The 15% growth, acquisitions, and investments from key investors are certainly appreciated. But we seem to be missing something, which is a crucial point. A hospital’s operations focus around two major components — doctors and infrastructure. While investments in infrastructure are important, as they lead to improved facilities, growth, more growth, etc., we may face a critical shortage of medical manpower in India. This creates a vicious cycle. 

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In the past, people with a fire in the belly for medicine would come as doctors, and an MBBS degree was sufficient for that. This was the scenario about 30 years ago. Later, with multiple factors — the increased complexity of diseases and healthcare services, as well as the rise in patient numbers — the demand for specialized care has grown significantly. Patients now require more than just basic consultations; they often undergo extensive health check-ups, and the healthcare system must cope with this rising demand.

 

The availability of doctors is extremely limited. In cities like Kochi, we have seven major hospitals and about 20–22 smaller ones. The challenge is not just about infrastructure but about whether the market is ready to absorb more doctors and staff. The shortage extends to other healthcare professionals like nurses, as well as other staff too. Government institutions are not adequately addressing the problem, partly due to limited beds and resources. 

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The introduction of exams like NEET has led to students from various regions coming to kerala for education, which in turn introduces cultural and language barriers. The government has not provided viable solutions to these issues. 

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In this context, pumping more money into the system only increases the demand for the already limited community of healthcare professionals. For instance, if a doctor is already established and has a patient base, the influx of money will simply chase that doctor. The concentration of wealth in different segments of the healthcare industry creates the perception that more investment will yield higher returns. However, this is a two-sided issue. 

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The more money we inject into healthcare, the more inflationary pressures we create. Many are investing in healthcare because of its growth potential, but this is not a sustainable solution. The return on investment (ROI) may not meet expectations very fast, and eventually, the rising cost of healthcare will make it less affordable for many. This could lead to unintended consequences, with the current situation resembling a bubble. In the long run, I believe this is going to generate a positive impact. 

The paradigm shift in healthcare must be improved not only by investing in hospitals. The basic infrastructure must be increased, and the number of seats for doctors and medical colleges must be increased. There have to be more medical colleges, and this must be a straight policy taken by the government, where these medical colleges must have more facilities. 

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Instead of investing in private hospitals, if the government looks into the public healthcare domain, we can achieve standardized infrastructural growth. Again, this will be on a social basis. The investment will lead to significant results. So, the problem is that the people who really want to invest in healthcare must get returns also. The horizon we are looking for is a different game. 

For example, BMH is taken care of by KKR. Now KKR is infusing ₹1200 crore into it. If we are infusing ₹1200 crore, there must be a greenfield project, not a brownfield one. Slowly, a peripheral hospital under the brand width of one big brand. Now, the rate can be standardized, and the penetration of insurance would be very high. Insurance is becoming a commanding business now. 

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So, two things are going to happen. First is the basic infrastructure for bringing in clinical manpower, which is very important, and second is the insurance mentality of taking coverage. After post-COVID, there have been lots of changes in people’s outlook. Health insurance also must be standardized for all. It cannot be like anybody goes and does whatever they like. 

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Currently, what we are facing in Kerala and Tamil Nadu is very simple — wherever there is money, people go and take it. The doctors are getting rich day by day rather than the hospitals or infrastructure. There is no platform-level growth happening. If we look at the medical college facility and seats, they are the same. The NEET is a crucial part here. 

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If a person comes from Assam and studies in Kerala, he doesn’t know the language or territorial diseases — kind of geographical aspects — so whatever he studies may not be true when he goes back home. Now we see a lot of demand for PG, and the demand for specialization is also very high. This must be monitored, and people want more specializations, equipment aspects, etc. We need to track these kinds of things. 

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Yes, the better hospitals with bigger size will become bigger and stronger, and they will start commanding the market share. But unfortunately, this is not going to end the demand-supply gap. Because if we look at Kerala — for every 1000 people, we have 2 doctors, but if we go out, there is only 1.7 doctors per 1000 beds. That’s the average statistic. 

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Places like MP, Assam, and Odisha also contribute a major part to healthcare. When coming to the southern part, the south is a little better than the north, but more input of money is not going to generate more business — that’s what I feel. 

Talking about care delivery — care delivery is understanding disease and treating the disease. Now, most of the students who came out of colleges or with an MBBS, their colleges’ basic infrastructure is not right, their seats are very limited, and their exposure is also limited. The number of cases seen by these doctors, who are supposed to be called professionals, is not very comforting. They do not know how much time to spend with patients, or what aspects to look at. They diagnose without proper CT support, any kind of lab support, etc. — the reasons and causes of disease and the root cause. 

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Now, it has become more of a business — how many medicines and prescriptions you are writing, how many lab tests you are ordering, how many scans you are employing, how many investigations you are doing, etc. Even in understanding the process, we don’t have proper radiologists. 

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The best example is that in hospitals in Kerala, Andhra, and Tamil Nadu, the problem is that we don’t have 24×7 radiology services. So, there will be a lot of misdiagnosis and mistreatment, which is commonly seen in the northern part because the doctors are not trained properly, have less expertise, and have not seen enough patients. The sample size is very small, so when a doctor comes out, they don’t understand what they need to do. 

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So, for care delivery, we must go back to the previous system. Again, the basic infrastructure and the number of seats in existing colleges need to be increased. Instead of creating more colleges, the number of seats in existing colleges has to be increased so that students will get a “touch and feel” factor for how many patients they will see. 

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For example, in Calicut Medical College, the seats are very limited, but the inflow of patients is very high, and beds are limited. So, the government must either borrow or find investors to invest in the public health system so that they can build bigger infrastructure and better facilities. This will improve the care delivery system. 

The same applies to nursing. Now people don’t know how to administer IV, they don’t know how to put a lead in, or they don’t know what diagnosis is going to happen. Basically, the old nurses were like half doctors. Now, the situation is not very good. BSc nursing candidates have significantly decreased. Moreover, in India, private hospitals are offering higher salaries than government ones, making it difficult for the public sector to admit and accommodate people. 

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So, basically, we will have one BSc nurse, and under her, there are ANMs who are not trained to manage diagnoses and interventions. This will create a care delivery system with inappropriate aspects as well. 

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Changes in the life of healthcare employees? I really doubt it. Yes, there might be a lot of change in the lives of professional healthcare employees — that is, basically doctors. Because when you have a good patient base, and you are a well-renowned doctor, and people are coming to you, demand is higher, and your cost will also be higher. 

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So ultimately, what happens is — if I am a doctor and I am charging around ₹10 lakhs a month as a retainer, it is not going to be free of cost. It will be chargeable, and the patient has to pay for it. So, it is not going to generate any high impact, and the opportunity that is going to be generated in a hospital is also low. 

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In a big hospital, unlike other service industries, this is a manpower-run organization. Whenever you talk about cost reduction, every CEO or CXO looks at reducing the number of people working. That is not the kind of output we need to have. We need to employ more people because service delivery must be the primary importance in both small and large hospitals. 

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Now, the success of Aster MIMS Hospital is very basic — there are more people to give care to patients and do what is needed. The moment we come to a bigger hospital, the first thing that comes to our mind is that we are intimidated by the size of the hospital, and we don’t know where to go or whom to talk to. There must be people who come and help patients understand what is.