DOCTORS ARE LEAVING CLINICS

AND JOINING MANAGEMENT

COURSES
 PRESENTED BY GROUP NO 10
 MISS SHIKHA JAIN
 DR SUHASINI DHILLON
 MR AMBRISH KUMAR CHANDAN
 DR VIKAS GOYA
 MR RAHUL GUPTA
 DR RUPINDER SAHOTA
HEALTHCARE ,the word which
rings in every ear
Now imagine a situation like
this…
 WHERE

LEAVE THEIR CLINICS

 INTRODUCTION
 THE PURPOSE OF THIS STUDY IS TO
DETERMINE THE FACTORS RESPONSIBLE
FOR CLINICIANS ABANDONING THEIR
CLINICS AND TAKING UP MANAGEMENT
COURSES.
 PROBLEM IDENTIFICATION
 MORE AND MORE DOCTORS ARE
COMPLETELY LEAVING THEIR CLINICAL
PRACTICE TO JOIN MANAGEMENT
COURSES AND THE NUMBER IS
INCREASING EVERY YEAR. On the other
hand the statistics show that India is
facing serious shortage of doctors.
 LITERATURE REVIEW
STUDY TIME RESULTS
LOCATION

DOCTORS SEE MBA

FLORIDA 1993 AS KEY TO
PERSONAL AND
CAREER
FULFILLMENT
DOCTORS DO MBA
YALE 2003 FOR EFFECTIVE
UNIVERSITY DELIVERY OF
HEALTHCARE
CONNECTICUT
 PROBLEM DEFINITION
 Increasing number of young doctors are
currently leaving their clinical practice to
join management, and are hence in a
short supply in India .As a result number
of people devoid of health care is also
increasing day by day.
 PROBLEM DEFINITION
 Salaries of doctors in India have been
steadily shrinking, while those of
managers are heading the opposite
direction. Doctors earnings are not
keeping up with their expenses.
 PROBLEM DEFINITION
• Government has appointed many allopathic
doctors on Contractual basis ,and has also given
chance to doctors practicing Indian systems of
medicine (under AYUSH).
• Also 6th pay commission promises good salary to
doctors.
• Yet this does not seem to motivate young
doctors.
 PROBLEM JUSTIFICATION
 India is short of 6 lakh doctors. This
works out to be approximately 1 doctor for
about 1634 people.
 The multi billion dollar NRHM was
launched 3 years ago, but India’s 6.5 lakh
villages continue to face a shortage of
doctors
SHORTFALL OF DOCTORS IN PHC’S
AND CHC’S
PERCENTAGE SHORTFALL OF DOCTORS

64.8
70
60
50
40 PHC
PERCENTAGE
30 CHC
20
7.8
10
0
PERCENTAGE
SANCTIONED POSTS VACANT

PERCENTAGE OF SANCTIONED POST VACANT OF

DOCTORS

60
50
50
PRERCENTAGE

40
30
20.8
20
10
0
PHC CHC

PERCENTAGE
SHORTFALL OF SPECIALISTS

percentage shortfall of specialists as compared to

requirement based on existing infrastructure

80 75.1 75
70.9 70.2
70
60
60
percentage

50
40 percentage
30
20
10
0
Surgeons O&G Physician Paeds Total
 PROBLEM JUSTIFICATION
 As a result quacks are rushing to fill in the
vacuum.
 More scary is that, fake doctors are more in
number than genuine ones.
 The figures for quacks for just Delhi is estimated
to be 40,000.
 They not just misdiagnose ,but often prescribe
harmful steroids, and also sell spurious and
expired medicines.
 Contd….
 In rural areas most of the time these fake
doctors are responsible for increasing the
severity of the people’s disease and
sometimes even death.
 Contd….
 The amount of resources (time ,money,
effort) that go into completing a medical
or dental degree is huge , still doctors
leave their profession.
 GOALS
 OUR GOAL IS TO DETRMINE THE CAUSES
WHICH ARE FORCING THE DOCTORS TO
LEAVE THEIR CLINICAL PRACTISE.
 PROVIDE A STRONG DATABASE FOR
TAKING NECESSARY ACTION.
 Objective :
A descriptive study will be conducted by the IHMR in 4
colleges of healthcare in INDIA.

