Teamwork in private medical practice – India

“Alone we can do so little, together we can do so much.” – Helen Keller

Healthcare delivery should be all about teamwork! Though physicians play a crucial role in clinical decision-making, it’s the nurses and paramedics that actually implement the decisions by providing care in the inpatient settings. The pathologists, radiologists and physical therapists involved as well have an equally important role to contribute to reaching the goals of treatment. That being said, operating rooms and intensive care units are ideal environments for displaying seamless teamwork!

In private practice, the scenario is completely different from that of government healthcare centers. Most of the time, the physician is the lone warrior in his or her clinic with one or two non-clinical staff at their mercy. In India, healthcare is mostly private, and we see patients queuing up at private clinics and hospital OPDs. Government healthcare centers are still not very patient-friendly (1).

Existing Scenarios

Physicians’ practices show marked variation in patterns of delivery and quality (2). There are standalone clinics run by primary care physicians, or “general practioners” as they are commonly addressed, and specialists who have two settings – hospital (inpatient and outpatient), as well as the private clinics.

It is very common to see that 4-5 doctors of the same specialty have different amounts of patient turnover. There are “high-volume practioners” with a high patient turnover. I know of specialists in my city examining patients at 11pm in their clinics, due to the large number of patients. Such scenarios are definitely neither physician-friendly, nor patient-friendly. Patients have to wait for a month for a follow-up appointment with some specialists. I had heard about this happening in the UK’s NHS and the USA, but this scenario has become very common in India, too.
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Private specialty practice is very competitive. It thrives on good referral management which also includes fee-splitting practices and bringing many patients under one umbrella.

There is a huge dearth of specialists in both urban and rural settings. The type of model most commonly seen here is specialists visiting villages once a fortnight or once a month. Specialists thrive in these places on good referrals and bringing back some practice to their primary institutions in cities.

Changing Patient Behaviour

Patients are making their own choices about which doctor to consult and how much to include doctors in their disease management, and many patients now use the internet to access health information on their own. In a survey taken by the digital agency WebChutney, 72% of online users in India reported using the Internet to research health information. (3)

In rural settings, doctors’ choices may be made on the basis of “consult-cum-dispense,” providing an exam/consultation as well as medicines within the village, so that no further money will be spent on investigations and buying medicines separately. They prefer this kind of “prescription and advice” care as a second resort (4).

Patients should normally be at the centre, but private practice is very demanding in India for doctors who function in varied clinical settings. It is commonly seen that doctors face stressors like work overload, excess working hours, sleep deprivation, and dealing with difficult patients. To add to this, there is stress from managing an irregular social and family life, due to the inconsistent working hours (5). This actually demands training doctors on different skill sets during their medical education.

Restructuring of private practice is essential, and it requires active participation from the doctor fraternity itself, in order to function effectively. Group practice or working in teams can be an effective solution to bring about a positive change. This is a trend in the West, but it should also be followed in India for better functioning for doctors and patients.

There are some specialists who are following good practice models where they function as a team – for instance, a senior doctor with a team of resident doctors and consultants working in perfect harmony, or a group of 3-4 doctors of the same specialty working together. However, these models are few and far between.

There are some exemplary models established with the help of technology, such as the telemedicine network established by Narayana Hrudayalaya and InTeleICU, where group practice includes 15 Critical Care Consultants who provide comprehensive services for managing Critical Care Units. Adopting newer advances in technology, like mHealth, would also help maintain a better workflow among the teams.

Advantages of Teamwork in Private Practice

The main benefits of teamwork are:

  • Better time management – spending more time with patients ensures patient satisfaction
  • Working systematically improves the overall functioning and will therefore boost patient turnover
  • More visibility
  • Better decision-making in difficult cases
  • Help to address patient safety issues
  • Help in financial management, in terms of choice of location for the clinic and buying better medical equipment

Teamwork demands a lot of reformation in order to be brought about in the current pattern. It demands respecting every person of the team. Unlike in the West, in India, doctors are the “superstars” as quoted in the Times of India article referenced below. In addition to that, there is lot of variation between practice quality, and doctors’ self-thinking plays a major role in treatment (4). However, group practice will demand standardization of care, which requires a change in the mindset and unity in the decision-making process. There will need to be defined roles and responsibilities, work delegation policies, and team-strengthening exercises.

An ideal group private practice in India would be comprised of 3-4 specialists and their staff, which includes resident physicians/medical officers, nurses, technicians and non-clinical staff, working together successfully. Collaboration and teamwork in the practice will be the best future model for private practice in India.

AK Valimbe Dr.Ashwini Valimbe, Health IT Consultant, US and Indian healthcare domain. Expertise in health outcomes, EMR, Meaningful Use and Comparative Effectiveness Research. Current interests includes designing and implementation of simple tools for private clinics in India and physician education to adopt technology and transform healthcare.

References (click to show/hide)

  1. Study on Patient Satisfaction in the Government Allopathic Health Facilities of Lucknow District, India, Indian J Community Med. 2009 January; 34(1): 35–42; Ranjeeta Kumari et al.
  2. Das J (2011) The Quality of Medical Care in Low-Income Countries: From Providers to Markets. PLoS Med 8(4): e1000432. doi:10.1371/journal.pmed.1000432
  3. Changing Patient Behaviour in India: 72% of Indian Internet Users Search for Health Related Information. NeedStreet blog. Accessed 02/15/2014 at:
  4. Meenakshi Gautham et al.‘First we go to the small doctor’: First contact for curative health care sought by rural communities in Andhra Pradesh & Orissa, India Indian J Med Res 134, November 2011, pp 627-638
  5. Dr.Anil Kakunje.Stress Among Health Care Professionals – The Need for Resiliency OJHAS Volume 10, Issue 1; Jan-Mar 2011
  6. Teamwork? Just what the doctor ordered. Times of India, Crest Edition. 2011 Dec 24.


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One Comment

  1. Dr. Valluri Ramarao
    Posted Jul 2014 at 2:08 pm | Permalink

    Yes, indian conditions may permit group practices in certain metros.not always successful.In rural india you are right.we need more interaction among specislists and GPs.This is lacking in many towns, as there is more cmpetition among medical fraternity.There are many corporate hospitals around so no chance of group practice like in the west.This is purely my observation.
    Thanks for your article with references.

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