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COMMENTARY
Year : 2022  |  Volume : 66  |  Issue : 2  |  Page : 226-229  

The Honorable “Honorary system” in teaching/university public hospitals - An ideal blend of academics and prosperity for the medical professional


1 Sr. Consultant Neurosurgeon; The Neuro Health Foundation Clinic; Sr. Consultant, Department of Neurosurgery, HCG and Navneet Hi Tech Hospitals, Mumbai, Maharashtra, India
2 Research Assistant, The Neuro Health Foundation Clinic, Mumbai, Maharashtra; Resident Doctor, Department of Neurosurgery, Narayana Hrudayalaya, Bengaluru, Karnataka, India

Date of Submission20-Sep-2021
Date of Decision07-Dec-2021
Date of Acceptance09-Dec-2021
Date of Web Publication12-Jul-2022

Correspondence Address:
Mrudul Mohinish Bhatjiwale
The Neuro Health Foundation Clinic, 006, D-31, Yogi Nagar, Borivali West, Mumbai - 400 091, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijph.ijph_1817_21

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   Abstract 


The options available for a specialist in India today can be broadly divided into joining a public teaching institution in the capacity of lecturer or higher, freelancing, and taking up a full-time corporate position. Whereas public teaching institutions have an abundance of academics, skill and mastery development potential, corporate positions and freelancing offer better monetary stability. From an ideal blend of both systems, stems the honorary system. This article elaborates on and exemplifies the same with several doyens who have been involved, and have been a product of the honorable “honorary system.”

Keywords: Academic, healthcare, honorary, public hospital


How to cite this article:
Bhatjiwale MG, Bhatjiwale MM. The Honorable “Honorary system” in teaching/university public hospitals - An ideal blend of academics and prosperity for the medical professional. Indian J Public Health 2022;66:226-9

How to cite this URL:
Bhatjiwale MG, Bhatjiwale MM. The Honorable “Honorary system” in teaching/university public hospitals - An ideal blend of academics and prosperity for the medical professional. Indian J Public Health [serial online] 2022 [cited 2022 Aug 16];66:226-9. Available from: https://www.ijph.in/text.asp?2022/66/2/226/350662



Instilling quality care in public hospitals uniformly across a vast democratic nation like India is a daunting task. Partnering with the private sector carries the potential for meaningful benefits, including reduced government spending with better health-care management.[1] The “honorary consultant system” is an arrangement where qualified well-trained professionals are recruited by a teaching university public hospital and paid a small honorarium for their clinical services. The success of this system, when operational earlier in Mumbai, largely depended on an adequate number of consultants being recruited to share the workload, long-term secure appointments, and an unrestricted atmosphere that encouraged clinical, operative, and academic contribution within the framework of reasonable regulations and ethics. The benefits as history showed over five decades (between 1930 and 1980) in Mumbai teaching hospitals were astounding.

To name a few, Dr. A. Baliga, Dr. R. Cooper, Dr. N. Purandare, Dr. B. Purandare,[2] Dr. R. Soonawala, Dr. E. Bharucha,[3] Dr. Noshir Wadia, Dr. Tehemton Udwadia, Dr. Farokh Udwadia, Dr. K. Datey, Dr. Kuldeep Goleria,[4] Dr. V. Athavale, Dr. P. Udani, Dr. G Phadke,[5] Dr. Umesh Vengsarkar,[6] all stellar luminaries who did pioneering work in their respective fields. Many of them went on to create national societies which would streamline development and guide generations of doctors. Dr. Ravin Thatte, Dr. S. Bhandarkar, Dr. S. Bhagwati,[7] Dr. B. Singhal, Dr. P. Ramani, Dr. Pravina Shah, Dr. M. Kirtane, Dr. Ashok Johari and more, have been benefactors, contributors, and beneficiaries of the system in recent times [Figure 1].
Figure 1: A few of the earlier generations of honorary luminaries: Top row (L to R): Dr. A. V. Baliga (Surgery), Dr. Rustom Cooper (Surgery), Dr. B. N. Purandare (Gynaecology), Dr. Eddie Bharucha (Neurology). Middle row (L to R): Dr. R. P. Soonawala (Gynaecology), Dr. Noshir Wadia (Neurology), Dr. Tehemton Udwadia (Surgery), Dr. Farokh Udwadia (Medicine). Bottom row (L to R): Dr. K. K. Datey (Cardiology), Dr. G. M. Phadke (Urology), Dr. Kuldeep Goleria (Craniofacial Surgery), Dr. Umesh Vengsarkar (Neurosurgery).