 What : Descriptive study.

 By whom : IHMR
 To whom : All medical graduates studying in the following
institutes
 When : March 2009- May 2009
 Where : 4 colleges
IHMR JAIPUR
IIHMR DELHI
TISS MUMBAI
SYMBIOSIS PUNE
 Purpose : Determining factors which are responsible for
doctors to leave their profession.
 Research question:
Why more and more doctors leaving the
profession of medicine??
 Study design:
The study will be Retrospective, descriptive
type, analyzing the factors responsible for the
switching of the profession.
 Methods
 Definition of terms:
 IHMR:- Institute of Health Management
Research Jaipur.Giving admission to 120
students.
 TISS- Tata Institute of Social Sciences,
Mumbai, Giving admission to 20 students.
 IIHMR-International institute of health
management research, Delhi. Giving
admission to 60 students.
 SYMB: Symbiosis Institute of Health Sciences
Pune.Giving admission to 60 students
 Population
All the Doctors studying in above 4
institutions.
 Sampling process
Sample comprises of all the doctors
studying in the already mentioned institutes..
they can be -
1.MBBS
2.BDS
3.BHMS
4.BAMS
Table Depicting Sample Size

MALES FEMALES

IHMR
JAIPUR
IIHMR DELHI

TISS
MUMBAI
SYMBIOSIS
PUNE
 Data collected:
The individual questionnaire will help in
collection of primary data on the basis of their
medical education background which is qualitative in
nature.

 Data collection procedure:

The individual questionnaire will help to collect
data through Semi structured Interviews of the
individuals of all the 4 colleges.
 Data Instrument:
Individual Questionnaire
 Table Depicting Sample Size
for Pre-testing of Sample
IHMR MALES FEMALES
JAIPUR > 5 YR EXP > 2 YR EXP 0-2 YR EXP > 5 YR EXP > 2 YR EXP 0-2 YR EXP

MBBS
BDS
BAMS
BHMS
 Interviewers and supervisors will be trained
for pre-testing in 2nd week of march whereas
for field work the interviewer and
supervisors will be trained in 4th week of
march to assure quality in data collection.
 While carrying the semi structured interview
the interviewer will have enough space to
ask a question in different ways to ensure
quality data.
 TABULATION
The data will be tabulated by hand.
CODING
 MBBS 1
 BDS 2
 BHMS 3
 BAMS 4
 RESULT STATUS OF THE
QUESTIONAIRE
 COMPLETED 1
 PARTLY COMPLETED 2
 DOCTOR ABSENT 3
 REFUSED 4
QUESTIONAIRE
 YES 1
 NO 2
 CONTD……..
 The data will first be edited in the field by
the interviewers and then by their
respective supervisors in order to check
any error or inconsistency.
 ANALYSIS PLAN
Analysis of data will be done under following
heads:
 Our focus group will be the doctors who
have work experience & now pursuing
management course.
 Description of the doctors; tabulated as
age, educational profile, family status,
years since completing the medical.
 Contd…….
 The interview will be conducted in organization
as mentioned in our proposal & the discussions
will be recorded. Then report writing will be
done on the basis of the recorded evidence.
 Further the data will be analysed by proficient
analysts.
 Coding will be done after finalization of the
schedule by pre testing.
 The data operator will then enter the data in the
computer with the requisite software.
 PLANS FOR INTERPRETATION
 GENERALIZABILITY
The result can be generalized as an evidence to see the issue as it is
conducted in top four institutions of the country.
 LIMITATION

Our sample size is small. It includes many fresher doctors. The idea
may vary in the view of top , well established doctors.
 POTENTIAL CONTRIBUTION

