Though ideally patient should not be divided on economic considerations, on reality, from a clinician's point of gaining experience, Government Hospitals will have to serve a variety of IN PATIENTS and huge in infrastructure and facilities; whereas the private will have to serve the "urgent care in the proximity" and affordable ones to be attended within the available infrastructure and facilities.
At times in government hospital the infrastructure and facilities may take not be available during urgent requirements (as a mass of population would be queuing to use the facility).... and also would consume more time to get repaired (as bureaucratic channel needs to organize)
The answer to your question would very much depend on the country you plan to practice in.
As for what I can see from outside the profession the pros of government (public) service is usually job security, benefits, and experience as the number of cases one sees is much more than private practice. Many doctors use this as a vehicle to establish a reputation before they go into private practice.
Pros for private practice the pay is much better and the load is much lighter.
I also, think that the answer will depend on the age of the doctor for a young doctor or a young specialist based on what I observed in Jordan I would recommend public service for a good while and then move into private practice. For a mid-career professional I would say go into private practice.
Keep in mind that this is an outside the profession opinion.
I think that the quality of the hospital is more important than whether it is governmental or private hospital.
This depends on the hospital itself. I think the larger the number of patients and the number of operations, the better the hospital will be for the clincian.
In Crisis Greece every patient goes to public hospitals. In fact public hospitals are not bad. Thus in this case the clinician has to go to public hospitals. In other countries where thaere are different coditions, it might choose private hospitals.
As you all say, conditions vary from country to country. At present the U.S. is experiencing its greatest crisis of public veterans´administration hospitals. Veterans come home wounded from our wars and cannot get immediate treatment or treatment at all because of grossly negligent bureaucrats. The government is trying to change this disaster, but it took a crisis of national proportions to call this disastrous situation to public attention. So right now, in the U.S., all indications are that private hospitals outflank public ones in quality (and speed).
Yes, as Nelson says conditions are different in different countries. In India, those who want to live a comfortable life, with no work stress and pressure, like to work in Government-run hospitals. But the earings in these are far less. If one is well-versed and well-known specialist in her/his field s/he can fabulous money in some of the finest private hospitals--up to 2 to 3 times than those getting in government hospitals.
Let me do some critical analysis with this question.... The CLINICIAN work in government or private depends on the "OBJECTIVE" that person has....
Each of these are different parameters but at the same time cross linked....Depending on what the individual's objective the decisions can be varied...
Both public sector & private sector hospitals are required to treat patients & they have their own responsibilities . The public sector hospitals take care of the lower middle class & poor patients . These hospitals concentrate on primary & secondary care with limited tertiary care facilities . They are free of cost & funded by the government . The private sector takes care of the middle class & elite of society & have excellent tertiary care facilities .
In the developing countries , the public sector hospitals have an important responsibility to take care of its poor citizens . The health of a nation is determined by Infant mortality rate , Maternal mortality rate & life span of its citizens . These parameters can be improved by the public sector hospitals in both urban & rural areas . Public sector medical colleges do a good job in patient care , teaching & research & many doctors would like to work in these Institutes . Doctors with higher speciality training prefer to work in tertiary care facilities because of excellent infrastructure .
The responsibility of a doctor is to treat patients & save lives & working in both these Institutes is fine , provided they work sincerely . Even in UK , the NHS is doing a great job in the public sector . The problem with tertiary care is that it has become very expensive & therefore preventive health , primary & secondary care are very essential in both private & public sector hospitals to reduce the cost of health care & do more good to health of society . It is the goals of heath care that should motivate doctors to chose where they intend to work .
Hi,
I think government hospital should the first because you gain a lot of experience .afterward those who want to go to private hospitals could go.
As far as practice is concerned, clinicians will get more hands on experience in government hospitals !
Dear Mohamed, I agree the fact that one would get more no of patients in government hospitals compare to private sectors. Specially in India, different categories of people chose different hospitals...says middle class/ lower class people are force to chose government hospital whereas the upper middle class/ high class people preferred private sectors. What may be the reason why they preferred differently? Some possible reasons are:
From this points one may understand that practicing doctors in both the sector provided service differently even after having same degree with them. This may be due to different in policy of hospitals....
Practise in private and work for government should be the ideal way to look at things. If you are in the government sector and being paid it means that you are a part and parcel of the government in enforcing the ideals and duties of the govt. I wouldnot call it as practice but as yur contribution towards health.
In private practice there is a one to one interaction and more flexibility to follow the case.
