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Jun 16
2010
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Running a medical Diagnostic centerPosted by: Dr. Sridhar V on Jun 16, 2010 Tagged in: Radiology practice , Diagnosis
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How easy or how difficult is to run a diagnostic center?? Any idea??
Everybody says that Radiologists are the luckiest among the Medical Profession and it is assumed by our Non radiologist friends that Radiologists make a lot of money without much sweat whether working for somebody or running own diagnostic center. .Nothing is far from the truth.
Some of the Radiologists as soon as they successfully complete their course may want to start independent diagnostic center.
The center can just have one Ultrasound machine initially with two receptionists and two helpers in the beginning
Not many problems initially faced by the radiologist and running of the center is a smooth affair.
Once the radiologist starts thinking of expansion either due to severe competition going on in the market or because of customers demanding... add on facilities…….. the problems start one by one.
So as the idea of starting a full fledged center crops up…. more and more machinery are added besides the Ultrasound machine.( the machines include, Digital xray,CT,MRI,,Complete lab equipments, Mammogram, PFT,EEG ,Nerve conduction test ,Endoscopy etc.)
Present day setting up of a diagnostic center is not as simple as one may think .Gone are the days when one was very comfortable by enjoying a decent profit...
Problems are staring at you from every corner.
Problems can arise from one of the two categories.
Category I
Problems can arise
- -from the Doctors you have employed.
- -From the staff members
- -From the patients
- -From the machinery you invested
- -From the owners of the premises if you happen to be a tenant
- -From the ref clinician
Category II
Problems can arise
- -from IT
- -from labour dept
- -from PF
- -from ESIC
- -from PNDT
- -from BARC
Let us limit our discussion to Category I
From the Doctors you are employing
You may employ radiologist, pathologist, Sonologist or endoscopist...
-it is a fact that you depend on them.
-Problems may arise from the
1. WRONG reporting…due to whatever reason.
Remember center and yourself are liable for all the omissions and commissions of the Doctors
2. The above doctors, if do not maintain their timing problems may arise in the delivery schedule
of the Reports.
In one instance, pt was asked to come by 7.00am for upper GI endoscopy, but the gastro man
Never turned up .Pt was furious because he was subjected to starvation and the center was sued.
Since the consultants belong to the same profession and you depend on them, you can not be
Harsh with them.
From the Staff Members
The problems due to the staff are mind boggling
Coming late
Bizarre excuses by the staff regarding coming late for the duty is in a standard format like
- -Faulty Alarm Clock
- -Bus late
- -It is raining no
- -Relative died
- -my child is sick etc.
Office Brawl... from Feuding employees
- -ego clashes among staff
- -Not able to adjust the shift timings
- -personal hatred
- -Jealousy
- -Superiority complex
Stealing
Unscrupulous staff may steal office items or may damage costly equipments.
Wasting time
Spending more time during lunch break indulging in gossip
Net result…. The image of the imaging center is in troubled waters.
From the Patients
Enough of this we have gone through in the blog and also in the forum topics.
http://www.iradix.in/482-Difficult-Patient.html
General nature
- -center is dirty
- -Staff are dirty
- -Delay in doing the scan
- -Reporting male pattern for female patients and vice versa
- -Technician is not competent etc etc
Specific in nature
- -Problems one has to face due to contrast reactions
- -pt getting caught in the Lift due to current failure for few minutes
- -Giddiness while doing TMT
- -Unconsciousness while blood is being withdrawn for lab tests
From the Machinery
Once the machines complete first year of their existence …they start behaving erratically due to strange and unknown reasons and manufactures breathing down on your neck for AMC etc etc costing not less that lacs of rupees, more so for CT and MRI draining totally the owner of the center.
All the owners know how hard it is to maintain these machines.
The less said is better about the promises and commitments offered by the manufacturers/suppliers at the time of selling the product.
From the owners of the Building.
If you happen to be a tenant, you are the unfortunate soul. Be prepared to face the periodic shocks from Rent Hiking which unfortunately you can not pass on to the customers.
From the Ref Clinicians
Greedy ref man may knock you down
So at the end what do you think?
Is it worth undergoing all the tensions at the cost of ones health?
Why the General impression that Radiologists mint money?