The research provides us with the reasons as to why doctors are

leaving their profession & searching for other jobs.
It necessitates some action to be taken by the govt. by taking cue of
the situation.
PLANS TO REPORT THE RESEARCH
FINDINGS
The key findings of the results will be disseminated
to the people through different publications like:
 IHMR JOURNAL ON HEALTHCARE
 NATIONAL MEDICAL HEALTHCARE JOURNAL
 INDIAN JOURNAL ON HEALTHCARE
MANAGEMENT
 EDITORIALS OF NEWSPARERS LIKE THE HINDU
& THE TOI
 CONFERENCES/SEMINARS LIKE FUTURE
CHALLENGES IN HEALTHCARE MANAGEMENT
 JOB PROFILE
 PROJECT DIRECTOR- 1(for 2 months)
Preferred qualification: PH.D with 5-6 yrs. Of experience in the field of health
system research.
Will be responsible for the coordination of the whole project & its different
levels.
 STATISTICAL CONSULTANT-1(for 2 months) preferred qualification – M.sc.
(statistics)
 DATA ENTRY OPERATOR- 1(Full time)
Punching the collected data
 FIELD COORDINATOR- 2(For 2 month)
Preferred qualification-PGDHM/MSW With minimum 2 yrs. Of experience.
 INTERVIEWERS-4(For 2 month)
Responsible for conducting personal interviews
Spot checking of data quality
Interpretation & reporting to the institute
 FACILITIES
 OFFICE SPACE : 2 rooms(2*600sq.ft with attached latrine, bathroom)
 FURNITURES:
4 tables
10 plastic chairs
2 steel almirahs
 OFFICE APPLIANCES:
2 intel core 2duo computer system with internet facility
1hp laser jet printer
1 blank cd set
1 landline phone
4 mobile phones
2 portable tape recorders
2 digital camera
1 water purifier
 Contd….
 STATIONERY
Pen, pencils , erasers, sharpeners, stapler with
pins, punching machines, carbon paper,
registers, a4 size copier, printer cartridges,
folder files, audio cassette, stamp, stamp pad
 TRANSPORTATION & ACCOMODATION

TA/DA cost for the interviewers by economy class

flight
Boarding and lodging in “A” class hotel
 WORK SCHEDULE
ACTIVITIES APRIL MAY
PHASE 1
Determine sample 1st week
Recruit interviewer 1st week
Prepare interviewer manual 1st week
Draft code book 2nd week
PHASE 2
Train interviewer for pretest 2-3 week
Pretest questionnaire 3 week
Finalize questionnaire 3 week
Finalize interviewer manual 4 week
PHASE 3
Train interviewer for fieldwork4 week
Train coordinator for fieldwork 1st week
Carry out interview 1-2 week
Code data 3 week
Enter data 3 week
PHASE 4
Prepare preliminary report 3 week
Conduct detailed analysis 3 week
Prepare final report 4 week
PHASE 5
Print final report 4 week
 TENTATIVE BUDGET FOR THE
RESEARCH
 PERSONNEL SALARIES & WAGES
S.no. Particulars no. Period salary/mnth Net am
1 Project dir. 1 2 55000 1,10,000
2 Statistical con.1 2 23000 46,000
3 Data entry op. 1 2 7000 14,000
4 Field coordina. 2 2 15000 60,000
5 Interviewers 4 2 18000 1,44,000
total=Rs3,74,000
 FACILITIES
Sl.no. Particulars quantity Rs/quantity Net amt.
1. Room(1*600ft.) 2 10,000pm 20,000
2. Tables 4 1000 4000
3. Chairs 10 500 5000
4. Steel almirah 2 1200 2400
total=Rs 53,000
 OFFICE APPLIANCES
Sl.no. particulars quantity Rs/quantity net amt.
1. Computer & net 2 25000 50,000
2. Printer 1 10000 10,000
3. Blank cd set 1 1000 1,000
4. Landline ph. 1 3,500 3500
5. Mobile ph. 4 5,000 20,000
6. Tape recorders 2 5,000 10,000
7. Digital camera 2 15000 30,000
8. Water purifier 1 7,500 7500
total= Rs. 1,32,000
 STATIONERY
Sl.no. Particulars Quantity Rs/quantity Net amt.
1. Pen 25 5 125
2. Pencil 30 3 90
3. Eraser 15 3 45
4. Sharpener 20 3 60
5. Stapler & pin 3 100 300
6. Punching 3 100 300
7. Carbon ppr. 1pkt. 120 120
8. Register 20 35 700
9. A4 copier 10pkt. 120 1200
10. Cartridge 4 750 3000
11. Folders 20 50 1000
12. Audio cassette 30 30 900
13. Stamp 3 40 120
14. Stamp pad 6 32 192
Total=Rs 8,152
 TRANSPORTATION &
ACCOMODATION
S.no. Particulars Person Fare/time Net amt.
1. JAI-DELHI 8 2884/2576 43,680
2. JAI-MUMBAI 8 2091 16,728
3. MUMBAI-PUNE 8 4900 39,200
4. PUNE- JAIPUR 8 6177 49,416
5. Other traveling expenses 10,000
Total = Rs 1,59,024
 BOARDING & LODGING COST

