New Delhi: The National Medical Commission (NMC) Bill, 2019, which was tabled in the Lok Sabha on Monday by health minister Harsh Vardhan, continues to receive criticism from several quarters of the medical fraternity.
On Tuesday, resident doctors voiced strong criticism of the bill, while doctors associated with the Indian Medical Association (IMA) said they would sensitise MPs about their concerns.
The IMA burnt copies of the bill outside its Delhi office. It is also planning a protest march on Monday from Nirman Bhawan to Jantar Mantar demanding amendments to the bill.
The NMC Bill, which will repeal the Indian Medical Council Act, 1956, was first tabled in December 2017 in the Lok Sabha, but was referred to the Standing Committee on Health and Family Welfare as many doctors, and even few MPs, opposed its provisions. With the end of the 16th Lok Sabha’s term, the bill lapsed.
The MCI was dissolved in 2010 following a series of corruption charges against its then president Ketan Desai and other members. Since then, the Union government has been appointing body of governors each year through ordinances to perform the functions of the council.
The current NMC Bill, if passed, will be the primary Act regulating medical education and human resources in health in India after almost a decade of instability.
But will the new bill cover the loopholes which gave way to corrupt practices under the IMC Act?
The doctors have their doubts.
Clean Medical Education?
Under the new Bill, the annual inspections of medical colleges may end. Instead, the regulatory body can appoint a third party for assessing if the medical college has the required resources to run. Under the existing system, the medical schools are annually inspected and they need permission from the MCI to increase the seats. The MCI then sends a team to inspect the colleges.
It was this area of inspection where the alleged corruption crept up in MCI. The inspection teams allegedly used to take commissions to give positive reports.
But doctors fear that loosening the grip on medical colleges will not automatically lead to self-regulation.
Dr Sumedh Sandanshiv, president of FORDA, an association of resident doctors, says giving a free hand to hospitals will have a devastating effect. He explains how private medical colleges, under the current stricter rules, are stopping courses mid-term as they have no faculty after three years of admitting students. With lax rules, the medical colleges will be more reckless.
“Even in Delhi, medical colleges do not have enough faculty. Situation is worse in smaller cities. With no checking, the quality of medical education will deteriorate,” says Sandanshiv.
Changing the composition of the new proposed medical regulation body from being an elected to a centrally nominated one will also not end corruption, says IMA.
Under the IMC Act, two-thirds of MCI’s members are elected. The NMC comes with a heavy control by the Union government. The Centre, through a search committee, will select who gets to head and be members of national and state medical councils, which will be formed under the NMC.
“My right to vote has completely ended. Also, in the last 10 years, only 3.5 years of MCI were under an elected person. For the rest of the years, MCI was run by nominated member. A democratically elected body will any day ensure a better form of governance,” says Dr RV Asokan, Honorary Secretary General, IMA.
Another issue in the Bill which is being perceived as pro-private medical colleges is the clause of government regulating fewer seats in private medical colleges.
India currently has 506 medical colleges, out of which, 279 are run privately, offering 53% of all MBBS seats in the country. The NMC proposes that the government can regulate fee in only up to 50% undergraduate seats in medical colleges. This means that the government will have no control on the fee structure on more than 18,000 seats.
“The private medical college seats, the fee for which the state governments currently regulate, are as good as government college seats. By reducing control over the fee structure of these seats, the government is robbing a chance from the poor children to pursue medicine and are giving it to the rich,” says Asokan.
A New Class of Practitioners
The biggest sticking point under the new Bill is the licence to mid-level practitioners to practise modern medicine in primary and preventive care. Both the IMA and the FORDA have a history of opposing this move by the government which has been proposed many times in the past.
In 2010, a PIL was filed in the Supreme Court which suggested introducing bridge courses to train health practitioners, such as AYUSH doctors and Auxilary Nurse Midwives who live and serve in the rural areas, in primary care medicine. The PIL said that with basic training, these community health workers can prevent and cure ailments in areas where qualified MBBS doctors are absent. Thereby, making up for the acute shortage of doctors.
The SC directed the health ministry and the then MCI to implement the course, but the programme could never take off. Bridge course was also part of the 2017 bill. The NMC proposes a similar idea by providing licences to community level workers, but the doctors, once again, are up in arms against it.
“The healthcare facilities in rural areas are not well-equipped. How can the government expect a doctor to serve in such areas?” says Sandanshiv. He adds that the introduction of licence to practise is only to improve the doctor-patient ratio, but will not serve any real purpose.
“Who will take responsibility of cases if the treatment given by the licensed practitioners goes wrong?” asks Sandanshiv.
Entry or Exit?
To streamline the system of examination, the NMC proposes one exam -- the final MBBS exam -- which will serve multiple purposes of an exit exam to give licences to a doctor to practise medicine, as an entrance exam for admission in post-graduate courses and a screening test for foreign medical graduates.
The doctors allege that this streamlining is as good as diluting the current stringent checks and balances that a medical student goes through to be able to practise.
In the current exit exams, a student has a theory paper, after which he has a practical exam where he examines patients and four examiners assess him or her. The student then has a viva. After clearing all of these the doctor gets a licence to practise.
“Under NMC, there is no clarity on what the nature of the common exam would be, since the purpose of all exams which are clubbed are completely different,” says Asokan. Also, if the student does not clear the exam, what is the mechanism for him to reappear, ask doctors.
While the displeasure over the clauses in the NMC Bill 2019 continues, the Bill is expected to be tabled in the Rajya Sabha.