Earlier this year, Tata Memorial Hospital held a very frank and interesting positive discussion on cut practice in medicine, and how a young doctor can establish a successful practice without resorting to giving cuts. Dr Anirudh Malpani, IVF Specialist and a prominent physician and entrepreneur, shared his views on the Cut Practice and how to overcome it, followed by a panel discussion along with Dr Bhavin Jankharia, Radiologist, and Dr Sanjay Nagral, GI Surgeon (Jaslok) and editor of the Indian Journal of Medical Ethics. I had the privilege of moderating the session. Watch the full discussion below; Dr Anirudh Malpani’s talk begins at 4:09 min and the Panel discussion begins at 36:12 min.

I am sharing a few take home points with my two cents added.

– Starting a successful medical practice without giving cuts is difficult but not impossible. But you have to create other differentiators which make you stand above the competition. If you simply do the same things as the other equally good and qualified doctor who gives cuts, you are unlikely to get many patients.  You have to offer something beyond what the other doctors in your area are offering.

– Assuming equal competence, the obvious differentiator you can offer is price, as you can charge less and pass on the benefit to the patient. Another one is creating a more patient focused and interactive practice as volumes may be relatively low initially. This will give more time on your hands to interact directly with each patient (even if s/he comes for say a CT or x-ray and not an ultrasound), create personalized reports or whatsapps/sms es to the patient, consult patients who wish to understand their findings in more detail, and do other similar such things to create a direct connect.

– It is important to differentiate profit margin from patient volume. Say you charge 100 INR for a test of which 30 INR is your actual expense on the test and 50 INR is the cut; so you save only 20 INR (20% profit). If you had given no cuts, the same test would give you 70 INR profit (70% profit – equivalent to more than 3 patients with cuts!). You can even give the patient say a 30% discount, charge only 70 INR, and still make a more than healthy profit! This is also a big plus point for work-life balance.

– To cut the cut, cut the middlemen (viz GPs and referring physicians) and make the patient the center of your focus. Create online and offline presence with vernacular patient information videos and patient friendly material, and participate in the local community to get patients come directly to you instead of expecting other doctors to refer patients to you.

– Every area will have a few conscientious doctors who will be fine to refer patients tp you without asking for a cut. Find them and talk to them. Do the same with your medical college friends/acquaintances settled in the same city as yours. They can help propr up the numbers especially early on, when the patient volumes will be on the lower end of the spectrum.

– Have more online focus for tertiary level care practice (say an oncologist) and community focus for local practice (say a general radiologist). Work on retaining the patients who come to you, be it by good communication skills, simplified or structured reports/clinical notes, discounts etc.

– You need patience and may need a steady source of secondary income initially. Consider having a position elsewhere (govt or pvt or trust hospital), or dabble in alternative sources of income like stocks/mutual funds.

– Ultimately, if you are competent and communicate well with both patients and referring doctors, you will certainly do well.

– No cut practice works better for you in the long run. Once your practice is established, you will be earning much more while working less, as you will be earning only for yourself and your own practice, and not for your referring doctor.

– The eventual long-term systemic solution may be legal; a law regulating or banning cut practice. A bill was drafted after detailed consultations in Maharashtra with all stake holders 4 year ago, but is inexplicably in cold storage since then. This really needs to be passed asap.

Every doctor in private practice is an entrepreneur of sorts. Till now, cuts is the easy way to start off. Instead reorient these entrepreneurship skills towards attracting doctors and patients in a different way; think creatively, create a team of like-minded ethical doctors to help each other, target patients directly, and you can succeed with your head held high and with a good worklife balance. It is time to take your practice and medical practice in general a cut above the rest!

All the best!

– Akshay Baheti, Tata Memorial Hospital