National Medical Commission Bill, 2017- An Analysis

Context:

Recently, the Cabinet has approved the amendment to the National Medical Commission Bill, 2017

Medical Council of India:

1. The Medical Council of India (MCI) was established in 1934 under the Indian Medical Council Act, 1933.The Act was repealed and replaced by the Indian Medical Council Act, 1956
2. Functions:

• Maintenance of uniform standards of medical education,
• Recognition/de recognition of medical qualifications and medical colleges,
• The registration of doctors

3. Members: The MCI has elected members from the medical fraternity

The Need for National Medical Commission Bill:

Corruption in Medical Council of India

• Since 2010, the Medical Council of India has been surrounded by controversy when the erstwhile President, Ketan Desai, of the Council was accused of corruption and bribery while granting permits to medical colleges.
• A Parliamentary Committee Report in 2016 revealed that the Medical Council of India was largely responsible for corruption in health care. It observed that the MCI failed in its duties in setting up high standards in health care.
• The Report noted that between 1963 and 2009, just 109 doctors were blacklisted by the Ethics Committee of the MCI.

Other Issues:

• In 2006, the WHO identified India among the 57 countries facing a critical shortage of health workforce. Doctor-patient ratio in India is 1:2000 instead of the 1,000 people norm of the WHO.
• Inequitable presence of doctors- Lack of doctors in rural areas
• Prevalence of quacks, unqualified medical practitioners- For example: 2% of providers of “modern medicine” in rural areas do not have a medical qualification.

National Medical Commission Bill, 2017

The Bill seeks to repeal the Medical Council Act, 1956 which governs the Medical Council of India

Key Provisions

Criticisms:

1. Dissolution of electoral process of appointment and Composition of NMC:

• Critics argue that dissolving the MCI and the proposed appointment of members of NMC by the Centre would adversely affect the functioning of the medical profession. This would make the body completely answerable to bureaucracy and non-medical administrators
• Further, it will also give greater control to the government in running the commission
• Other issue: Inadequate representation of states

2. Functions of the NMC:

• Lack of clarity on the functions of the NMC is a major issue.
• The bill mandates NMC with laying down policies and assessing requirements in healthcare including human resource.
• These tasks however require inputs from multiple agencies. Assigning these tasks to the Commission will render poor results.

3. Medical Advisory Council (MAC):

• MAC has not been given an autonomous status
• Includes NMC members as its ex-officio members and headed by chairperson of NMC
• Critics are of the opinion that views and suggestions of MAC are expected to be prejudiced

4. ‘Bridge course’ for AYUSH Doctors:

• The Indian Medical Association (IMA) is of the opinion that letting AYUSH doctors prescribe allopathic medicines post a ‘bridge course’ will promote quackery and lead to medico-legal issues
• To expect a non-allopathic medical graduate to be able to learn allopathy from a short-term course is erroneous. Further, these bridge courses can be used as a backup route to MBBS

5. Issues with Registry of doctors

• According to the bill, those who have completed the bridge course to be tabulated separately in the Indian medical registry. This could lead to dual registration which is not permissible.

6. NEET:

• NEET replaces all state-based medical entrance exams and has been highly criticised as it violates the state rights
• Further, it is considered to be highly biased and disadvantageous for Non-CBSE student.

7. National Licentiate Examination

• There is an absence of standardization- great variation in the quality of education provided in medical colleges across the country. Critics opine that National Licentiate Examination may widen disparities.
• Further, doctors across the country protested against this provision as it is ‘highly insensitive’ to students who have been through a rigorous course

8. Fees

• The Bill permits private colleges to decide fees for 60% of seats
• Critics apprehend that this facilitate increase fees in private colleges and encourage corruption and reserve medical education only for the rich and well off.

9. No holistic approach:

• The bill fails to provide a holistic approach to healthcare. It excludes nurses, paramedics and other medical professionals from its ambit.

After widespread criticism and protest over the National Medical Commission Bill, the Parliament referred the Bill to a standing committee.

Recommendations of the Parliamentary Committee:

1. There should be 29 members of the Commission and while 9 of them should be elected representatives of medical fraternity, 10 should be nominated by states.
2. Government should explore the possibility of “restructuring and revamping” the Dental Council of India, the Nursing Council of India and other such councils for their effective regulation as envisaged by National Medical Commission Bill, 2017.
3. Provision to allow AYUSH practitioners to practice allopathy through abridge course should not be mandatory and the decision should be left to states.
4. Exit exam or licentiate: At UG level licentiate exam to be merged with MBBS final exam; common final UG exams can be conducted by states and state universities. Does not recommend merging PG entrance with licentiate exam
5. “Minimum compulsory period” of working within the country be fixed for doctors
6. Compulsory rural posting for all doctors graduating from medical schools
7. Formulation of regulatory, licensing or accreditation norms for all paramedical and allied health care professions like physiotherapy, optometry, etc
8. Common counselling to be held on all India and state levels in the first stage. Medical colleges are given authority to take admissions based on their own criteria for the seats that remain vacant
9. Government should regulate fees for at least 50% of the seats in private medical colleges, deemed universities and deemed-to-be-universities

Amendments to the National Medical Commission Bill:

1. No separate exam after MBBS to get license to practice- Final MBBS Examination to be held as a common exam across the country and would serve as an exit test called the National Exit Test (NEXT). It would also serve as the screening test for doctors with foreign medical qualifications in order to practise in India.
2. Provision of Bridge course for AYUSH practitioners to practice modern medicine removed- Left to state governments to take necessary measures to promote primary health care in rural areas
3. Fee regulation for seats in private medical institutions and deemed universities: raised from 40% to 50% seats
4. Number of nominees from States and UTs in NMC increased from 3 to 6, NMC to comprise of 25 members of which at least 21 will be doctors
5. Monetary penalty for a medical college non-compliant with the norms replaced with provision for different penalty options- warning, reasonable monetary penalty, reducing intake, stoppage of admission, withdrawal of recognition
6. Stringent punishment for unqualified medical practitioners or quacks- imprisonment of up to one year along with a fine extending up to Rs. 5 lakh

Way Forward:

1. Increase number of doctors more doctors and imparting proper training in their respective fields
2. Presence of public and private healthcare to remotest of regions
3. The problem of brain drain should be addressed. Emigration of doctors is a major factor contributing to shortage of doctors. Further, the issue of reluctance of serving in rural areas should be addressed.  NMC should limit emigration of newly graduated doctors.

Best Practice: Thailand

Thailand successfully adopted a measure to limit emigration of doctors in 1972. Their policy mandates three years of government work for all post-graduates. The first year is spent in provincial hospitals, while the second and third years are spent in rural or community hospitals.

4. The bill should also include paramedics, nurses and other medical professionals under its ambit
5. There is a need to revamp the admission test system. Further, there is no scope for testing ethics of an aspirant.

Best Practice: UK:

Undergraduate admissions are based on applications and the Bio Medical Admissions Test. It assesses the scientific aptitude, critical thinking and written communication skills. Based on the test, offers of admission are made to students after an interview process

6. There is a need to revamp the medical curriculum. It should be implemented with the integration of subjects such as medical ethics, behavioural science, communication skills, and managerial skills.
7. There should be larger consultation with professional organisations and civil society to arrive at a consensus over the Bill.