Average user rating from: 1 user(s)
Reviewed by Prashant Bhatt June 16, 2010
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Alok Varshney
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... Running a business is a simple matter of risk vs reward. If one strays from one's core competence (i.e. A radiologist adding non-radiological services to his business), one is foraying into risks associated with enterprise. One does it not because of goodness of one's heart, but it is the golden purse at the rainbow's end that motivates him to take that risk. After that it is a matter of providing the services at a price which earns a comfortable profit for the provider. If risk is too much or profit is too low, one can always pull out of that business. Every business has these problems, including the Tatas, Ambanis, Gates of this world. In fact the bigger one's business gets, the bigger the problems also get. Big business attracts a lot of sharks... |
Dr. Saneej Kanhirat
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... Hop you wrote these from your experience. The main problem is the hell lot of expenses which will come in a rally. The same burden cannot be put on patients, here in kerala the rate for ultrasound is still around 350 , mostly due to ill trained sonologists , who r ready to give cheap service. But we know the quality of their service. But patients get pseudosatisfaction. refering consultants are happy because they will make "some" diagnosis so that they can treat them for some time, placebo response... |
Vrajesh Majmundar
said:
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... For Radiologist owning medical center. Only good investment is sonography -color doppler. One can buy high end sonography unit and it is most profitable,easy to maintain without staff hedache. X ray based units like CR,CT are having all sorts of problem and real hedache for Radiologist owner. In MRI, if one is good in his subject, permenent magnet MRI has definitely less headche and more profitable. High end CT,MRI units- owner runs the show for supplying company, AMC, Bank , staff salary and in end owner gets left out money after all these expenses. Only those owner who has got very deep pocket, only shall venture in to CT,MRI area since it gives daily cash flow. |
Dr. Saneej Kanhirat
said:
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... Mr. Vrajesh, If we install a high end CT / MRI , We will have to get minimum patients right? This AMC and staff expences will create pressure? Permenant magnet MRI - AMC will be less?? But there will be limitations in imaging right?? |
Dr. Sridhar V
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... Many thanks to Dr.Alok Varshney,Dr. Saneej Kanhirat and Vrajesh Majmundar for sharing your views. Dr.Alok Varshney If risk is too much or profit is too low, one can always pull out of that business. After realizing that he/she is not able to do get reasonable returns....How Easy or Difficult it is for a Radiologist to pull out of the business after taking loan for high end CT / MRI and other costly equipment? Yes... still one can pull out of the business only after surrendering the collateral given to the bank as surety.( Then it is much easier to lead a platform life !!) Dr. Saneej Kanhirat I agree with you that ...whether it is patients or our own ref clnicians.. they or not bothered about quality / the annual recurring expenses in the form of maintenance. All that they expect....minimum charges from patient point of view and maximum cuts from ref clinician point of view. If this is the situation how to manage the show ? Who cares for quality in India ie our beloved Bharat ? Now the business dharma is.... You have to offer 'Three underwear' free' if you want to sell one 'Underwear'.if you subscribe to this policy you are fit to do business. Vrajesh Majmundar I fully endorse your view and feel that if at all a radiologist thinks of starting own business... (I also advice him/her) just to stick to one good quality USG machine and make good profits rather than going into expansion mode at a later stage. Not only they can maintain robust health..they can also enjoy their full life. |
Dr. Saneej Kanhirat
said:
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... Dear Sridhar, By sticking only to Ultrasound , as you told its easy to make profit and lead a good life. But in the inner mind of every radiologist , there will be a dissatisfaction of being sidelined only with ultrasound. Then the thought of CT/ MRI arises. Its sure that most of the indians doesn't mind quality. They look for cheap service. When there is a half cooked sonologist nearby giving cheap service, a well trained radiologist may be an expensive doctor for a common patient. To generate cases for CT & MRI one has to bow his spine in front of Ref clinicians.... Because to run a centre daily with CT/MRI is expensive,. What about investing by non doctors/ other ref doctors who are willing to invest, And the radiologist getting salary + certain percentage of profit share? Administrative headaches will be shared. No headache for a bank EMI. But it will be like a LTD Co. few people investing. Because Bank loan is a big Damocles Sword |
Dr. Sham Sunder Goyal
said:
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... After First year of warranty, The honeymoon ends and the bitterness of the married life begins in the form of "AMC". You are not willing to shell our Rs One lac per month just for labor AMC and the Parts if damaged will be extra. After three to Four years there is Technology change and you again need to invest again. This is the major Headache. In Ludhiana 3 well Running MRI Centers have closed their shop and they are heading towards CANADA. I feel something is seriously bad in the profession that Radiologists are taking such step. |
Dr. Saneej Kanhirat
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... Dear Dr syam sundar Goyal sir, Its a bitter fact.... Here in trivandrum also one multislice CT centre is going to shift.... AMC demand from companies are really big.... one has to go through unfair means to generate patients to make his centre a success... which is not good..... |
Dr. Anuj Mishra
said:
