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Dr Shah's Prescriptions for Better Health Care Systems

Madona Devasahayam in Washington DC

Dr Navin Shah knows where he is going. Some of his peers think he is too idealistic while some say he is too outspoken. But few would doubt his commitment to fellow Indian doctors and the medical establishment in India.

"Navin has always wanted to give back something to the community," says Dr. Sudhir Parikh, another influential Indian American doctor. "He is passionate about his concerns."

A Maryland-based urologist, Shah has taken up three causes as his life's mission -- safeguarding the rights and privileges of international doctors in the United States, spreading awareness of Indian culture in the United States and doing his part in improving the medical system in India.

When he came to the United States in 1971, little did he realize that he would stay so long and nurture and grow a force of American Indian doctors in the form of the American Association of Physicians from India.

A former president and present trustee of the AAPI, Shah was also instrumental in forming the International Medical Graduates Association. The main objective of this association is to encourage the IMGs (or foreign doctors) to get involved in fighting discrimination against them. Shah, who was honored recently for his services as the chairman of Prince George's County Medical Society's Peer Review Committee, has been lobbying relentlessly on the Capitol Hill for the introduction of anti-discrimination bills.

There are about 600,000 doctors in the United States, of which 165,000 (including 26,000 from India) are foreign doctors. By the year 2002, with severe cost cutting programs in place, there will be a surplus of 160,000 doctors, as managed care organizations will cover over 80 per cent of the population.

There is a widespread perception that with the reduction of federal and state funds for health programs, the managed care agencies will want to hire fewer doctors -- and the agency could arbitrarily dump foreign-born and foreign-educated doctors, however competent they are.

"These are tough times ahead for a foreign doctor because if the managed care companies don't give the doctor a contract, he doesn't stand a chance," Shah says. He adds that currently 4,000 foreign medical graduates are being absorbed by the industry but by the year 2002, the number will drop by 50 per cent. There should be a due process in selection or rejection of doctors by the managed health care providers, Shah has been advocating. He is lobbying for these changes with like-minded doctors and associations such as the AAPI.

Shah also continues to work on three proposals to improve the Indian medical system. This has been his passion for over two decades. Every year he goes to India, contacts government officials and hospital administrators to convince them to overhaul India's medical establishment.

First is the introduction of continuing medical education among Indian doctors. "Continuing medical education is the cornerstone of the American medical system. The government (of India) has accepted in principle the introduction of continuing medical education under which the doctor is required to complete 150 hours of education over five years to get his license renewed," says Shah. The medical education will be provided by AAPI teams sent to India, medical organizations in India and leading medical schools. The proposal will be implemented at the state level, the officials have told him, he says.

The second proposal is to put in place a system of documenting medical records in hospitals. "I have seen substandard care in India. There are no discharge summaries available. There is a need to make it compulsory," he says.

The third proposal is to have a mortality/morbidity peer review conducted in hospitals. Documentation is needed in this area to monitor improvements and changes, he says.

"Hospital management in India is in poor shape. There is no prompt and appropriate care and review of records."

Shah is going to India in November to follow up on the three proposals. The proposals, which were examined by a parliamentary committee attached to the health ministry, have been approved in principle by the government. The government has asked the Indian Medical Council, the registering authority, to work out the modalities for re-registration of doctors.

The three systems Shah has in mind have already been implemented in the Hinduja Hospital in Bombay where he is a consultant. A $2-million project was started last June in collaboration with the Johns Hopkins University. Called the Hinduja Institute of Hospital Management, the institute located in Hyderabad has faculty partly drawn from Johns Hopkins and funds from the Hinduja Foundation.

The AAPI is also involved in updating medical infrastructure and equipment in India, besides organizing seminars in India.

"India does not have the money to buy the latest equipment. When Narasimha Rao was the prime minister, we put in place a scheme of donating free medical equipment. The aim was to provide new and used medical equipment to medical schools and hospitals to enhance both education of physicians and care of patients," Shah says.

Shah has also labored for his alma mater. He led a fund-raiser among the alumni settled in the United States for B J Medical College in Pune. The funds raised (about $100,0000) went to modernize the college library. "When I saw the library in a shambles, I decided to do something. Libraries are the soul of any institution," he says. "I want to encourage people to do more."

Shah strongly believes in the potential of the 26,000 Indian American doctors here and their ability to help their home country. "But of the 26,000, not even 10 per cent are involved in doing something for their college or alma mater. I am looking at young American Indian medical graduates...they can do for India and keep up the quality of medicine there," he says.

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