Psychiatrist Dr. Shyam Shastri (name changed) regularly visits clinicians almost in southern Mumbai to deliver cash envelopes. Shastri, who has struggled to establish his medical practice for three years, finally decided to offer “discounts” to his honorary colleagues that patients pay him.
By sending these envelopes in cash, Shastri has made sure that doctors refer and recommend their services to their patients.
The current rate of these commissions, according to Shastri, is between 40% and 60%, which means that if a patient paid Rs 1000 to Shastri, he will have to pay between 400 Rs and Rs 600 for the referring doctor.
“I never thought about enjoying an unethical practice,” Shastri said. “This practice cuts like the way someone pays premiums to politicians by eliminating a project.”
He hopes to be able to stop paying commissions once he has enough patients and a fairly solid practice to pay his bills.
Senior colleagues Shastri also said they had to offer incentives to other doctors, especially physicians, at least once during their practice years. An older doctor working with a well-known hospital in Mumbai said at a time he paid at least 10 doctors to refer patients to him.
“I had decided not to go back into guilty practice,” he said. “But my practice was so bad that my family asked me to do it.”
Finally, it was established enough to stop cutting cuts.
A decade ago, when Tamara Zweck, a sports and orthopedic physiotherapist, moved her practice to Mumbai, Australia, her loved ones and her patients have been told to “connect with doctors” to improve their practice.
“In my opinion, the patient comes first and I decided to rely on word of mouth instead of offering or making cuts,” Zweck said. He added that fitness instructors, yoga teachers also accept the cuts to refer patients to doctors.
Cardiac surgeon Dr. Ramakant Panda of Mumbai, has launched a campaign with several doctors to end the practice of cutting. Panda regularly meets patients who advise angioplasty – a procedure in which catheters are guided by constricting arteries to expand or remove plaque – when they do not really need it. It is estimated that 30% of the angioplasties performed are unnecessary. “[Doctors] advise to get the procedure because they get cuts,” he said.
Many doctors hire PR officers to work as agents. “These agents are for general practitioners who have the doctor they work for and offer incentives to send patients,” said Dr. Jeevan Rajput, Aurangabad neurosurgery.
When Rajput began his private practice in Aurangabad there four years, other doctors suggested hiring a public relations agent and offering reimbursements in exchange for referrals from patients. “I wanted to start my own hospital and it was difficult at first because I do not even belong to a family of doctors,” he said.
Rajput decided to personally visit the doctors and ask them to refer patients for their abilities. Some were forced, some not. “Instead of offering rebates, I have offered discounts to patients and have never insisted on a deposit that has worked for me.” Some clinics require patients to pay a certain amount on deposit prior to treatment or hospitalization.