RSTV: THE BIG PICTURE- NATIONAL MEDICAL COMMISSION BILL
Introduction:
Resident doctors at government hospitals, including AIIMS and Ram Manohar Lohia Hospital in Delhi, went on an “indefinite” strike to protest the National Medical Commission Bill, 2019. Among the problems raised by the medical fraternity is Section 45 of the bill, which allows the government to override any suggestion of the National Medical Commission. The Post Graduate Institute of Medical Education & Research in Chandigarh and Medical students and doctors in Kerala also joined the strike. The bill looks to replace the existing Indian Medical Council Act, 1956 and reform the medical sector, in the wake of corruption allegations against the Medical Council of India. It also looks to regulate admission to medical colleges. The health minister defended the bill, describing it as “historic”.
Medical Council of India:
The Medical Council of India was first established in 1934 under the Indian Medical Council Act, 1933. This Act was repealed and replaced with a new Act in 1956. Under the 1956 Act, the objectives of MCI include:
- Maintenance of standards in medical education through curriculum guidelines, inspections and permissions to start colleges, courses or increasing number of seats.
- Recognition of medical qualifications.
- Registration of doctors and maintenance of the All India Medical Register.
- Regulation of the medical profession by prescribing a code of conduct and taking action against erring doctors.
Why is Medical Council of India being replaced?
- The Medical Council of India has repeatedly been found short of fulfilling its mandated responsibilities.
- Quality of medical education is at its lowest ebb; the current model of medical education is not producing the right type of health professionals that meet the basic health needs of the country because medical education and curricula are not integrated with the needs of our health system.
- Medical graduates lack competence in performing basic health care tasks like conducting normal deliveries; instances of unethical practice continue to grow due to which respect for the profession has dwindled.
- Compromised individuals have been able to make it to the MCI, but the Ministry is not empowered to remove or sanction a Member of the Council even if he has been proved corrupt.
The National Medical Commission Bill, 2019:
The Bill seeks to repeal the Indian Medical Council Act, 1956 and provide for a medical education system which ensures: (i) availability of adequate and high quality medical professionals, (ii) adoption of the latest medical research by medical professionals, (iii) periodic assessment of medical institutions, and (iv) an effective grievance redressal mechanism.
Key features of the Bill include:
- Constitution of the National Medical Commission: The Bill sets up the National Medical Commission (NMC). Within three years of the passage of the Bill, state governments will establish State Medical Councils at the state level. The NMC will consist of 25 members, appointed by the central government. A Search Committee will recommend names to the central government for the post of Chairperson, and the part time members. The Search Committee will consist of seven members including the Cabinet Secretary and five experts nominated by the central government (of which three will have experience in the medical field).
- Members of the NMC will include: (i) the Chairperson (must be a medical practitioner), (ii) Presidents of the Under-Graduate and Post-Graduate Medical Education Boards, (iii) the Director General of Health Services,Directorate General of Health Services, (iv) the Director General, Indian Council of Medical Research, and (v) five members (part-time) to be elected by the registered medical practitioners fromamongst themselves from states and union territories for a period of two years.
- Functions of the National Medical Commission:Functions of the NMC include: (i) framing policies for regulating medical institutions and medical professionals, (ii) assessing the requirements of healthcare related human resources and infrastructure, (iii) ensuring compliance by the State Medical Councils of the regulations made under the Bill, (iv) framing guidelines for determination of fees for up to 50% of the seats in private medical institutions and deemed universities which are regulated under the Bill.
- Medical Advisory Council: Under the Bill, the central government will constitute a Medical Advisory Council. The Council will be the primary platform through which the states/union territories can put forth their views and concerns before the NMC. Further, the Council will advise the NMC on measures to determine and maintain minimum standards of medical education.
- Autonomous boards:The Bill sets up autonomous boards under the supervision of the NMC. Each autonomous board will consist of a President and four members, appointed by the central government. These boards are: (i) the Under-Graduate Medical Education Board (UGMEB) and the Post-Graduate Medical Education Board (PGMEB): These Boards will be responsible for formulating standards, curriculum, guidelines, and granting recognition to medical qualifications at the undergraduate and post graduate levels respectively. (ii) The Medical Assessment and Rating Board (MARB): MARB will have the power to levy monetary penalties on medical institutions which fail to maintain the minimum standards as laid down by the UGMEB and PGMEB. The MARB will also grant permission for establishing a new medical college, starting any postgraduate course, or increasing the number of seats. (iii) The Ethics and Medical Registration Board: This Board will maintain a National Register of all licensed medical practitioners, and regulate professional conduct. Only those included in the Register will be allowed to practice medicine. The Board will also maintain a separate National Register for community health providers.
- Community health providers: Under the Bill, the NMC may grant a limited license to certain mid-level practitioners connected with the modern medical profession to practice medicine. These mid-level practitioners may prescribe specified medicines in primary and preventive healthcare. In any other cases, these practitioners may only prescribe medicines under the supervision of a registered medical practitioner.
- Entrance examinations: There will be a uniform National Eligibility-cum-Entrance Test for admission to under-graduate and post-graduate super-speciality medical education in all medical institutions regulated under the Bill. The NMC will specify the manner of conducting common counselling for admission in all such medical institutions.
- The Bill proposes a common final year undergraduate examination called the National Exit Test for the students graduating from medical institutions to obtain the license for practice. This test will also serve as the basis for admission into post-graduate courses at medical institutions under this Bill.
Significance and the need:
- The Bill seeks to regulate medical education and practice in India.
- The Bill attempts to tackle two main things on quality and quantity: Corruption in medical education and shortage of medical professionals.
- The Bill aims to overhaul the corrupt and inefficient Medical Council of India, which regulates medical education and practice and replace with National medical commission.
- Over the years, Medical Council of India has been marred by several issues regarding its regulatory role, composition, allegations of corruption, and lack of accountability.
- In 2009, the Yashpal Committee and the National Knowledge Commission recommended separating the regulation of medical education and medical practice.
Concerns:
- A bridge course allowing alternative-medicine practitioners to prescribe modern drugs is mentioned in the bill. Unscientific mixing of systems and empowering of other practitioners through bridge courses will only pave the way for substandard doctors and substandard medical practice. This will seriously impact patient care and patient safety
- Indian Medical Association (IMA) opposed the bill that it will cripple the functioning of medical professionals by making them completely answerable to the bureaucracy and non-medical administrators. NMC will become subservient to the health ministry, given that the representation of the medical profession in the new regulatory framework is minimal.
- The bill takes away the voting right of every doctor in India to elect their medical council.
- The bill allows private medical colleges to charge at will, nullifying whatever solace the NEET brought. The proposed NMC Bill discreetly intends to equate the post-graduate degrees given by MCI or proposed NMC and the National Board of Examination (NBE), which is unjustified too.
- Standards have been laid down for MCI courses, but not for NBE courses which are often run in private hospitals and nursing homes.
- It would replace an elected body (Medical Council of India, MCI) with one where representatives are “nominated
Conclusion:
India has suffered from the problem of inappropriately trained doctors of varying quality since a very long time. Decades back, the Mud liar Committee Report (1959) pointed out that doctors had neither the skills nor the knowledge to handle primary care and infectious diseases that were a high priority concern at the time. In recent times, the excessive reliance on a battery of diagnostic tests is reflective of commercial considerations and weak knowledge.
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