A global medical education platform can solve the problem of manpower shortage in the health care sector, Dr Devi Shetty, heart surgeon and founder of Narayana Hrudayalaya, tells Sreelatha Menon
You have been advising the government on health reforms and, more recently, were part of the consultations for the 12th Five-Year Plan. What do you think is the main issue to be addressed?
Shortage of manpower is the main problem, as far as health care is concerned. The situation would mess up further if nothing is done. As a result, salaries would shoot up, making things worse. One of the solutions is to bring all the streams of medicine together. Other schools of medicine should be allowed to prescribe allopathic drugs, too, after a little training. That brings us to medical education.
Your formula would not have takers in the Medical Council of India (MCI). It wanted three-year courses for rural practitioners.
The problem with the latter is that people in rural areas would not go to a three-year course person. As for training people from other schools of medicine, the idea I proposed, the council doesn’t approve of it. It is another matter that every medical course involves an elaborate five-year period of training. We are short of one million doctors and two million nurses, and we immediately need 500 new medical schools.
But the way we go about it has made education expensive. MCI doesn’t allow existing hospitals to become teaching institutions. So, a non-profit organisation has to get land, like a football ground, and build a college and a hospital. Naturally, the burden of the cost shifts to students. It costs Rs 2 crore for a seat for MD in radiology in Bangalore today.
Again, though diabetes is widespread and, as a result, people suffer from kidney diseases, the country produces only 60 nephrologists a year. The system is jacking up the price of doctors by creating such shortages. This would have to change. It is time for the world to come together and tackle this problem. We are proposing a medical education system outside India, using the best from curricula across the world, and trying for recognition from global universities. There is no Indian way of removing pain and a French way of removing pain. There is only one way. So, there is no conflict.
How would a global educational platform help India?
You are also planning to set up a medical centre in far away Cayman Islands, near the United States, as well as a chain in Africa. What purpose would these serve? Are these being put in place to generate funds?
At Cayman Islands, we are in the process of tying up with a US hospital chain. It would invest and its doctors would treat, while we would partner and provide our low-cost model of running a health care system.
What is the objective?
We have a model to demonstrate — that with only a fraction of their total cost, we can get the same outcome that they achieve with huge investment. Cayman Islands is close to the US. We want to change the way the US deals with health care. By 2020, India would become a super power. This can only be achieved by India being a caring nation. As for Indians, Cayman Islands is the only country that recognises an Indian medical degree. So, we can take Indian doctors there.
You are talking of shortages, but given the cost of medical education, how can ordinary people ever take up any of the medical professions?
That will change. What we do in India is not done anywhere else. Here, students pay hospitals to learn, while in the West, hospitals make you work while you learn. So, you don’t need to pay. It is like an apprenticeship.
There is a basic conflict of interest between profitability in the health care sector and the welfare of patients, as profits are made at the cost of patients. The more drugs you prescribe and the more invasive procedures you conduct, the more the profit you earn. Who loses?
In any market, you have to create excess capacity to bring down prices. No regulatory change would make this happen. You have to create competition for this.
So, why are the health care systems in the US and the UK in danger? At the Ramankant Munjal Foundation Memorial lecture, you said the UK system was collapsing.
They have other problems. In Europe, no one pays for health care. In the US, it is totally regulated and so, has outpriced itself.
You are opposed to the government running health care. Is it not better to improve it than pull it down?
Can the government run a software company or make a movie? No. So, it cannot run health care. It cannot do anything that is knowledge-based. The ideal way is to work in partnership with the private sector.
You are setting up low-cost hospitals in 14 towns. Are you doing this in partnership or alone? And, would these replicate your low-cost model of heart care?
It is different in different states. In some states, we have the government as a partner, while in some, there are others. But they are all Narayana Hrudayalaya hospitals. We have the same approach towards cutting and meeting costs with volumes. These are mostly 300-bedded hospitals in small towns, with a population of over a 100,000. We have been able to pull down costs of heart surgeries to Rs 60,000, and these would go down further. We would also have other specialties in these hospitals and would use innovative methods, such as training local people, in patient care to cut costs.
There is a low-cost model of health care practised by Arvind Eye Care Hospitals. Their profits come from related businesses, not just patients’ fees. Would you think of partnering them?
Theirs is also an excellent model. But we are not partners. However, we plan to include eye care as well.
What inspired the concept of Narayana Hrudayalaya?
I was working in Kolkata when I got a call from someone asking me to visit. Since I am a surgeon, I wondered what purpose would a home visit serve. I was told over the phone that it would transform my life. Therefore, I went. The caller was none other than Mother Teresa. I spent many years with her organisation and her work and the message of compassion has stayed with me.