We are grateful to Kattula (1) and Jain, Patil and Phutke (2) for their comments on our article on rural emergency medical care and our real problems in rural practice, their management and the threat to our survival (3). We agree with most of their points and the solutions they have advocated (1, 2).

However, since the medical profession has come under the purview of The Consumer Protection Act, 1986, fear of the hanging sword of the law has caused doctors constant stress, while their dedicated practice and interest in research are no longer of any value. To avoid legal liability, doctors are obliged to order several pathology investigations and expert opinions, which makes patients feel they are only profit-oriented, a belief shared by the authors of the second commentary (2). They are not aware of what it costs to run a private hospital while providing ethical care. We have stood firm against industry sponsorship of doctors’ participation in conferences and repeatedly fought against cut practice (4).

Today, rural government hospitals are often just buildings, with inadequate qualified staff including medical officers, and inadequate infrastructure. It is inevitable that the rural people are forced to depend on private healthcare. In this situation, unless there is universal health insurance for all, there will be no space left for the rural private healthcare providers.