The impacts of corporatisation of healthcare on medical practice and professionals in Maharashtra, India

A heterogeneous private sector dominates healthcare provision in many middle-income countries. In India the contemporary period has seen this sector undergo corporatisation processes characterised by emergence of large private hospitals and the takeover of medium-sized and charitable hospitals by corporate entities. Little is known about the operations of these private providers and the effects on healthcare professions as employment shifts from practitioner-owned small and medium hospitals to larger corporate settings. This article uses data from a mixed-methods study in two large cities in Maharashtra, India, to consider the implications of these contemporary changes for the medical profession. Data were collected from semi-structured interviews with 43 respondents who have detailed knowledge of healthcare in Maharashtra, and from a witness seminar on the topic of transformation in Maharashtra’s healthcare system. Transcripts from the interviews and witness seminar were analysed thematically through a combination of deductive and inductive approaches. Our findings point to a restructuring of medical practice in Maharashtra as training shifts towards private education and employment to those corporate hospitals. The latter is fuelled by substantial personal indebtedness, dwindling appeal of government employment, reduced opportunities to work in smaller private facilities, and the perceived benefits of work in larger providers. We describe a ‘re-professionalisation’ of medicine encompassing changes in employment relations, performance targets and constraints placed on professional autonomy within the private healthcare sector, that is accompanied by trends in cost inflation, medical malpractice, and distrust in doctor-patient relationships. The accompanying ‘re-stratification’ within this part of the profession affords prestige and influence to ‘star doctors’ while eroding the status and opportunity for young and early career doctors. The research raises important questions about the role that government and medical professionals’ bodies can, and should, play in contemporary transformation of private healthcare, and the implications of these trends for health systems more broadly

"Beyond aid" investments in private healthcare in developing countries

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The Freedom to Marry for Same-Sex Couples: The Opening Appellate Brief of Plaintiffs Stan Baker Et Al. In \u3cem\u3eBaker Et Al. V. State of Vermont\u3c/em\u3e

As the first state to prohibit slavery by constitution, and one of the few states which, from its inception, extended the vote to male citizens who did not own land, the State of Vermont has long been at the forefront of this nation\u27s march toward full equality for all of its citizens. In July 1997, three same-sex couples challenged Vermont to act as a leader yet again, this time in affording full civil rights to the State\u27s gay and lesbian citizens. Stan Baker and Peter Harrigan, Nina Beck and Stacy Jolles, and Holly Puterbaugh and Lois Farnham were denied marriage licenses by their respective town clerks in the summer of 1997. They sued the State of Vermont and the towns, arguing that the marriage statutes allowed them to marry, and that if the law did purport to limit marriage to different sex unions it would be unconstitutional. The trial court dismissed their claims in December 1997, and the couples appealed to the Vermont Supreme Court. The court heard oral arguments on the case on November 18, 1998

The Freedom to Marry for Same-Sex Couples: The Opening Appellate Brief of Plaintiffs Stan Baker Et Al. In \u3cem\u3eBaker Et Al. V. State of Vermont\u3c/em\u3e

As the first state to prohibit slavery by constitution, and one of the few states which, from its inception, extended the vote to male citizens who did not own land, the State of Vermont has long been at the forefront of this nation\u27s march toward full equality for all of its citizens. In July 1997, three same-sex couples challenged Vermont to act as a leader yet again, this time in affording full civil rights to the State\u27s gay and lesbian citizens. Stan Baker and Peter Harrigan, Nina Beck and Stacy Jolles, and Holly Puterbaugh and Lois Farnham were denied marriage licenses by their respective town clerks in the summer of 1997. They sued the State of Vermont and the towns, arguing that the marriage statutes allowed them to marry, and that if the law did purport to limit marriage to different sex unions it would be unconstitutional. The trial court dismissed their claims in December 1997, and the couples appealed to the Vermont Supreme Court. The court heard oral arguments on the case on November 18, 1998

Educating the Professional Engineer of 2020: The Changing Licensure Requirements

Engineering education programs would be well served to align their curricula and program outcomes to the Fundamentals of Engineering (FE) Exam and Professional Engineer (PE) Exam specifications. These exams are required steps in the process of becoming a licensed engineer in most states. NCEES (the National Council of Examiners for Engineering and Surveying) is a national nonprofit organization dedicated to advancing professional licensure for engineers and surveyors. It develops, administers, and scores these examinations used for engineering licensure. Starting in 2011, NCEES held survey-creation meetings with diverse teams to develop a draft survey containing the subjects in each discipline and establish consensus support. NCEES launched a web-based survey of technical society members, institution report recipients, deans and department heads of all EAC/ABET programs, PE and FE exam committee volunteers, and others; more than 7,000 people completed the survey. Respondents rated the importance of each topic area to indicate how important it is for a new engineer to have minimum competence in that area. Based on these survey results, a set of topics and associated weighting was proposed and approved. Starting in 2014 the various FE exams will contain some overlapping content (e.g., mathematics and engineering economics), but there will no longer be a common breadth portion. Each FE exam, including industrial engineering, will be a freestanding exam. The PE exam specifications have also been revised; the new specifications will be used beginning in 2013. This paper highlights these recent changes to the discipline-specific content of the industrial engineering (IE) exams and suggests possible resulting curriculum modifications. As the IE profession undergoes changes in its application of traditional principles and adds new areas of focus, it is timely that the FE and PE exam specifications have been revisited to reflect changing priorities within the profession. For academic departments to stay relevant and assist industrial engineering graduates to become PE licensed, modern curriculum should stay closely aligned to the FE and PE exam specifications but not attempt to teach to the test . The paper concludes with a discussion of how these specifications have been used to assess and update academic curriculum

The Freedom to Marry for Same-Sex Couples: The Opening Appellate Brief of Plaintiffs Stan Baker Et Al. In \u3cem\u3eBaker Et Al. V. State of Vermont\u3c/em\u3e

As the first state to prohibit slavery by constitution, and one of the few states which, from its inception, extended the vote to male citizens who did not own land, the State of Vermont has long been at the forefront of this nation\u27s march toward full equality for all of its citizens. In July 1997, three same-sex couples challenged Vermont to act as a leader yet again, this time in affording full civil rights to the State\u27s gay and lesbian citizens. Stan Baker and Peter Harrigan, Nina Beck and Stacy Jolles, and Holly Puterbaugh and Lois Farnham were denied marriage licenses by their respective town clerks in the summer of 1997. They sued the State of Vermont and the towns, arguing that the marriage statutes allowed them to marry, and that if the law did purport to limit marriage to different sex unions it would be unconstitutional. The trial court dismissed their claims in December 1997, and the couples appealed to the Vermont Supreme Court. The court heard oral arguments on the case on November 18, 1998

Retention of Female Faculty Members

The recruitment and the retention of female undergraduate and graduate students into engineering courses is discussed. A similar challenge lies in recruiting female faculty member from the limited pool of candidates in several fields at most universities. It is found that about half the females who were hired did not stay at the university. It is suggested that programs should be introduced to encourage mentoring and career development as such improvements would benefit all faculty members both female and male