Recently, one of my friends who is the Medical Superintendent of a mission hospital asked me the question that is debated at some point in every medical circle - how much should a doctor be paid? The more I reflect upon this question, the harder it is to answer! And having heard many opinions on the topic especially in the operating theatre lounge at Vellore, I know that there is no clear answer to the question. As far as I have understood from all the discussions I have had with different groups, the vast majority of doctors (at least in India) believe they are getting paid too little and I am sure that any view I express here to the contrary will not be taken kindly, especially as the majority of my readers are doctors in India!! But it is an area of great interest for me, as after all, working in a mission hospital will mean at some point becoming involved in these sort of discussions and I realise it is important to have some idea at least of the ground realities involved.
Now the first observation I have to make is one that I feel everyone will agree with. In a Utopian society, all men are equal and the nature of their work does not place them higher or lower on the social or financial scale. So in this ideal world, all men have their needs taken care of and the janitor knows his work is as important as the CEO. Thus there is camaraderie and justice for all and there is no major distinction between the 'biggest' and the 'smallest' person in the hospital - they are both valued for their work and both carry out their particular responsibilities to the best of their ability. Unfortunately, our country has been doggedly moving in exactly the opposite direction for so long that this ideal society will never be a reality until the New Jerusalem comes.
But there are a few places that seem to approach this ideal society. My limited knowledge leads me to believe that the Aurobindo ashram is one such place. But more interesting is the example of the Christian Fellowship Hospital, Oddanchatram. Here, even today, there is not a huge difference between the highest and the lowest salaries paid to employees of the hospital. There are 90 odd doctors working there, many of whom have made lifetime commitments. And some of my friends who work there are more than happy with their life, although their remuneration is about a quarter (or less!) of what they would get anywhere else! I am sure there will be discordant voices, but this is my general impression after spending a week there last year. And Christian Medical College, Vellore, itself had a similar policy till recently, when it was deemed impossible to retain doctors on those salaries.
But for the most part, doctors believe they should be on the higher end of the pay-scale and are unhappy when they are not. There are many reasons for this. The first argument is that a doctor spends more years in training than most other professions. This is true of course, and is my response to any young person asking me about my profession. It's just great to be a doctor provided you have the patience to struggle through a training period that lasts for 10 years or more. And of course, after your undergraduate studies, there is the huge hurdle of the post-graduate exams to cross. Unless you were born with a golden spoon, or are part of a community that has special reservations in the various colleges, admission into a medical undergraduate or postgraduate course is not really an easy thing. And often, when huge amounts of money change hands in the process of gaining admission to a course (and sometimes, even in the process of passing the exams to leave the same course!) there is a subconscious feeling that some payback is due. And so, every opportunity to make money is grabbed, often forgetting the greater issues at stake.
And what are these greater issues? In my mind (and as I say this I know there will be differences of opinion, for which I apologise!), the greatest issue that should engage the mind and heart of a medical professional is this - Is the purpose of spending so many years of my life in training to be a doctor just so that I can bank huge amounts of money and live a comfortable life? Or is there a greater purpose? Can I use the gift of my training and skills to change the lives of people who have nowhere else to go? There are many ways to do this. One is through groundbreaking research that will bring new knowledge into a particular disease process and its treatment. Another is by innovative utilisation of new technology that will bring diagnostic and therapeutic benefit in a particular field. These forms of medical involvement often call for skills and mental capability that are given only to few. Most of us have to find more of a 'mundane' way to utilise our skills and knowledge. And for most of us, that involves practice of medicine in the area we are trained in, to the best of our ability.
So here is the next question - where should I practice my skill? Am I like a commodity that is to be sold to the highest bidder? Or can I make a decision based on my understanding of where my services will be most worthwhile.... And work in an 'area of need'. Now, with the commercialisation of medicine and the huge investment being pumped into the health sector, new corporate hospitals are a dime a dozen. It is very easy to find a job that pays a 6-figure monthly salary as long as you have some basic skills and are good at public relations. But the problem with all our doctors clamouring for these jobs is that there are so few left to work where the need actually is. You see, the private hospitals cater mainly to the cream of our population. And they have all options open to them. It is the poor who have no options. And so very few doctors and health care systems in place to take care of them. Of course, our government health system is one of the best in the world on paper, but we all know that what is on paper is hardly what is the reality. And so, as is expected in a capitalistic society, the poor get marginalised even when it comes to health....
So that brings me back to the initial question - how much is a doctor worth? I guess, the figure is astronomical, considering the training and the effort involved. But that does not mean he or she needs to be paid as much. For the whole purpose of choosing to be make a difference means that something has to give somewhere. And the moment a doctor decides to work in a particular place without looking at the salary, his or her work takes on a new dimension. And the doctor will find the strange satisfaction that comes when our work is solely for the benefit of others and there are no strings attached. Of course, our needs have to be met, but in today's world, I do not think there is any place where the salary is so low that a doctor needs to struggle for existence. (As compared to the days when monthly packages were in the low 3-figures!).
So, my answer to the question - how much is a doctor is worth, is - priceless. But if you ask me how much he or she should be paid, my answer would be - it does not matter. So long as we are not begging for my daily bread, I believe there is great joy and satisfaction in knowing that our work is for a higher purpose than money. Of course, we may not have a mansion to live in, drive an expensive car or take holidays in the Bahamas. But our lives will begin to approach the abundance of joy that everyone erroneously seems to believe comes from huge amounts of money. Of course, money does bring many material things and with them, a form of happiness. And most of us are satisfied with this form of happiness, thus missing the even greater joy and satisfaction that can come when money is no longer in the picture. A joy that is independent of materialism. A satisfaction that is deeper than anything money can buy.
We need more people who can model this lifestyle for us right from our days in medical colleges. For in today's world, the majority of our doctors are seeking success solely from a monetary perspective. There is little or no interest in defining 'success' in any other way. And in this system, doctors will slowly lose their position of respect in society. For they become nothing more than vultures, seeking to profit from the suffering and (and sometimes, death) of others.......
(This is a rather long post, but, believe it or not, I have more to say on the subject!! Part 2 will follow sometime!!)