Reviving the Family Doctor

Neighbourhood health clinics are trying to revive the dying breed of GPs

Published: Sep 19, 2012
HEALING TOUCH Chains of clinics with GPs are making a difference by ensuring that patients dont have to run around for elementary diagnosis
Image: Manoj Patil for Forbes India
HEALING TOUCH Chains of clinics with GPs are making a difference by ensuring that patients dont have to run around for elementary diagnosis

In August, Norwest Venture Partners invested Rs 25 crore in Bangalore-based NationWide Primary Healthcare Services, a chain of clinics that promotes family doctors. Healthspring, another similar chain from Mumbai, has received Rs 20.5 crore from Catamaran Ventures, Reliance Venture Asset Management and BlueCross BlueShield Venture Partners.

In Bangalore, The Family Doctor chain has announced an ambitious plan to expand to 30 clinics (up from its existing 13 in the city) across the country. 

Such initiatives to prop up neighbourhood clinics mark a trial-and-error approach to revive the dying breed of once-ubiquitous family doctors.

General practitioners lost out somewhere along the growth path of large hospitals. With big money coming in for specialists, being a GP wasn’t good enough. Despite long hours and the perils of being on call 24/7, graduating doctors went for specialisations.

Dr Shantanu Chattopadhyay, founder & MD, NationWide, says, “If you go to a medical college today, probably only three in a class of 100 would like to be general physicians.” In a class surveyed by Forbes India, the number was zero.

Dr Ramnik Parekh, president, Federation of Family Physicians’ Association of India, reiterates the lack of the doctor-next-door. “There are 1.7 million family doctors in India. One-third of them hold MBBS degrees, one-third are ayurvedic or homeopathic doctors, and the rest are unqualified or quacks,” he said.

Dr Rana Mehta, executive director of consulting firm PricewaterhouseCoopers (PwC), estimates there are about 200,000 family doctor clinics
in the country.  That roughly works out to 0.16 GPs per 1,000 people. In stark contrast, Canada has 10 GPs per 1,000.

This is where chains like NationWide, Healthspring, and The Family Doctor are trying to make a difference by bringing together GPs, and ensuring that patients don’t have to run from pillar to post for elementary diagnosis.

If you go to a hospital with a sprained neck, for instance, the outpatient department will straightaway direct you to an orthopaedic for whom you may have to fork out at least Rs 400.

Add to that the expenses for a battery of tests that a specialist is likely to recommend. The Family Doctor, on the other hand, charges Rs 125 per patient, NationWide Rs 200 and Healthspring Rs 350.   

The teething problems were there, of course.  Naresh Malhotra, director, The Family Doctor, had told Forbes India on an earlier occasion: “We had priced our consultation fee at Rs 50, but no one came in because they had doubts about us being professionals. Then we increased it to Rs 125 and our patient pool doubled.”

Buoyed by its success, the chain plans to open 100 clinics across the country by the end of 2013.  

The Family Doctor keeps
its operating costs low by working out of an area of 400-800 square feet. For stability, they are looking to hire women doctors as they “tend to stick around in the organisation for longer”. The clinic won many fans last year when it alerted civic authorities about a possible outbreak of malaria after it diagnosed at least 11 patients with similar symptoms.

An organised chain of qualified family doctors also substantially eases the burden on large hospitals by detecting primary-stage ailments, and reducing cases that require complicated procedures. NationWide and Healthspring have earned plaudits among the on-the-move professionals in Bangalore and Mumbai, respectively, for delivering quick and efficient services.

NationWide founders Dr Shantanu Chattopadhyay and Dr Shantanu Rahman are trying to create India’s version of the UK’s National Health Service.

One of the ways of achieving this is through their database that tracks patients’ medical records. This plays the role of family doctors who would treat patients from their childhood and know their medical history like the back of their hands. “When people move into a new city, they struggle to find such practitioners. It’s an area we are trying to work on,” said Chattopadhyay.

If numbers are to be believed, the concept is slowly catching on. Healthspring CEO Kaushik Sen said they’ve treated about 50,000 patients across four clinics since September 2011, while The Family Doctor has seen about 60,000 (including repeat patients).

At NationWide, about 1,000 have signed up for annual memberships that include 24/7 doctor-on-call and discounts on lab and pharmacy services.

Why are patients returning to GP clinics? “The key lies in establishing good relationships. Any good GP practice is based on trust,” said Rahman. Doctors are hired on a full-time basis and the chains are doing away with referral fees to ensure they don’t chase monetary benefits.

Ronald Mascarenhas, a 71-year-old from Mumbai, is very happy with the personalised care provided by the clinics.

“I have taken the diabetic plan at Healthspring and pay Rs 9,500 annually. Compared to big hospitals in Mumbai, it works out to be very economical because all my diabetic tests are covered and  extra consultancies for cold, fever, etc are free. These places are good for people who live alone. They are not like general hospitals, where you go for a check-up and then you are forgotten. They even call to check and remind me that my blood test is due,” he said.

