Private Practitioner’s Forum: Our Expectations & Our Responsibilities

Dr. Milind Pol
President, MSCISA
State coordinator for PPF

Dear friends,

Private Practitioner’s Forum (PPF), is getting en-rooted throughout India. This newly launched forum is committed towards making amicable solutions to each & every problem faced by Private Practitioner in Anaesthesiology.

The need of PPF was in discussion since years at National ISA level. This need arose after seeing the poor participation of private practitioners at ISACON, the National Conference of ISA.

A separate forum is demanded to raise the issues of Private Practitioners, as, though majority of Anaesthesiologists are private practitioners, it is felt that the problems of private practitioners are neglected.

Hence a Private Practitioners Forum is formed by ISA in 2017. Then after, PPF is working as a branch of ISA like IRC. National coordinators Dr. Virendra Sharma (Hon.Treasurer, ISA) & Dr. Pankaj Gupta along with State coordinators from all state chapters & city branch coordinators are working in streamlining the private practice in Anaesthesiology, pan India.

In 2018,PPF has come up with Guidelines of PPF, which were endorsed in Agra GBM. These guidelines are derived specifically considering the infrastructure in OTs, ways of Private Practice & the remuneration.

So, let us first discuss the guidelines in short.

1. It states about minimum monitoring standards in OT.
2. It states about Documentation.
3. It states about participation of private practitioners in city branch activities, state chapter & different conferences.
4. It states about RVG (Relative Value Guide), an easy tool to calculate the remuneration, an Anaesthesiologist should get for a particular case.

 All these guidelines are available on our website www.isaweb.in, in the PPF section. Readers, please go through these guidelines for details.

Now, what are our expectations from PPF?

• We want PPF to make efforts to increase our remuneration.
• We want our association,to protect us from medicolegal cases.
• We want PPF to fight for making our OT environment, more stress free.
• We don’t want to work for our association, but we want us to be recognized.
• We oppose our colleagues to take decisions for our association, but still we want our association to function smooth!
• We don’t appreciate what our association is doing for us, but we easily say, our association doesn’t do anything for us.
• We want…..We want……We want……………
• The list is endless!

Now, let us see, what PPF is doing?

As already stated, PPF has given RVG to calculate the exact remuneration to be taken for a particular case, taking into account, nature of surgery, time required & risk involved.

ISA has tied up with ICICI Lombard for professional indemnity for it’s members. In this, medicolegal assistance is also provided through a panel of Anaesthesiologists.

PPF has given minimum monitoring standards for OTs, which will definitely reduce your stress if implemented.

Documentation will make you safe.

CMEs are been arranged on PPF, the participation of private practitioners as faculty in conferences, is been looked for. Separate session of PPF, meeting of PPF is being organized in conferences.

In all, PPF is on right path, only thing is lacking, is our responsibilities as member of PPF.

What are our Responsibilities?

All over India, more than 70 per cent members of ISA, are private practitioners. In Maharashtra state, this goes upto 80%.

In total around 4500 members, 4000 members are private practitioners. This is a huge number. Many branches of MSCISA contain only private practitioners. Hence, Maharashtra has wide scope to spread PPF, at the same time, chances of failure in implementing certain guidelines of PPF, should be kept in mind. Because, the more number, means the more difference in thinking & the more number of defaulters of implementation.

At present, the base work of PPF is being done at all branches, but individual contribution is lacking. Everyone is aware of the theory of PPF, but members are not interested in going for practical.

The basic thought behind this is “PPF should do these things for us”.

Previously, it used to be “Somebody should do it for us”. After introduction of PPF, somebody is replaced by PPF.

Let me ask you one question. Who is this Somebody?

Somebody is nobody other than myself.

If we don’t think this, then nobody will help us. All these things are for betterment of my anaesthesia practice. Unless we imbibe this thought in our mind, PPF will not flourish. Every one of us has to follow the guidelines given by PPF, in order to increase safety of patient as well as Anaesthesiologist.

Now, we can summarize our responsibilities as:

1. We should implement the minimum monitoring standards in our OTs. This may be a collective movement through city branch or individual responsibility.

Thanks to NABH! Many of smaller set ups are also getting the entry level NABH accreditation, which makes Multipara monitors, Defibrillator, Boyle’s machine, compulsory in OT.

Many of these hospitals are also upgrading to Anaesthesia workstations, a positive change towards safety of patient!

In Ahmednagar, more than 25 set ups have installed workstations in last 2 years. Every OT is having Multipara monitor.

• We must keep records through documentation. Again thanks to NABH! In NABH, utmost importance is given to documentation.

It includes Consent for Anaesthesia, Pre Anaesthesia evaluation, Surgical safety checklist, Intraoperative monitoring including documentation of technique of anaesthesia, intraoperative complications, Recovery from anaesthesia as modified Aldreit scoring, post-operative monitoring.

Registers about the usage of scheduled drugs like Ketamine, opioids has to be maintained.

Blood transfusion form has to be filled.

All these documents are for our medicolegal safety. If we document every single incidence during the course of Anaesthesia, it will definitely help in Data collection & research.

• We must have sufficient professional indemnity on our name.
• We must help our colleagues during emergency situations.
• We must abide by the decisions taken by our city branch, state chapter & ISA National.
• Even if we don’t take active role in our city branch as office bearer, it’s our moral duty to be present for the monthly meeting, CME, Workshops, Conferences.

These events are specifically arranged for academics as well as to increase rapport between the members. The faculties, who have come to deliver lectures, have sacrificed their precious time & taken a lot of efforts in preparing lecture for us. If the attendance is poor, definitely, the faculty feels really bad.

See, we can take the horse to water but it’s up to the horse, whether to drink the water or not!

Also, activities like COLS are helpful in building our image in society.

If we follow these responsibilities, which are shouldered on us as individual Anaesthesiologist, I think, we will definitely have some say when we put forth RVG.

Our success in implementing RVG mostly depends on our own behaviour as Anaesthesiologist in hospital premises.

Hence, be responsible & committed towards safety of both Patient & Our self!

Tomorrow is definitely promising.

Long live ISA!