practice is trust. But it is hard for young doctors.

Like FM, the South Bombay psychiatrist, for example. There are at least five more psychiatrists near her clinic who come with a decade or more experience and naturally have more trust. She told us how these days corporate hospitals or their branded clinics, like say for example the Apollo clinic chain, are everywhere. So most people, if they do not know a good doctor in their health, area just end up going to these branded clinics because there is some expectation of quality. Three of the doctors who spoke to the Ken said that there is a reason that these chain clinics

charge less money. The doctors claim that these clinics also add as feeders to their main hospitals where they can refer patients to higher ticket treatments and surgeries. And then there is the telemedicine boom post-pandemic. Some doctors, like FM get patients online for the same charge as their clinical consultations. But there is another side to it. Free video consultations and cheaper telemedicine services are also derailing the business of many private practitioners. An MD physician from Mumbai who did not want to be named told the Ken that since 2020

patients are okay with sitting at home and talking to doctors online, especially if they do not need physical examination. Many doctors charge less online compared to private clinics and some healthcare companies even offer free consultations. So you see how chasing a return on investment is super difficult and complex. Most young doctors choose a commission-based setup. They work many years at a private hospital with a 60-ist-40 fee-sharing model and this helps them build a patient base before opening their own high-cost clinics. Sheikh, who is an MBBSMD, for example, juggles a private practice in Pune, a super specialty as an intensive care expert, and as a hospital administrator for a nursing home. His days stretched to beyond 16 hours.

During COVID, Sheikh had applied for a job in a hospital in Oman. There were 600 candidates just for four positions. So what Sheikh has done is that he's partnered with a pathology company. and set up a small lab within his clinic, absorbing about 40% of the pathology costs. He told us that for sticking to private practice, resilience isn't enough. It needs deep pockets and even a certain kind of nerve. Plus, patients now want a premium experience, like fancy-looking clinics, appointment reminders, electronic prescriptions and digital records.

And of course, there's also online and social media marketing. that these doctors need to do. Those who can't do it themselves have to shell out money for it. So you see, a new medical economy seems to be emerging in India, mostly being shaped by corporate giants.

And in this space, it seems that the days of the independent practice are numbered. The daybreak is produced from the newsroom of the Ken, India's first subscriber-focused business news platform. What you're listening to is just a small sample of our subscriber

undi offerings. A full subscription unlocks daily long-form feature stories, newsletters and podcast extras. To subscribe, head to the ken.com and click on the red subscribe button on top of the Ken website. Today's episode was hosted by Snigda Sharma and edited by Rajiv Siyiv Siam.