Some pointers for returning doctors/physicians from Shivshankar
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From the JIPMER Alumni Electronic Newsletter
Volume 1 Number 9, 15 January 1997
Date: Mon, 6 Jan 1997
From: Shivshankar Sastry(sastry@giasbg01.vsnl.net.in)
Subject: GOING BACK TO INDIA
Dear fellow Jipmerites,
I have brought this upon myself - having offered to upload some guidelines about how to return to India and settle down successfully after spending many years abroad. I can only give you my own experiences and I returned and settled down after 7 years in the UK.
I shall try to be as brief and informative as possible.
The first requirement is to want to return and "rough it out" if necessary. By this, I mean the willingness and ability to live in India for 2 to 3 years *even if you earn nothing* here. This WILL NOT happen - you will start earning soon. You must have savings and/or investments to give you at least Rs. 6,000 to 10,000 spending money per month until your own local earnings take over. This document has the following headings:
A) GENERAL
B) MEDICAL SYSTEM IN INDIA
C) WHEN TO RETURN ?
D) WHAT TO COME BACK AS ?
E) WHAT SORT OF PLANNING IS NEEDED ?
F) WHAT TO DO WHEN YOU RETURN ?
G) BUILDING A HOSPITAL?
H) WHICH CITY/TOWN ?
I) WHAT IS LIFE LIKE IN INDIA?
A) GENERAL
Essential pre-requisites for returning are
1) A house in the town/city you select
2) A car
3) A telephone
These three essentials must be ready by the time you get back or soon after. Additional advantages are having children under 10 years of age - so that they are flexible and adjust easily to the local life and schools.
It is NOT always advisable to become an investor or a shareholder in a new local hospital. Big cities and town have a thriving private health service, and a spanking new hospital may look nice, but will not have many patients coming to it for several years.
B) MEDICAL SYSTEM IN INDIA
If you decide to return to a major city or town, do not be under the mistaken impression that conditions are likely to be primitive and that you will be the person to bring some advanced and good medicare to the area. Every place is full of competent doctors who have spent time abroad and there are a lot of well equipped hospitals alongside little hell holes of hospitals.
Indian cities have a strange medical system. The worst off do go to Government hospitals, though they would avoid this if they could. Patients come directly to doctors, and often directly to a specialist, such as a cardiologist. There are GPs, but a formal referral system is non existent. GPs vary from being extremely good and competent, to the worst kind, who may be busy, but send out referrals only to those who will give them a "kickback". It is common practice for hospital owners to offer incentives to GPs for referrals, and the treating specialist often has no idea about any deal. He is referred a patient to treat in the hospital and gets paid for his services.
We Jipmerites are at a particular disadvantage. Having spent years in Pondy, and later in a foreign country, we find that we have no classmates, seniors or juniors who would welcome you and send you the first few patients to help you find your feet - but this disadvantage can be overcome. JIPMER has an excellent reputation, and patients and doctors realise that you have done whatever you have done on merit, and not by paying capitation fees. It is important to have a set of visiting cards printed, and it is worth stating on the card that you are from JIPMER eg: Dr Shivshankar Sastry, MBBS (JIPMER), MS (JIPMER), FRCS (Edinburgh). This may sound funny, but it seems obvious and natural after you settle in.
C) WHEN TO RETURN?
When you do decide to return, come back after September 30th but before March 31st. This will ensure that you will not have to pay tax or submit tax returns in India for more than a year after you return, since you would have been a "Non resident Indian" for the year in question, having spent less than 6 months in India in the financial year that you return.
D) WHAT TO COME BACK AS? ;-)
What to come back as? - A strange sounding question but an important one. Even if you intend to practice as an internist or a general surgeon ar a radiologist, do not simply say this. It is important in India to give the appearance of being some sort of super-specialist. Again, this sounds silly, but patients seem to think you are more competent or qualified if you have some kind of super speciality. This means that you pick from your subject a branch that you have special interest or experience in and say so verbally and on your card. I practice general surgery, but my card says Laparoscopic surgeon and endoscopy specialist and this obviously forms only part of my work. A physician can describe himself as having a special interest in Cardiology or neurology or perhaps diabetology. I think some of the newer specialities would do rather well if promoted in the right manner - eg rehabilitation. Niche specialities like endocrinology will always find a place.
E) WHAT SORT OF PLANNING IS NEEDED ?
What sort of planning is needed (aside from house, car and telephone)? It is worth considering having a consulting chamber of your own - a reception/waiting area, and a consulting room, and perhaps a side room as a minor OT or something - eg echo, treadmill, endoscopy etc.
It is a good idea to have some sort of "machine" to help you get your practice going. Not all pre existing hospitals have endoscopes or color doppler or a treadmill or a laser or even a C-arm. Any such equipment that you can bring or invest in over here may be an asset. Also any skills you may have in any kind of interventional work - cardiology, radiology, endoscopy or whatever, is an asset. Other items that people consider setting up are lithotripsy units or perhaps CT scanners or MRI scanners. You will really need upto date info on local competition if you want to go in for a big thing like Lithotripsy or CT. The little ones, like treadmill, endoscope, ultrasound etc, are really handy. Indians are always on the lookout for the "latest" - so keep your eyes and ears open about what is the "latest".
F) WHAT TO DO WHEN YOU RETURN ?
What to do when you return? After settling in, get a set of visiting cards printed and start visiting local hospitals and nursing homes to meet people and see the set up. It is also worth meeting some prominent local specialists and GPs and handing them your card. In general, most hospitals welcome a new specialist from abroad in the hope that you may be the "Goose that lays golden eggs" and bring them a flood of patients. It is usually possible to fix up several hospitals to visit and some may give you a consulting room as well. It may be necessary initially to visit 4 or more hospitals. Things will pick up after this.
You may want to make settling down easier by getting a job in a local teaching or other large hospital. This is a good idea if you are worried about striking out on your own as a private practising specialist who is new in town. Unless you have local influence you would probably not be able to arrange to have such a job waiting for you when you get back. You would have to come back and hunt around.
G) BUILDING A HOSPITAL?
You may want to start a hospital here and may have the resources to do it. It is expensive business and I have no experience of this. However it seems to me that trying to build a mega hospital with 200 or more beds may be a waste. Enough people are doing it in the bigger towns already. A smaller hospital (20 to 50 beds) may be easier to manage, but to do this you need lots of money and several preliminary visits to India. As regards investing money in a hospital to be built by someone else - my own experience, and from what I have seen of others this is risky and may not give you the desired returns. It is all too easy to have a consulting room and no patients.
H) WHICH CITY/TOWN ?
I must point out that the larger cities and towns in India are already getting quite developed as regards medical care. It may be difficult and frustrating to try and settle down in Delhi, Madras or Bangalore, and worse if you don't know the local language. It can be done though - requires perseverance. It may be a good idea to scout the smaller towns where property prices are lower and you may end up being "king" there.
I) WHAT IS LIFE LIKE IN INDIA?
In my opinion, life is superb here. You are a respected and prized citizen. You are rich, though you probably will not earn as much as in the US. If successful your earning will match middle east jobs and the earning potential in the UK. Roads are bad, but you can have a driver. You need never operate the dishwasher, washing machine or electric iron again in you life. You and your kids will have plenty of company. Getting privacy is more of a problem than company.
I hope this is of some help to someone, and I wish you luck. Feel free to ask me any queries. My email address is sastry@giasbg01.vsnl.net.in, and my voice number is 91-80-6607571.
Shivshankar Sastry
Batch of 1972
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