Insights into Editorial: Medical Council needs urgent therapy
02 April 2016
Referring to the report of a parliamentary standing committee, the British Medical Journal (BMJ) in its latest issue has called for a ‘radical prescription’ to reform the Medical Council of India (MCI) in order to eliminate corruption and lack of ethics in healthcare.
- The report of the Parliamentary Standing Committee (PSC) on the need to reform the Medical Council of India (MCI) has come as a glimmer of hope. The committee has broadly agreed to all the recommendations of the many reports that have been submitted over the decades and that had, until now, fallen on deaf ears.
- The scathing indictment of Medical Council of India (MCI) which regulates medical education and professional practice, by Parliament’s Standing Committee on Health, was long overdue.
Important findings by the committee:
- India has far fewer doctors than the WHO recommended minimum doctor population ratio of 1:1000.
- Six states with 31% of the population account for 58% of MBBS seats, while eight states with 46% of Indians have just 21% MBBS seats.
- Quality of medical education is at its lowest ebb and the current system is not producing the right type of medical professionals.
The MCI was established in 1934 under the Indian Medical Council Act, 1933, as an elected body for maintaining the medical register and providing ethical oversight, with no specific role in medical education.
- The Amendment of 1956, however, mandated the MCI “to maintain uniform standards of medical education, both under graduate and postgraduate; recommend for recognition/de-recognition of medical qualifications of medical institutions of India or foreign countries; accord permanent registration/provisional registration of doctors with recognised medical qualifications; and ensure reciprocity with foreign countries in the matter of mutual recognition of medical qualifications.”
- The second amendment came in 1993, at a time when there was a new-found enthusiasm for private colleges. Under this amendment, the role of the MCI was reduced to an advisory body with the three critical functions of sanctioning medical colleges, approving the student intake, and approving any expansion of the intake capacity requiring prior approval of the Ministry of Health and Family Welfare.
Why reform the MCI?
- Like a license-raj permit controller, MCI has for long focused too much on licensing of medical colleges and stipulating impractical conditions, while ignoring its other mandate of maintaining ethical conduct in the profession.
- It has failed to stop the sale of medical seats in private colleges for capitation fees going up to Rs.50 lakh.
- Over the years, it has emerged as a single, all-powerful agency heavily influenced by corporate hospitals to provide accreditation to institutions and assess their quality, ignoring blatant conflicts of interest.
- Comprehensive reform of the MCI should begin with the separation of functions: approving standards and accreditation requirements for medical education, fixing norms to assess the competence of medical graduates and laying down ethical practice guidelines.
- As suggested by the government-constituted committee of experts led by Ranjit Roy Chaudhary, a National Medical Commission to oversee education and policy should be constituted.
- Separate boards for undergraduate and postgraduate training, assessment of institutions and medical ethics should be created.
- Inducting non-medical professionals of integrity and community health experts to regulatory bodies would help advance public interest.
- The larger goal of a revamp should be to produce medical professionals, especially postgraduates, in such numbers that would improve the doctor to population ratio and ensure their availability across the country.
- The possibility of having an exit test for medical graduates at the end of their course and before they start practising, as a measure of standardisation across States, should also be considered.
- The government should also enforce a uniform national entry and exit examination.
- Given the disparities in the country, there is also a need to guard against elitism.
- As suggested by the standing committee, replacing the existing MCI with an architecture consisting of four independent boards to deal with curriculum development, teacher training, and standard setting for undergraduate and postgraduate education can also be considered.
Bill to revamp MCI:
On grounds of corruption, the MCI faced the ignominy of being set aside by the Supreme Court in 2002 and again in 2010 by an ordinance issued by the government.
- Seizing the opportunity of the temporary suspension of the elected MCI, the Ministry of Health drafted a Bill to establish a National Commission for Human Resources for Health (NCHRH).
- This Bill sought to revamp the MCI to consist of nominated bodies to carry out the functions of human resource planning, curriculum development and quality assurance, with the elected body limited to register doctors and govern their practice in accordance with ethical standards.
- It was laid on the table of the Rajya Sabha in 2011. The PSC returned the Bill with some observations to the Ministry in October 2013.
- In 2014, another committee under the chairmanship of Dr Ranjit Roy Chaudhury was appointed. This committee submitted its report in February 2015. The latest report of the Parliamentary Standing Committee, which was submitted to the Rajya Sabha recently, is in near unanimity with this report.
Health matters to everybody and no matter how much money government spends on this sector, much of it will be wasted if we have too few doctors, huge regional imbalances in their distribution and serious question marks on the quality of their medical education. Clearly, a thorough clean-up in the manner medical education and health-care institutions are regulated is overdue; no compromise should be made on transparency, public interest and the highest ethical standards in doing this.