S.No. Particulars Person Days c/d Net

1. Delhi 8 2 500 8000
2. Mumbai 8 2 700 11200
3. Pune 8 2 800 12800
Total = Rs 32000
 PUBLICATION COST
PARTICULARS COST OF PUBLICATION
 IHMR JOURNAL ON HEALTHCARE 20,000
 NATIONAL MEDICAL HEALTHCARE 21,000
 INDIAN HEALTHCARE MGMNT. 19,000
 EDITORIAL COST 9,500
Total= Rs 69,500
 TOTAL ESTIMATED COST OF
RESEARCH
 TOTAL COST OF RESEARCH 8,24,176
 OVERHEAD COST 50,000
 OTHERS 50,000
GRAND TOTAL = Rs 9,24,176
 BIBLIOGRAPHY
 Public health in India By V.N Bhatt 1990 /Edi – 1st Amar
Prakashan
 Medical administration for front line doctors By Andrew
Pearson 1990/ Edi – 1st FSG Communications Ltd
 Doctors and management in NHS 1996 By Harnoch ,
Gordon 1996 / Edi – 1st Open University press
 Doctors in Distress: Some organization behavior facets
By Peston jee 1997 / Edi – 1st Rawat publications
 CONSENT FORM
 Hello, My name is ---------------------------- and I am working for IHMR, We are
conducting a Survey as to why doctors are leaving clinics & going for management
courses. We would very much appreciate the participation of your in this survey. I
would like to ask you some questions about the same. The survey usually takes about
25 minutes to complete.
 Whatever information you provide will be kept strictly confidential.
 Participation in this survey is voluntary and you can choose not to answer any
question or all of the questions. However, we hope that you will participate in this
survey since your participation is important.
 At this time, do you want to ask me anything about the survey?
 In case you need more information about the survey, you may contact these persons.
 GIVE CARD WITH CONTACT INFORMATION.
 Field coordinator
 Project Director
 May I begin the interview now?
 Signature of interviewer--------------------------------------- Date-----------------------
 RESPONDENT AGREES TO BE INTERVIEWED……1 BEGIN INTERVIEW
 RESPONDENT DOES NOT AGREE TO BE INTERVIEWED ......2 END
 RECORD THE TIME: HOUR………… MINUTES…………
 LIST OF ABBREVIATIONS
 NRHM - NATIONAL RURAL HEALTH MISSION
 PHC- PRIMARY HEALTH CENTRE
 CHC- COMMUNITY HEALTH CENTRE
 MBBS- BACHELOR OF MEDICINE,BACHELOR OF
SCIENCE
 BDS- BACHELOR OF DENTAL SCIENCE
 BHMS- BACHELOR OF HOMEOPATHY MEDICAL
SCIENCE
THANK YOU