Who needs high-cost doctors anyway?

The future of healthcare is in embracing a low-cost, hybrid model that uses doctors and technology in an efficient mix

Many Indian medical students had to be evacuated from war-torn Ukraine in the wake of the Russian invasion in February. Some Indian students also had to be evacuated from China in 2020 in the wake of the severe Covid lockdowns imposed in that country at that time. The question is: Why do they go to study in places where they can be vulnerable to such shocks?

There are two obvious answers: The shortage of medical seats in India, and the exorbitant cost of an education in private institutions. Private medical institutions in India could take in up to Rs 1 crore (or more) in fees for an MBBS course, when government institutions cost a tenth of that amount. Fees in Russia and Ukraine, or even Bangladesh, can be well below a third of what it costs to become a doctor in India.

At that kind of cost, you are more likely to be creating a mercenary than a doctor. Simple math will tell you that you could earn at least Rs 50,000 a month (even at the current low fixed deposit rates) for the rest of your life if you didn’t invest Rs 1 crore in medical education. The money saved could easily be used to learn other skills that can also earn you a decent living. The upshot: Indian healthcare is heading for a serious crisis, not to speak of public health.

The reason why many Indians tend to self-medicate is because most people cannot afford doctors and hospitals. This is also why we see spats between various streams of medicine. Last year, the Indian Medical Association and Baba Ramdev got into verbal fisticuffs over allopathy and ayurveda. They are fighting for market share. It goes without saying that many doctors created by a high-cost system of medical education will be looking for returns on investment rather than living up to their Hippocratic oaths.

Is there a way out? The answer is a big yes. As we saw during the pandemic, when many doctors embraced teleconsulting to advise patients who could not come to hospitals, the way to cheaper healthcare is technology and the use of artificial intelligence and patient databases. We also need to gradually move to a hybrid system of medical education, where anyone with any degree — whether in allopathy or ayurveda or Unani — can be given a basic right to practise any form of mixed medicine with some crossover educational modules. If they are dealing with anything beyond everyday illnesses, they can serve as referral agents for specialists and expert doctors.

Illustration: Binay Sinha

Some years ago, billionaire venture capitalist Vinod Khosla upset the medical fraternity when he asked a basic question: Do we need more doctors or more algorithms? He has been investing in many start-ups that promise to make healthcare more efficient and cheaper with the use of artificial intelligence and disease databases.

 However, technology could commoditise basic doctoring skills, making it tougher for all but the most skilled ones to retain current earnings. This is because technology does two things: One, it polarises the demand for skills, with high skills attracting high wage premiums and lower-level skills going at a discount. Two, technology makes it easier to manage with average or low skills. Just as an Ola driver does not need anything more than the ability to read a Google map on his mobile, tomorrow’s basic healthcare worker will be as equipped as an MBBS doctor in terms of his ability to diagnose and treat basic symptoms and illnesses.

As Mr Khosla has repeatedly pointed out, consider what your general physician does. He spends some time asking you about your complaints, takes your temperature and pulse, makes a visual observation and checks other vitals, where relevant. Technology will make all these available at home through cheap devices and apps that can take down all your complaints and give the doctor suggestions on diagnosis. All the doctor would have to do is take his or her pick from the diagnoses offered by the algorithm, and prescribe your treatment. Alternatively, he can refer you to a specialist or ask for more diagnostic tests. But even path labs will face competition from devices that anyone can procure. (Examples of devices already in use include glucometers and oximeters). Tomorrow, many more devices will enable diagnosis and monitoring at home.

The resistance to change, both from the medical profession and the healthcare industry, can be easily understood: The monopoly of knowledge that enables them to earn a premium from dispensing medical advice, and for educational institutions to earn high fee incomes, will go poof! With some help from technology and some crossover education, the existing pool of doctors from ayurveda and Unani, and even nurses, will be in a position to dispense basic medical advice or refer patients to super-skilled experts. The cost of doctoring will come down dramatically for citizens.

Not only that. It is simply impossible for a doctor to keep up with the explosion in medical knowledge without technology. So, he or she has to learn to live with this reality that an algorithm wedded to a database (on medical records and cases) will always know better. The only way to retain earnings is by raising productivity.

Obviously, those who have spent Rs 1 crore earning an MBBS degree or equivalent will not be pleased at the prospect of a fall in income as a result of competition from the new entrants, but is there any remedy for high-cost goods or services apart from stronger competition?

Whether it is real estate or healthcare, high incomes are unsustainable in the age of technology-mediated services. Just as land prices can be crashed by allowing builders to go more vertical and the use of 3D building processes, healthcare costs can be slashed and the supply of doctors increased with the help of technology and a rejigged medical education. Sooner than later, your average family doctor will not be able to charge a premium for his services. Not only will his knowledge be available for free on the internet but his diagnostic skills will also be devalued by smarter technology.

India’s healthcare system can be modernised at low cost, and the only real challenge is the resistance to change by legacy beneficiaries like doctors and hospitals. The future is in embracing low-cost, hybrid healthcare using technology and doctors in a more efficient mix.

The writer is editorial director, Swarajya magazine