Monetary wise there will be more burden on the client, more chances of exploitation,
facility wise the private and govt sector compete with each other.
public and private complementary service would be beneficial.
health check tests are rarely conducted by the govt sector but by te private sector which should raise eyebrows
I agree with Sathyaprasad that doctors who work in government hospitals can practice in private clinics in the evenings . The only caution is that they do not neglect the patients in public hospitals . In government medical colleges , they should also do good quality research & teaching & should not neglect them for the sake of private practice . There are many doctors who are dedicated to teaching & research & they should be given all the opportunities to work in public sector teaching Institutes . In developing countries , doctors are very important professionals & the government should take good care of them , as they work in remote rural areas with very limited facilities . The only solution is that the government opens a medical college in every district to provide good quality care & train many young students to become doctors . I agree that private & public sector would be complementary & be beneficial to all segments of society .
Teaching in a private or public hospitals require a high degree of commitment.
practicing medicine in private involves many seen and unseen factors, which directly or indirectly are transferred to the client.
free medicine to all sectos of the society is a viabe option which can decrease pill burden and unnecessary tests
The purpose of this paper is to analyze the satisfaction and importance levels of doctors from their working conditions and environment which are key determinants of patient satisfaction.In general, majority of the governmental hospital doctors are unsatisfied with the aspects of working conditions; whereas, the satisfaction levels of private hospital are higher than that of governmental hospital doctors.
http://www.emeraldinsight.com/journals.htm?articleid=1865338
I believe practicing in private hospital is much better, because usually there are more incentives.
I agree with Lala that the majority of the governmental hospital doctors are unsatisfied with the aspects of working conditions.
In my country governmental clinical hospitals offer lower salaries but better occupations to develop as profesionalist (governmental 4-5 years specialization, many therapeutic methods, even experimental) and scientists (due to many clinicians on academic posts and ability to conduct clinical research). Private clinics try to maximize their financial result, thus don't apply risky experimental methods, sometimes don't provide health care for the most severe (=expensive, not guaranting theraputic success) patients, in the most cases there is lack of financing courses and research for staff. We hope this situation will change, but I am afraid not in the future. It seems only better awareness of the patients and their families, lack of queues, and more money spend by the government on health care may improve it.
Dear all, if you compare the govt and private sector involved in providing health care to public, Th govt starts its provision of health to all through the PHC.
Practice of medicine even though begins in the doorstep of government medical colleges, the shift and lean will be towards private practice.
If one analyses a few reasons then it would begin with satisfaction of the patient.
A one to one reasonable co ordination is possible with private practice, and a subject oriented practice is possible with govt practice..
Other reasons would also include timings spacing, overcrowding, in the govt sector versus well maintained staff, with SOP, respect to patient, and accountability.
Government hospitals may avail a wider range of conditions and/or diseases! Private hospitals might however offer a wider range of facilities!
Period!
As many said, it varies from country to country... In France, in public hospitals you can have the perspective to have the teaching and training branch that you can't have in private hospitals. Most of the development and the research labs are working only with public doctors because the majority of the labs are in public structures.
Being a student, I had nurse practice in the public hospitals.It was very productive for training simple manipulations there.Our doctors were highly professional and devoted to their noble profession.We were taught to medical ethics and tried to be much alike them in every way.Surely, my father was my main doctor teacher and a role model..As a specialist in massage I was taught and had practice and passed exams in the private medical institutions. The head doctors were perfect. Nowadays a lot of doctors try to find a place for work in the private clinics. Surely, it's advantageous to have excellent facilities for medical practice.Besides, it's profitable from the materialistic point of view. There are a lack of special doctors in the public clinics, because the salary is extremely low. Nevertheless, I'm sure, that a highly professional specialist may be found just in the public hospitals. They are not corrupted, they are humanistic, they don't belong to corrupted elite.Patients have their own friends doctors, whom they believe a lot. From medical ethics, patient's belief is 90% of success.As for me, I, being ill, try not to attend clinics at all. I phone to my friend doctor and cough in the phone. My friend appreciates my time and makes prescription on the phone after professional anamnesis. To be ill in our country is extremely expensive "pleasure".Old people on pension are miserable patients.
Public hospitals are very well equipped and there are many and various types of patients, which is sine qua non for a clinician to practice. As for the ethics both public and private are moving by money! In public there is "fakalaki" whereas in private they ask directly a high price.
To experience real practice or to feel the service of medical assistance to the needy and poor, the Government Hospitals are the place of first approach in the likely event of illness or injury. For the physician in Government hospitals remains a leaning over suffering patients in well-appointed hospital beds. Today private health center or hospitals are more upgraded and modernized than the free government hospitals were a balm for lives on the edge of subsistence, protection against financial ruin and suffering.