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The honorary system continued for well over five decades and scores of pioneering doctors developed, nurtured, and inspired younger talent along with professional progress of their own. The enormous number of patients in these public teaching units led to skill enhancement and an opportunity to use these skills in private practice ensured great name, fame, and prosperity. In return, the professionalism groomed in private practice was brought to public hospitals and improved the discipline and ethos of work in these institutions. Public funds were never burdened by the small number of honorariums paid and these funds could be re-routed to upgrade technology and newer public hospital projects. The creation of more government-funded teaching units in semi-urban and district locales would ensure a healthy distribution of specialists across towns and districts. The burden of a heavy public unit can also be lightened by recruiting a greater number of honorary consultants [Figure 2].
Figure 2: A few of the notable honoraries in recent times: Top row (L to R): Dr. S. N. Bhagwati (Neurosurgery), Dr. S. D. Bhandarkar (Endocrinology), Dr. Ravin Thatte (Plastic Surgery), Dr. P. S. Ramani (Spine Surgery). Bottom row (L to R): Dr. B. S. Singhal (Neurology), Dr. Pravina Shah (Neurology), Dr. Milind Kirtane (Cochlear Implants & Endoscopic Skull Base Surgery), Dr. Ashok Johari (Pediatric Orthopedics).

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The modern surgeon/physician postqualification, many-a-times finds himself or herself in a dilemma between a full-time salaried job in a government academic teaching institute, a freelancing private practice, or a job in a corporate hospital, an increasingly common option in recent years. Each option has a positive attractive facet and another not so pleasing one. The government postpromises immense clinical opportunity but with a cap on financial gains whereas a freelancing surgeon/physician has ample monetary prospects but loses out on skill development and academics. The corporate job though ensures sufficient remuneration, with some academics and skill development more on the technology front, is yet no match for the opportunities available in a teaching public hospital. None of the current options, therefore, give the budding specialist an advantage of both skill-academics and prosperity, which are both necessary for the complete fulfillment of a professional career.

Hybrid systems that allow full-time government surgeons/physicians to have a private practice beyond duty hours cause professional fatigue, lessen the family time, and are of no real help to the public health budget. Dr. Sunil Pandya envisaged in 2006 that such a system would make students, both undergraduate and postgraduate, and patients alike, suffer as a consequence.[8]

Prof Tehemton Udwadia, a doyen in the field of laparoscopic surgery says he is all for the “honorary system” if it functions as it did (Udwadia T, Personal Communication, May 22, 2021). He notes that to differentiate the grain from the chaff, the selection process should ensure professional excellence, love for teaching, and ethical standards. He further cites the example of Prof P. K. Sen and his first heart transplant team alluding to the importance of having a full-time 'Head of Department' to maintain departmental discipline and drive training and research.

The “honorary system” hence must be revisited, its pros strengthened and cons corrected. Its reintroduction must be in a staged manner and in consideration of current trends of public and private medical practice. To believe that it was a generation of its kind and cannot be revived is to undermine the potential of human genius and its great heart. Is the honorary system then a jewel lost in the administrative quagmire of public healthcare, waiting to be rediscovered? [Table 1].
Table 1: Achievements of some of the luminaries of the “honorary system” in public teaching hospitals

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Acknowledgments

We are sincerely grateful to Prof. Tehemton Udwadia, Prof. Pravina Shah, and Dr. Priyam Bhatjiwale for their help in making the manuscript.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Nikolic Irina A, Harald M. Public-Private Partnerships and Collaboration in the Health Sector: An Overview with Case Studies from Recent European Experience. HNP Discussion paper series;. World Bank, Washington, DC. © World Bank. https://openknowledge.worldbank.org/handle/10986/13684 License: CC BY 3.0 IGO. 2006.  Back to cited text no. 1
    
2.
Purandare CN, Patel M, Geetha B. Indian contribution to obstetrics and gynaecology. J Obstet Gynaecol India 2012;62:3-4.  Back to cited text no. 2
    
3.
Shah P, Seshia S. Dr. Eddie P. Bharucha (December 28, 1916 – December 14, 2017). Ann Indian Acad Neurol 2018;21:91-2.  Back to cited text no. 3
    
4.
Puri V. Dr. Kuldeep Singh Goleria: A true karma yogi. Indian J Plast Surg 2017;50:228-9.  Back to cited text no. 4
[PUBMED]  [Full text]  
5.
Patel A. Dr. G. M. Phadke: The first president of the association of genitourologic surgeons. Indian J Urol 2008;24:2-3.  Back to cited text no. 5
    
6.
Muzumdar D. Professor Umesh Sawalaram Vengsarkar – A genius neurosurgeon (27th September, 1934 – 5th July, 2016). Neurol India 2016;64:1422-24 [doi: 10.4103/0028-3886.193775].  Back to cited text no. 6
    
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Deopujari CE. Neurosurgery at the Bombay hospital. Neurol India 2017;65:600-6.  Back to cited text no. 7
[PUBMED]  [Full text]  
8.
Pandya SK. Where is medical practice in India heading? Mens Sana Monogr 2006;4:50-61.  Back to cited text no. 8
[PUBMED]  [Full text]  


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