Since 2009, when the idea of revamping the Medical Council of India was first mooted and was replaced by way of an Ordinance in 2010, several discussions took place on this topic. Yet when the National Medical Commission (NMC) Bill was placed on the Table of Lok Sabha, it was greeted with anger and a day-long strike by all doctors in the country. In the face of stiff opposition cutting across party lines, the Bill has been referred to the Parliamentary Standing Committee.
The article seeks to explain the four major irritants: the architecture of the proposed Commission, licensing of doctors, cross practice and permitting practice without prior screening, and fees. These aspects need a careful review in view of the long-term implications for the kind of doctors we produce and have in our country.
The Bill seeks to replace a 106-member elected body with a 65-member Medical Advisory Council (that includes 25 members of the NMC); a 25-member NMC with four verticals consisting in all 12 members and dealing with setting curriculum, standards and registration. Barring five, the remaining 72 persons, of whom half would be doctors, are to be appointed by the Centre, upon the advice of a seven-member search committee chaired by the Cabinet Secretary.
If the advisory council meets once a year, the NMC is expected to meet quarterly and the verticals monthly. So in effect, the secretary of the Commission is expected to run the day-to-day matters, coordinating different bodies and the various expert committees that each may constitute. For discharging such important duties, his stature, experience or medical knowledge are not specified. It is enough if he is a postgraduate.
The specialised verticals consisting of persons having expertise in the subject, is expected to lay down norms, standards and guidelines in accordance with need. However, the advantage of such responsibilities can be realised only when matched with a measure of autonomy and strict accountability.
This is, however, not the case. On every issue, recourse to appeals has been provided—to the NMC and/or the government.
The government also reserves the power to issue directives that the NMC, states and elected state medical councils have to comply with whether these directives pertain to policy or otherwise. Besides, the government is also empowered to dilute the norms and criteria laid down for sanctioning colleges, approve degrees, courses and grant permissions to anyone to practice. The Centre can even overturn punishment meted out to a doctor found guilty of negligence of malpractice by the state Medical Council, the Ethics and Medical Registration Board and the NMC.
Such centralisation and bureaucratisation of the Regulator is unprecedented, more so because the NMC already consists of all the technical advisors of the Ministry: DGHS, DG ICMR, heads of its premier institutions like AIIMS, PGI Chandigarh etc.
If NEET was considered necessary for ensuring a minimum standard of knowledge to be possessed by students to deal with the tough medical syllabus, the Bill provides for an exit examination. The provocation being that there are varied standards across the country in the quality of doctors being produced. So a licentiate examination would help standardise the “Indian doctor”. The exam is for being eligible to get a licence to practice and also qualify to pursue postgraduation.
The problem is the fate of students who go through a five-year study in an accredited medical college, pass an approved examination process consisting of viva and practicals and are declared fit to practice, but fail to qualify an MCQ paper conducted by the NMC. Their options are either to spend huge amounts in private coaching centres or practise clandestinely. The students most likely to be affected will be those from backward provinces and poorer families. This needs further deliberation.
The third issue is a joint sitting of the Commission and the heads of the AYUSH Councils to design bridge courses for undergraduate and postgraduate courses under which AYUSH practitioners would be eligible to prescribe allopathy medicines. Such AYUSH doctors do not have to go through any licentiate examination or screening and yet are registered by the NMC, providing dual registration.
As such, this provision regularises an ongoing practice where, in many private hospitals, including some corporate ones, AYUSH doctors are working and being shown as ‘doctors’, albeit at much lesser pay. This provision is fraught with undesirable impact and needs to be carefully deliberated. The Bill also provides for the government to exempt persons who can do surgery and practise without being screened. Such powers can be abused in the wrong hands.
The Bill provides for the NMC to fix fees for “up to 40 per cent” seats. This will make it very expensive for students, forcing them, after graduation, to look for lucrative jobs in cities or deter them, even if selected, to join on grounds of unaffordability, as is the case now. There is no justification for such a provision. The Bill is also very lax on penalising wrongdoing and fraud and weak on demanding accountability and adherence to rules.
The Bill has now been referred to the Standing Committee. There are several operational issues too that need to be ironed out such as the four-year term for the Secretary and the Commission that may impact institutional memory. A dialogue will provide an opportunity to debate some of these contentious issues and hopefully enable a more balanced Bill that is acceptable to all. Since medical education is in the concurrent list, the participation of the states is critical and needs to be factored in.
K Sujatha Rao
Former Union Secretary, Ministry of Health and Family Welfare and author of Do We Care?: India’s Health System