Aravind is to Eye Care as McDonald’s is to Hamburgers

When Dr. G. Venkataswamy founded Aravind Eye Hospital in 1976, he sought to fix India’s problem of needless blindness. To make a dent in the “backlog of 20 million blind eyes,” Dr. V. passionately described modeling the hospital system after McDonald’s. After all, is there any reason selling sight-restoring operations should be more difficult than selling millions of hamburgers?

Aravind models more than just its social marketing after the fast-food chain. The entire model of the hospital is based on efficiency, which allows just one of their thirteen hospitals to see an average of about 3,500 patients every day, six days a week. In fiscal year 2017-18, the hospital system saw over four million patients and performed nearly 500,000 surgeries. Since the inception of the hospital in 1976, Aravind has had over 56 million outpatient visits and performed over six million surgeries and laser treatments.

A large reason Aravind is able to see so many patients is because of its community outreach camps. In 2017-18, Aravind had 2,779 of these camps, accounting for 16% of their total outpatient populating and 32% of their cataract surgeries.

An eye surgeon at Aravind performs an average of 1,500 surgeries each year, whereas the average surgeon in India performs only about 300 surgeries per year, and Thailand only about 200 surgeries per year. The efficiency of Aravind surgeons is so impressive due to the large role of MLOPs, or mid-level ophthalmic personnel. Each year, Aravind selects over 500 young women from nearby villages to go through training to become an MLOP. They perform most of the routine clinical tasks so the doctors can focus on diagnosis and surgery. For every one doctor at Aravind, there are six MLOPs. They provide high quality care and increase productivity of the surgeons at a lower cost to the hospital system.

The hospital is able to provide free or steeply subsidized care to over a million people every year. Last year, 28% of all outpatient visits were offered free of charge, and nearly 50% of surgeries and laser treatments were performed for free or at a steeply subsidized rate. Aravind has a “no questions asked” policy – anyone can receive treatment at the Free Hospital if they choose, regardless of ability to pay. Doctors alternate between working at the Main Hospital and the Free Hospital, so patients receive the same high-quality care at the free or steeply subsidized rates that they would receive if they were paying patients. The President of India once received treatment at the Free Hospital!

*The Free Hospital is located one block away from the Main Hospital, which is just down the road from the Inpatient Block and our office in LAICO.*

Aravind’s financial model is entirely self-sustaining. Even after providing so many services for free or almost free, Aravind finishes every year in the black. This is due largely in part to the sheer number of patients they see every day. Aravind can treat so many patients because of the large role of the MLOPs. In the operating theatre, surgeons sit and perform the ten-minute, sight-restoring cataract surgery on a patient. As this is happening, the MLOPs are on the other side of the room preparing another patient for their surgery so that as soon as the doctor finishes one surgery, all he has to do is swivel his chair and begin performing the same surgery on the next patient. The MLOPs will lead the patient whose operation was just completed out of the OT, and the next patient will be ushered in and prepared for surgery. Not a minute of the surgeon’s productivity is lost, and there is no evidence to prove that this affects infection rates. In fact, Aravind’s infection rate is one-sixth of the average among U.K. eye hospitals.

Aravind’s success in restoring sight to millions of people is absolutely incredible, and its financial success is especially impressive. I could not help but think about the cost problem we have in the United States and wonder if a similar model could be replicated back home to provide high-quality care at a low cost. Although these seem like desirable ends, I doubt a similar hospital would be very successful in the U.S. At Aravind, waiting rooms and hallways are packed with people, and doctors do not spend much time with their patients. In the U.S., we like to spend time with our doctors and ask questions about our prescriptions and treatment options, and the Aravind model would surely make many patients feel like cattle being herded through the system.

Here is a waiting room in the afternoon. There is no appointment system at Aravind, so patients usually come early in the morning to ensure they will see a doctor. This is not very crowded compared to other areas of the hospital during peak hours.

Additionally, physician burnout is a common problem causing dissatisfaction among doctors in the U.S. Doctors lack physical, emotional, and spiritual energy to keep going after long, busy days. At Aravind, doctors work from 7:30 a.m. until about 7:00 p.m., Monday through Saturday. Fellows work the same hours, and they are required to work at an outreach camp on one or two of their days off each month. If they get sick, they have to use a personal day to take off (that is, if they are not pressured into pushing through the sickness and coming in anyway, which is more likely). These doctors are constantly advising patients or performing surgeries, with very little (if any) time to catch their breath between patients. Simply put, burnout is not an option.

Despite the amazing success of Aravind in India, I do not think a hospital like this one will be coming to the U.S. any time soon. Due to our expectations for personalized care and working conditions, I do not think people would be happy with going to or working at a hospital like Aravind. But here in India, McDonald’s has inspired a model that serves more and more patients every year, working slowly and steadily towards achieving Dr. V.’s goal of ending needless blindness.