Financially, private hospital may pay more!
Professionally, public hospital may offer a wider range of conditions and/or diseases!
Period!
The best outcome for the old and weak is the nearest and dearest. If you are a lucky dog, you have noble and honest relatives. You can be sure your old years and awards will be supported.Nobody in your state helps you. I was shocked when my father, who had been a noble and famous man,turned out to be a rubbish, in the situation of hard illness.We can save him thanks to our doctors-friends
It depends on the degrees of freedom for doing the research and not on the legal status, private vs public.
I believe most clinician prefer to practice in private hospital than govermental hospitals. As we know, the routine work of governmental institutions is responsible for all the delays and negative esults in business.
I think both are important to practice
I governmental clinicians will see and manage different various cases including the difficult/ complicated one. In private sector clinicians will practice in different environment
It depends, Some countries are interested in healthcare, in this case you could find all modern equipment with a very specialized staff at the governmental hospitals, on the other hand, some countries are suffering from the neglect of health field, in this case private hospitals will take the main role.
Strong relationship between a number of factors and effective management practices. In particular:
- Competition helps improve managerial standards .
- Hospitals with clinically qualified managers are associated with much better management scores.
- Higher-scoring hospitals give managers higher levels of autonomy than lower-performing hospitals.
- Scale and size matter. Larger hospitals are better managed.
- When it comes to ownership, private hospitals (including not-for-profits) achieve higher management scores than public hospitals across all countries
http://www.leadingsystemsnetwork.com/pdf/Management_Matters.pdf
@ kAMAL
I agree with you, however in India, Insufficient number of doctors in government health care
- Institutional Issues
- Incentives
- lengthy Period of stay in RURAL AREAS
http://www.hrhindia.org/assets/images/HRH%20Policy%20Note4.pdf
Governmental hospitals have many problems and face many difficulties. The health care services in private hospitals are much better than in governmental hospitals.
In addition to that, sometimes, the medicine is not unavailable in the pharmacy of the the hospitals all the time. It happen that medicine is not availblle for weeks or more.
Dear Krshnan I don't think there is dearth of doctors in India. With many private medical colleges the number has reached a saturation point. Distribution of work and allotment of these doctors in peripheral areas will enhance the capacity of the working doctors there by improving performance. The basic difference between private and public is ownership attitude,
Given any scenario which will provide better pay and security most of te doctors will prefer govt hospitals
would like to add selection of sector whether private or governmental hospital does not depends on how much we earn but there are other factors like certain specialties needs
special requirements ,equipment s where the doctor will have no choice the sector which is providing him with these tools
Another issue is doctor perspective or what he or she is looking for if his or her interest more related to research or teaching will go to governmental if more toward money and more social relations private will be preferd
classical thinking of if you work in private you look for money and if you work in governmental you are not cannot be generalized since in certain countries it is the opposite government give more money
learning and teaching would be best in Govt sector while private sector has the best use of technology. the choice is left to the doctor
Dear Satyaprasad Venkata thank you this re emphasized the choice of the dctor
I agree with Kamal. For me, it is a matter of principle. As a working doctor, it would be noble to work, teach and do research in a public healthcare system. This is were you could reach out to the most needy in the society. This is however, my personal point of view, might help you in reflecting on what your decision might be.
I think it depends on the objective of the clinicians and on the availability of the type of clinic, and on the country itself.
The Maharashtra government has decided to terminate the services of around 265 striking doctors, who are among the 12,000 government medicos on strike since July 1, demanding better pay and working hours, among other things. But the Maharashtra Association of Gazetted Medical Officers (MAGMO), which is leading the strike, is showing no sign of backing down and has said the strike will continue unless some of its main demands are met.
http://www.downtoearth.org.in/content/maharashtra-docs-refuse-call-strike
I believe both governmental and private hospitals are suitable for clinician to practice in. But, the problem is with the routine work of the governmental hospitals.
Why and How the Private Health Sector Bloomed?
A weak government health care delivery system, coupled with the poor quality of care (QoC) offered by it, is a major contributing factor to the growth of the private health care system. Other important factors are discussed below.
