Why look for alternative means of earning to compensate for subsidy provided in consultation fee Many doctors claim that they charge only Rs100 or 200 as consultation fee. Can they survive with this subsidy? Probably not… So, they try to find some alternative sources of income. Some of them may be ethical and some unethical. Medicine is regarded as the most noble of all professions. And, a doctor is accorded a status next to God. Hence, a doctor is duty bound to practice ethical medicine, which also includes ethical earning. We are professionals… we have a professional degree, which gives us a privilege to practice medicine … we are registered with a professional regulatory body … we follow a Code of Ethics as prescribed by the council. Our privileges to practice can be withdrawn in case of breach of the ethical code. We are also required to charge a legitimate and ethical professional fee for consultation or for skilled procedures. To earn ethically, it is important to understand the economics of a consultation. A consultation charge is not the fee for consultation alone. It also includes non treatment costs in addition to professional charges for services provided such as consultation, diagnostic/therapeutic procedure and interpretation of X-ray/lab reports. The billing process begins right at the time when the patient arrives at your clinic or hospital, with registration charges. Patient may also be billed for facilities provided in the clinic or hospital. Charges for making patient summary, charges for the assistant/nursing staff/paramedical staff, charges for drugs and materials used, issuing a certificate, point of care investigations with no subsidy, dispensing medicines with no subsidy, Administrative charges, charges for utility services etc. are other heads under which the patient can be charged. Accepting rebates and commission from diagnostic centers/laboratories and hospitals or fee splitting without involving any service for the referring, recommending or procuring of any patient is unethical. And, any income generated out of such practices is unethical earning. So, why not earn lawfully and ethically instead of trying to create income from illegal and unethical practices, which only corrodes the trust in a doctor-patient relationship. Why give subsidy in the fee charged and at the same time, try to make up the deficit by other means, which may be unethical? If it is not possible to survive on a fee of Rs 200/- per patient, let us try to change it nationally and come out with a valid sustainable fee. Remember, even in temples, the charges for darshan and aarti differ depending on the time of the darshan/aarti or the type of pooja offered. Let us all charge our legitimate fee and pass on the benefits of concessions on diagnostics etc. to the patients. Keep in mind the following: • I have a right to charge rationally for my fee. • I have a right to charge for every consultation, even the same day. • I have a right to charge extra for emergency appointments, same day appointments and routine appointments. • I have a right to charge extra for night visits. • I have a right to charge extra for long consultations. • I have a right to charge for accompanying a patient for diagnostics. • I have a right to charge for briefing my senior specialist. • I have a right to charge for visiting my patients when they are admitted in a hospital under a specialist. • I have a right to charge for legal certificates. • I have a right to charge for telephonic consultation. • I have a right to charge for reviewing reports. • I have a right to charge for only giving opinions on reports.