As doctors, how often have you spent 30 minutes or more walking a patient through a complex diagnosis, only to be handed the same consultation fee as someone who came in with a basic seasonal cold? And how often do you shrug and move on, because “that’s how it’s always been”?
It’s a conversation that’s already happening across specialties—especially as patient loads get heavier, chronic illnesses grow more complex, and the expectation to educate, reassure, and manage everything from prescriptions to diet plans keeps expanding.
And while we’re at it—why are we, as doctors, the only professionals still charging flat fees regardless of time?
It’s efficient. It’s simple. But is it fair—to you?
In Every Other Profession, Time = Value
Look at any profession where expertise and time are the core product. Legal professionals, business consultants, financial planners—they all follow a very different pricing logic.
Ask a lawyer for advice, and the clock starts ticking. They bill per hour, often in units as small as six minutes. Why? Because every minute of their professional input is considered billable expertise. If a case is complex or involves more meetings, more documents, or more risk, the bill reflects that.
In management consulting, it’s the same. Large firms like McKinsey, BCG, or even mid-sized Indian firms charge based on the level of expertise involved and the time investment. A senior consultant or partner doesn’t cost the same as a junior analyst. That’s not just accepted—it’s expected. Clients know they’re paying for deep thinking, tailored strategies, and high-stakes decisions.
Even mental health professionals and life coaches—people with similar relational and advisory roles to doctors—structure their pricing around time. A 30-minute session costs less than a 60-minute one. You book the time you need, and you pay accordingly.
So, when we step back and look at how professionals who trade in time, judgment, and insight operate, the question becomes even louder: why does a doctor who spends 45 minutes unpacking a chronic illness and creating a full lifestyle plan charge the same as another doctor who completes a routine prescription refill in 5 minutes?
And let’s not forget—medical advice is arguably the most high-stakes advice a person can receive. If time is valued in legal or business circles, it should be even more so in medicine. After all, our decisions can save or drastically change lives.
The landscape of the consultation room has shifted. Thanks to technology, digital health tools, and a growing level of patient awareness, a consultation is rarely just about diagnosing and prescribing.
On any given day, you’re explaining lab results, discussing lifestyle changes, answering WhatsApp-forward-driven health myths, handling family anxieties, updating electronic medical records, writing referral letters, and managing chronic medications—all within the same “consultation slot.”
As Dr. Sharma, an endocrinologist in Mumbai, puts it:
“You’re not just handing over a prescription. You’re explaining how insulin works, how to monitor sugars, what to eat, what not to eat. And often, you’re dealing with fear. That takes time. And when patients come back better, it’s because you gave that time—not just the tablet.”
In mental health and psychiatry, it’s even more layered. A psychiatrist may spend an hour understanding a patient’s family background, trauma history, work-related stress, and medication side effects—yet the standard consultation fee often doesn’t reflect the time or emotional investment involved.
Yet, under the current flat-fee model, there’s no distinction. The patient who comes in for a routine checkup pays the same as the one who needs detailed counselling, family education, and comorbidity management.
Time-Based Billing Is Already Here
Source: http://: https://practiceforces.com/blog/time-limit-for-medical-billing/
A 2022 study published in JAMA Network Open looked at time-based billing in outpatient settings and found that physicians who billed by time earned more for longer, more complex visits compared to those who used standard coding based on medical decision-making (MDM). More importantly, the time model better represented the cognitive and emotional load of those longer consultations—things that often get underrepresented in traditional billing systems.
In the Indian context, while formal studies are limited, insights from case reports and hospital audits echo the same sentiment. A case study from a Chennai-based super-specialty hospital revealed that rigid flat-fee outpatient models were not only inefficient but demoralising for physicians. The hospital eventually proposed time-linked modules and digital scheduling systems to ensure both better patient flow and provider satisfaction.
What does this tell us? The time invested is not just a practical parameter—it’s the best available proxy for effort, attention, and quality of care.
Still, many doctors hesitate. The most common fear? That patients won’t accept time-based pricing. That they’ll see it as exploitative or “commercial.”
But here’s what we often forget—patients already understand the concept of time-based pricing in other parts of their lives. They pay therapists, yoga instructors, lawyers, even salon professionals based on session time. Many book nutritionists and lifestyle coaches by the hour without question.
Online platforms like Practo, Mfine, and DocVita already offer visible time slots with tiered pricing: ₹500 for 10 minutes, ₹900 for 30, and so on. Patients pick what they want, and they rarely question the model. If anything, they appreciate the transparency. It builds trust, not friction.
So, the resistance isn’t from the patient side. It’s from us. Perhaps we worry that we’ll be seen as too transactional. But when time equals attention, and attention equals better outcomes, we’re not selling time—we’re investing it. And like any good investment, it should come with fair returns.
Dr. Tara Srinivas, a Hyderabad-based paediatrician, shares:
“At first, I was nervous. But once I explained the model, parents actually preferred it. They felt reassured knowing they’d get enough time with me when needed.”
What Factors Should Influence Your Pricing?
Fee-setting isn’t guesswork and time isn’t the only variable that should shape your consultation charges.
- Experience – Years in practice matter. Clinical wisdom deserves fair pricing.
- Specialty – Complex fields like neurology, oncology and super specialties that require advanced expertise justify higher fees.
- Consultation time & complexity – Longer, cognitively demanding consults require more effort.
- Infrastructure – If your clinic offers EMRs, diagnostics, and staff support, that’s value added.
- Technology – Tools like AI diagnostics or tele consult platforms enhance care quality.
- Location – Metro clinics and rural setups have very different economics.
- Non-clinical time – Report reviews, follow-ups, and coordination take real effort.
- Patient demographics – Pricing should match the local population’s paying capacity.
So yes, charge what you’re worth—but make sure your worth is clear, consistent, and backed by service quality and transparency.
Is this ethical?
The Indian Medical Council Regulations (2002) make it clear:
- Your fees must fairly reflect the treatment provided.
- Patients have the right to ask for a detailed bill—and you must provide it.
- Overcharging could land you in trouble for professional misconduct.
The Clinical Establishments Act, 2010 requires clinics and hospitals to display their consultation charges clearly. No hidden surprises. A proper bill or receipt isn’t just good practice—it’s legal and as well as liability protection.
Being compensated fairly for longer, more complex, or emotionally intense consults doesn’t make you commercial. It makes your practice sustainable. It allows you to spend time where it’s needed most—without watching the clock or worrying that you’re falling behind.
Maybe it’s time to shift the perspective. Because that level of care and investment of time deserves fair compensation.