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... Starting a business is easy, but running it successfully is an 'art'. Have a 'vision' for your venture. Don't just start-off as a small 'shop' with no long-term goals. Any business would depend on 3 P's - people, product, profits. One must invest wisely in the workers who are loyal and hard-working. Thereafter, focus on your medical reports. it does not matter if you are not an expert in MRI or CT scan. If you have the resources, you can hire the best radiologist. Remember, its always the teamwork that pays. A 'good' chef uses same ingredients as everyone else, but cooks with 'passion', that sets him apart from the crowd. So whatever you do, just do it with 'passion' and zeal. And also remember, do not run after money. Just do your job to the best of your capabilities, and the money will run after you. |
Dr. Saneej Kanhirat
said:
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... Dear Dr Anuj Misra What you mentioned is right. But The "people" in 3 "P"s is the most difficult one to get. To get loyal and hard working staffs is really a luck.. Really Long term goals will work, in any Business... |
Dr. Anuj Mishra
said:
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... Very well said Dr. Saneej..... 'Vision' is of utmost importance before starting any business. No business can be successful if run without proper short terma and long term goals to fulfil that 'vision'. All the best!!! |
Dr. Saneej Kanhirat
said:
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... For a medical diagnostic center permanent magnet MRI is better right??! considering running cost & AMC as well as huge initial investment. We have shortlisted siemens 0.35T and SANRAD MDT xstar 0.45 T . Anyone has opinion which is better? Also in Dual slice CT machines GE / Siemens scores good? |
unknown
said:
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... quiet interesting article. But please focus on the Category II of the problems as well and inform what to do in 2 cases: For problems arising from PNDT tests - (a) what if the display board per section 4(2) of the PNDT act is not present on the premises and (b) what if the radiologist is falsely implicated in a crime by other rival medical professionals by alleging that the radiologist has been determination sex of the foetus? - regards, an unknown person (do not want to be identified) |
Dr. Mohit Rai
said:
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... it is a interesting topic. A goood business man should have following qualities 1. capable of selling product & in our case to clinition. If he refers then only u will get the case. 2 cleverly u should be able to tell lies & be able to convince every body around that u are the best. 3 be dishonest. Do not fool yourself by practising honesty.When we are giving the cuts we should not give sermons regarding honesty.Actually the profession has become so cheap that some of radiologists are giving cuts to paramedics , chemists & dais in the villages. If u want to save yourself skin never ever talk of honesty in marriage functions etc. I know most of us may not be able to generate these traits in them so they have to assess them selves accordingly. However if u can not stoop to such a level & are not mad about money we can do a few things in our life---------- 1..never do sex determination.u will be peaceful at the end of the day. 2..never criticise any doctor u will have minimum enemies .Let every one live life in his or her style.U have to be responsible for your actions & they will face their own. 3... do not entertain every one ( Tom Dick & Harry) for a few cases.You will be able to maintain the dignity of your centre.Tell them that we do not give cuts & SINCE U HAVE SENT THE case we appreciate your overture.And in future your near & dear will be entertained preferentially May be at subsidised rates. 4... Keep discussing the cases with clinition so that no confusion arises in the relations. 5.... do not give more cuts than what others are giving so that clinitions are not able to play games. 6.... these things can be put into practise only when radiologists unite. But that is difficult since from our college days we see our professors critising each other . So the life of orthopedic or gynaec is relatively easier in these fields ( though their lives are also difficult in some aspects) regards & good luck Dr Mohit |
Dr. Sridhar V
said:
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... Thank you so much Mr.Unknown and Dr.Mohit Rai for your feedback Ref.Mr.Unknown 1. If the Display Board ...ref section 4 (2)is not present in the premise in English and in local Language the penalty is as follows. Case may be launched in the court of JMIC u/s 25 of the Act,Punishment may extend to 3 months or with fine,which may extend to Rs.1000/- for the first offense.Additional fine up to Rs.500/- per day for the period of contravention for the subsequent offense. or Show cause notice u/s20(1).(2) for temporary suspension of registration. or suo moto action u/s 20(3) and suspend the registration without issuing show cause notice. 2.Ref the 2 nd situation. It is really sad the one is implicated for no fault.However the onus is on the radiologist to prove that he has been falsely implicated. In this situation the radiologist has to help himself with the records available that he has not committed the offense. Remember all the offenses under the PNDT act are Cognizable,Non bailable and non Compoundable.In other words a Simple ' No escape ' Ref.Dr. Mohit Rai Your observations can be grouped into 1.Practical advice and 2.Philosophical advice. Your practical advice is for a short term gain at ones peril. Your philosophical advice is for life long gain. As you have suggested ...it is wise to leave the choice to the individual decision. Thank you once again for your worthy advice. Non unity among the radiologists is their birth right, which you very well reinforced in your 6 th point. |
dr archana
said:
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... can any one guide about starting a new ct scan centre, where to get permission, and whether registration is required, man |
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