Experts sceptic about allowing doctors to run their private practice within state-owned hospital walls

Health Minister Zahid Maleque, however, believes the programme will help out plenty of vulnerable patients

The government is set to allow doctors appointed to the civil service health cadre to open shop for their private practice within the hospital grounds after hours. 

The argument is that younger and seasoned physicians alike can put in more hours into their practice under this new scheme, and patients can find doctors at ease. 

The move has drawn praise from some. 

But many independent health experts bdnews24.com has spoken to were sceptical about the argument; instead, they believe the chances of veteran, specialised doctors joining in the scheme are pretty slim. 

However, they all agreed that “some” younger doctors and patients will benefit from the scheme and questions about the ethics and legality of private practice using state-owned facilities have also been raised. 

Earlier this week, Health Minister Zahid Maleque said the government-employed doctors would practise in their private chambers beyond office hours at their hospitals beginning in March. 

These doctors can privately practice medicine in outside facilities and clinics for a fee.

With the scheme's introduction, minister Maleque said specialist doctors would be able to diagnose their patients at their respective workplaces and save hundreds of thousands of people from the trouble of visiting doctors at clinics and pharmacies. 

Dr Md Jamal Uddin Chowdhury, president of Swadhinata Chikitshak Parishad or SWACHIP, a powerful ruling party-endorsed forum for doctors, said they endorsed the programme after receiving assurance from the concerned minister that patients will at least get one specialised physician every day. 

THE NAYSAYERS 

Bangabandhu Sheikh Mujib Medical University Hospital, or BSMMU, Bangladesh’s only post-graduate medical teaching hospital and an autonomous institution, introduced the scheme as a pilot project. The government wants to copy the model and present it to government hospitals nationwide. 

Dr Rashid-E-Mahbub, former president of the Bangladesh Medical Association, said the scheme needs to make more sense to him as charging people for diagnosing within the state-owned hospital grounds and working outside the parameters of hospital regulations is against the service rules for government-employed doctors. 

Doctors' private practices are regulated under a 1982 ordinance titled the Medical Practice and Private Clinic and Laboratory (Regulations). 

The fourth provision of the ordinance clearly states that government-employed doctors cannot

work for their private practice during their office hours.   

“It was illegal before, and it still is [charging people for diagnosing]. As of now, it’s a public offence. Who will take responsibility when the law comes knocking at your door?” he said. 

He also believes that if concerned authorities greenlight the programme eventually, it may open Pandora’s box for other government service providers. 

“Then police will start charging people seeking help, engineers will bring their freelance commissioned job to government workplace, and veterinary surgeons and agriculture experts will follow suit too. Who will be bothered about their government-mandated work anymore?” 

Public health expert Dr Abu Jamil Faisal believes the patients and younger doctors may be beneficial from the scheme, as fees will be at a fixed rate [minister Maleque posited Tk 200 per patient] which will come as a breather for patients with a limited budget. The scope of younger doctors to see more patients and study them will enrich their experience level. 

However, Dr Abu Jamil believes the government needs to make renowned and specialised doctors participate in the programme. 

He presented the case of BSMMU, which could have attracted more senior doctors to participate in its programme. 

“Hardly any senior physicians see patients within the hospital [BSMMU] grounds now as they can charge at least Tk 1,000 per patient in their outside practice, while they are not allowed to charge more than Tk 200 here,” he said. 

Another doctor, who is currently posted outside Dhaka and did not want to reveal his name, raised other limitations the doctors participating in the programme will face if it gets the nod. 

“Perhaps an autonomous institution like BSMMU can pull it off, but at a government hospital, I will need almost similar staffing during private practice hours as daytime. For example- if an expecting mother comes in who requires an immediate C-section, I will need an operation theatre, and such facilities require a workforce. Who will provide it?” the doctor said. 

BSMMU’s head of the interventional hepatology department Professor Dr Mamun-Al-Mahtab said he is worried that activities of con artists within the government hospital grounds may increase as the new programme will open some more advantages to scam vulnerable customers. 

“Some people with ulterior motives may con the vulnerable patients by claiming that they can arrange an appointment with a specialised doctor against a charge of their own,” he said. 

MINISTER DEFENDS MOVE 

As a pilot project, the government would like to introduce the programme at 50 Upazila Health Complexes, 30 general hospitals at district headquarters and three medical college hospitals in March and a high-level committee will soon be formed to take immediate steps to make this a reality, Health Minister Zahid Maleque said while speaking to bdnews24.com on Thursday.  

He also said he wants the programme to succeed so that younger physicians can put in more hours into their practice to increase their knowledge level. 

“The more patients you see, the more knowledgeable you become. That’s why seasoned and specialised doctors get most of the patients in larger towns. But the government-appointed doctors stationed in remote Upazilas, who could be just as good, hardly get the opportunity. That’s why this scheme is important,” 

The minister also clarified that senior specialised doctors will not be forced to participate in the programme. 

“We won’t even make it mandatory for all younger doctors either. In some places, it will be optional,” he said. 

When approached with whether the scheme may contradict the regulation and guidelines, Maleque said nowhere in the regulations bars doctors from seeing patients privately, whether

inside the hospital or outside. 

“Since these doctors are practising outside facilities anyway, we believe if we introduce the scheme, doctors will be more available in government hospitals. The hospital will be benefitted as it will receive a portion of the fees for letting doctors run their private practice.” 

HOW IT’S GOING ON IN BSMMU 

The BSMMU launched afternoon services for outpatients with specialised doctors in 2011. 

Doctors of 24 departments were supposed to see patients from 3 pm to 6 pm on working days for Tk 200 per patient. 

According to the rota of the service, one specialist from each department sees patients every day. 

Patients said the crowds in the afternoon are more prominent than those in the morning for the particular services. 

Asked why he brought his wife in the afternoon, Abdur Rahim from Narayanganj said: “Because the senior doctors work at this time.” 

Enayet Hossain from Mirpur said patients crowd the medicine, neuro medicine and neurosurgery departments the most. 

Vice-Chancellor Dr Md Sharfuddin Ahmed said department heads fix the rota, and the money collected from the patients is distributed among the doctors, hospital and staff. 

[Written in English by Adil Mahmood and Osham-ul-Sufian Talukder]