Aruna Sakhuja, a 69-year-old entrepreneur, was touched when her physicians from NationWide paid her a visit after she underwent surgery at a large hospital. “No one does that these days,” she said.

(This story appears in the 28 September, 2012 issue of Forbes India. You can buy our tablet version from Magzter.com. To visit our Archives, click here.)

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  • Parag Paul Choudhury

    The only way the local house physician can add value, volume and make significant contribution is to update themselves to changing technology and get various help through this. For example if they can get access to a platform called NurseCall Exchange they can get many other doctor\'s advice FREE as and when they face a problem. The quality of their output will also increase. I can give many more suggestion if anybody wants them.

    on May 27, 2013
  • Dr Snehil Jain

    Family Medicine: Nice, efficient, cost-effective concept for the 90-95% healthcare needs of community. Lets realize the barriers/conflicts in India in this most-needed-used but neglected field ultimately leading to indirect promotion to quacks in community. 1. Govt is not supporting this field- still family medicine is not promoted as specialty. 2. Lack of health awareness- people don\'t know to find right doctor for their needs. They don\'t know that every headache do not need neurologist or every chest pain-a cardiologist. 3. More creamy the society - more the specialist is consulted. May this lead to over investigated and over treated. 4. Organ/system and not the person/patient is treated resulting in deficiency in care. Specialists many a times forget about their basic learning in MBBS classes. 5. Basic clinical skills are not developed as internship is the period for theoretical preparation for pre MD/MS entrance test- more important for future/career. 6. There is no provision/compulsion for regular update for family physicians in India resulting in no development in skills/care with time. In last I thank for making a platform for family medicine.

    on Jan 5, 2013
  • Dr Kunal Kothari

    The general practice is facing onslaught by specialist. Public perception is declining and people are choosing dr according to organ specific disease.The general practice of primary care is relegated because the lack public education and large publicity in print and visual media and endorsement is lacking in primary care. The same service thrives in public sector or ESI like structure

    on Oct 28, 2012
  • Dr.pragnesh M.vachharajani,president I.m.a. Ahmedabad

    We are already doing this. Reviving family practice is need of the hour. Insurance companies must bring a system that any referral without advice of family physician should not entertained.This will drastically reduce the cost on health care. Again stringent measures are required to check quacks. At the same public education is must, so that they make an informed choice of doctors. We need a paradigm shift. Read more about us on http://familyclinics.blogspot.in/

    on Oct 5, 2012
  • Dr Jayendra Kapadia

    hi,i am praticing at Surat since last thirty five years as Family Physician.Family Physician Association Surat has started FPA clinics for their members since 2009,we have about forty FPA clinics functioning very successfully and are cost effective too.our patients are extremely happy with us with our humble and honest approch.we shaii be delighted to impart our guideline to all who wishes to start such clinics.

    on Sep 25, 2012
  • Dr Hsr Arora

    I live in Kondapur Hyderabad.If Concept of Family Phy is revived lots of ills of Health Care Organization can be minimised. I am keen for it.

    on Sep 24, 2012
  • Olinda Timms

    This is the corporate approach to a major health need that developed with the growth of cities, the race for specialization and the fade out of the family doctor. Im not certain if this is the best answer but without doubt there is a huge vacuum and patients will vote with their feet. Standard of care and referral will be critical as the fresh MBBS doctor may not have the experience required or diagnostic abilities. Proper training and oversight is an answer. Attrition will be another problem with young doctors moving on along career paths. Ethical standards too are critical as there is an entrenched practice of lab and hospital referral kickbacks and commission and it it take tremendous effort to build and maintain a blemish free reputation for this chain of clinics. Some institutions offer PG training in Family practice which can be encouraged among the young medico recruits at these clinics in order to retain talent.

    on Sep 24, 2012
  • Ashok Singhal

    I am a G.P. for 25 yrs and working in the name HEALING TOUCHES HOSP. Happy to hear that others have started to think the same. BUT you have to see the clinical establishment act which does not allow the GP to give his best to the society.

    on Sep 21, 2012
  • Philip9876.com

    I still remember going to our family doctor for any ailment. Only a phone call was needed for him to come attend to us at our homes. Sad, such necessities are a thing of the past today.

    on Sep 21, 2012
  • Anupsoans

    This seems to be a backdoor corporate entry into the last bastion on private practice. GP in independent private practice can hardly be compared to a GP in corporate service.

    on Sep 19, 2012
  • Kapil

    Great post, bring out lot of facts about GPs. I came across a very interesting post "Re-Energising the GP" this comprehensively highlights the trends, challenges and possible solution framework. You can read the post over here http://www.trendscape.in/re-energizing-the-gp/

    on Sep 19, 2012
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