Government Policies
The National Health Policy, 2002, seeks to increase the availability and coverage of health services by encouraging private investments so as establish an integrated network of evenly spread specialty and super-specialty services. The National Population Policy, 2001, advocates a partnership between non-government voluntary organizations and private sector organizations, including corporate houses (Planning Commission, 2001) to achieve the goals envisaged. The National Rural Health Mission (NRHM) envisages the participation of the private sector to ensure that the states make full use of the health care providers available in remote regions, and to also encourage better utilization of publicly owned health facilities.
Indirect Government Support
The Government of India (GoI) offers a number of financial concessions to corporate hospitals in the form of subsidized sale of land, reduced import duties and tax concessions for medical research. Other benefits received by the private sector include reduced utility charges, discounted or free land, and low-interest loans. Gradually, health care has emerged as a blue-chip industry, attracting individual as well as institutional investment. Domestic and foreign companies have also come forward to set up tertiary care/super-specialty hospitals.
Quality of Care in the Private Sector
According to the World Health Organization (WHO), quality of care (QoC) is interventions that are known to be safe, that are affordable to the society in question, and that have the ability to produce an impact on mortality, morbidity, disability, and malnutrition. The private health care delivery system (PHCDS) in India is made up of two major subsystems: namely,
(a) individual practioners and
(b) institutions (nursing homes and hospitals). The majority of the individual practitioners in the country, in both the modern and traditional systems of medicine, are in the private sector. They are often referred to as private medical practitioners (PMPs). Hospitals in India comprise:
(a) For-profit hospitals and nursing homes,
(b) Corporate hospitals and
(c) Not-for-profit NGO and missionary hospitals. During the last two decades, the number of private hospitals has significantly increased, especially corporate chains like Apollo, Fortis, Max among others.
Private Medical Practitioners (PMPs)
Compared to practitioners in the government-run hospitals, PMPs are more patient-centric, offer acceptable services, and enjoy the confidence and trust of the patients, winning their loyalty and word-of-mouth promotion in turn. Many private sector facilities offer poorer patients free or less expensive care, discount prices, free samples of medicines, deferred payment plans, and payment in- kind, paving the way to their popularity
http://journal.asci.org.in/Vol.41%282011-12%29/41_2_phrao.pdf
Working at Government hospital give a chance to physician and.or doctor to work for masses as everyday number of patients are many times higher than the private ones. It is an opportunity to help poor millions and also to continuous professional development too. Regards
Both private and governmental hospitals are good for practice though the infrastructure in the governmental hospitals, in many cases, not up to the mark of excellence.
In my country, i liked all of them (governmental in the morning & private in the evening) with keeping the same Principe during dealing with patient. Regarding private i prefer my own because private of others may have limited facilities which not coincide with my experience.
In government sectors doctors have more cases and gain more experiences but less money. Unfortunately, after doctors get their reputation they leave to a private sectors and recruit their patients to their clinics.
I think it is according to regulation of the countries. Some countries give chance to work in both sectors. According to my experience the governmental sector is better and save for the physician and the patients .
i think that both governmental and private hospitals are suitable for clinician to practice in
In my opinion, it makes no difference whether government or private hospitals for clinician to practice in.
Both private and public services are rewarding to any health professional. They are different in almost all the cases in the wold. Doctors have to be aware of these differences and work as if there were no difference for him. In some cases, there will be a need for an extra creativity, respect, but always the customers should never be able to notice that they should have used the other system instead.
I think the private and governmental services are not mutually exclusive
In China different specialties have different opportunities to undertake DP: surgeons have more scope for Dual Practice (DP) than physicians. Patients think the income of doctors is quite high compared with the rest of Chinese society. A national health policy on DP is hopefully to be issued by the MoH in the near future, within which it is considered that DP is accept able and legal, but should be implemented under sound management of the public hospital.
http://r4d.dfid.gov.uk/pdf/outputs/healthecfin_kp/wp07_03.pdf
Dear Kamal,
you point it out. Discipline and ethics are demanded, not to focus on the "privates" and not to neglect the "publics". We know this selective behaviour depending on the health insurance. Privates get quick dates, often find special waiting rooms, the medical service is prompt.
One another option is to work abroad, because of monetary considerations.
In Uganda, the Medical courses are expensive in terms of tuition and stationery. Privately-sponsored students pay over sh1m per semester for five years, making the courses a no-go area for students from poor families.
Challenges to the healthcare system in Uganda include lack of drugs and other resources in the hospitals, poor working conditions and high patient loads.
Compared to practice in the public sector since the private sector pays better. Entry level graduate doctors and pharmacists in the public sector are on salary scale U4 where they earn a gross pay of sh700,000 per month or a net pay of sh500,000 (plus other benefits). In the US, a doctor earns over $100 (about sh170,000) per hour. This translates to sh1.3m per day (eight hours), sh27m for 20 days and sh40m for 30 days.
http://www.newvision.co.ug/D/8/459/616900
In India,,both are different setups.....but both simultaneously may be seen in many times with well balanced life.but ,in my personal opinion,,the academic people and good scholars remains in public or govt services, whereas the persons with good commutation and already set up from heridity ,will do the private. Altimately money is also the prior importance thing regarding first investment and then earnings.
Regarding better for clinician in India ,its the private sector.....as previously there are the excellent people in government but the percentage is very much low now a days in my opinion.
Yes indeed dear Professor @Kamal, especially physicians can earn in private sector a lot of money that can not be compared to governmental positions.
Kamal Sir,,agreed with you fully sir,,,,i am not criticizing the knowledge or any other skills as, both are the brilliant people,but its the mentality and social responsibility which matters a lot beyond your needs in terms of money..... persons in private also serves the poor people,if they wish.thank you sir......
In US the conditions are different, from Individualism to Group working also in private. The structural shift is being driven partly by declining reimbursements for physicians from both government and private insurers. Doctors also are under pressure to make hefty new investments like adopting electronic medical records, or face penalties from the government. Those are among the same factors behind hospitals' serial acquisitions of doctors' practices.
"In this competitive environment and with falling reimbursements, there's just not enough margin for everyone in the health care landscape," said Kristine Mighion, president of HealthCon Corp., a Chicago-based health care consulting firm. "For physicians who want to retain their autonomy, combining together with other similarly aligned practices is the only real alternative to being purchased by a hospital."
Through such combinations, a larger group of doctors gains bargaining clout on several fronts, including negotiations with hospitals and insurers, as opposed to a two- or three-physician practice.
http://articles.chicagotribune.com/2012-12-05/business/ct-biz-1205-doctor-consolidation-20121205_1_three-physician-practice-large-doctors-government-and-private-insurers
Yes, it varies country to country. But in my country India, governmental Hospitals are better to practice as clinician as there are lot many patients visiting each day with lot many problems.Thanks
It all depends on the mentality and attitude of the physician. Service to humankind alone or service with hefty returns which normally does no good to anybody which can be realized very lately.
In our setting both private and public sectors are not mutually exclusive and any one can work in both and can complete each other
It is mandatory that one should follow the standard norms and practices as per WHO or as per their own country irrespective of private or government hospital. .
Does Private Practice Pay?
Most private practice in the UK is conducted by doctors who work for the NHS, and there is an increasing sense that the dividing lines between the NHS and independent practice are blurring and will become increasingly blurred, and that care quality standards set in the public sector must be carried through to the private sector, and vice versa.
http://www.aagbi.org/sites/default/files/June_1.pdf
Private for financial reward!
Public for professional reward!
Period!
Hypothetical question
As the conditions changes from place to place and country to country. Governmental agencies in developing countries really need young and energetic health care professionals like you as I see hundreds of patients suffering and striving for better care. Working and being a part of such agencies will give you self satisfaction and happiness for being a better part of health care system. Practice standard guidelines of therapy and implement as of private set up, YOU WILL BE THE BEST.
All the best
I feel a clinician has a choice to practice either in the private or public sector unless he does his work for which he has achieved his degree (ethically, selflessly, honestly, etc.). A clinician shoud be loyal and true to his work. He should always has a feeling of serving to people.
Dear Bhavesh Tiwari
I think clinician can serve poor people who truly need the service in the governmental sector
During the first period of the career is public (professional) after toward the private to improve the standard of living!
Yes, it follows Pros. and Cons approach. However, the principal definitive answer might underlie under the health system status of a particular country.
I think public hospitals are much better than the private sector for many reasons. I will consider the training part only. Public hospitals provide an internship services for the Medical registrar, house officers and even consultant. Also it provide a full scholarship in sub-specialties. Both these services are not presented in private sector. However, good payment for sure in Private sector.
personally, i prefer the governmental due to the stability in management (might be negative sometimes). the only concern for private hospitals is money! and this is will be on behalf of many employees
Dear Prof Ahmed Hassan Fahal
I agree with you
what do you think if some one fail to find job in the public sector
We can find a good doctor (humanistic and professional) in the both systems.The difference is in price.
The practice is best in the public sector as all says, the principles of safe and best practice can be applied easily and smoothly, but in private sector, i think there is a problem here !!
Dear Ahmed Abd Elrahman
I think some sectors have to be private e.g IVF and infertility mangement
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