Why in news?

• The Union Cabinet has cleared the National Medical Commission Bill, which does away with the Medical Council of India (MCI)
• The bill replaces MCI with a regulator that will do away with “heavy-handed regulatory control” over medical institutions

Present structure

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 The Medical Council of India (MCI) was established in 1934 under the Indian Medical Council Act, 1933.The Act was repealed and replaced by the Indian Medical Council Act, 1956

Functions

• Maintenance of uniform standards of medical education,
• Recognition/de recognition of medical qualifications and medical colleges,
• The registration of doctors
• Members: The MCI has elected members from the medical fraternity

Why this bill?

• The Bill is aimed at bringing reforms in the medical education sector which has been under scrutiny for corruption and unethical practices.
• Over the years, the Medical Council of India has become a seat of corruption and has fallen into the hands of a small lobby of private medical practitioners.
• Instead of attracting professionals of high calibre, it is run by a coterie secure in the belief that they will be protected by politicians and bureaucrats at the highest levels.

Key provisions of the original bill

1. The Bill sets up the National Medical Commission (NMC).  The NMC will regulate medical education and practice.  It will determine fees for up to 40% seats in private medical institutions and deemed universities.
2. The NMC will consist of 25 members.  A Search Committee will recommend names to the central government for the post of Chairperson, and the part time members.
3. Four autonomous Boards have been set up under the supervision of the NMC.  These Boards will focus on undergraduate and postgraduate medical education, assessment and rating, and ethical conduct.
4. There will be a National Licentiate Examination for doctors to obtain a licence to practice after graduation.  This examination will also be the basis for admission to post-graduate medical courses.
5. State Medical Councils will receive complaints relating to professional or ethical misconduct against a doctor.  If the doctor is aggrieved of a decision of the State Medical Council, he may appeal to successively higher levels of authority.

Amendments approved in Bill

In April 2018, Centre amended the National Medical Commission (NMC) Bill, which will now be tabled in Parliament.

Key features of the amended bill

• Final MBBS Examination and exit test: The final MBBS examination will be held as common exam throughout country. It will serve as exit test to be called National Exit Test (NEXT). It will ease burden on medical students as they will not have to appear in separate exam after MBBS to get license to practice. NEXT will also serve as screening test for doctors with foreign medical qualifications in order to practice in India.
• Provision of Bridge course: It removes provision dealing with bridge course for AYUSH practitioners to practice modern medicine to limited extent. Now state governments have been empowered to take necessary measures for addressing and promoting primary health care in rural areas.
• Fee regulation:  The maximum limit of 40% seats for which fee will be regulated in private medical institutions and deemed universities has been increased to 50% seats. The fee will also include all other charges taken by colleges.
• Number of nominees from States/UTs in NMC: The nominees of States and UTs in National Medical Commission (NMC) have been increased from 3 to 6. TNMC will comprise of 25 members of which at least 21 will be doctors.
• Monetary penalty for medical colleges: It adds provision providing different options for warning, reasonable monetary penalty, reducing intake, stoppage of admission leading up to withdrawal of recognition on medical college non-compliant with norms. Earlier, wide range of monetary penalty, ranging from one half to ten times annual fee recovered from batch was to be imposed in a graded manner.
• Stringent punishment for quacks: It provides severe punishment for any unauthorized practice of medicine or by quacks with imprisonment of up to 1 year along with fine extending up to Rs. 5 lakhs.

The significance of the bill

NMC to be less draconian:

• Deterrence for non-compliance with maintenance of standards is in terms of monetary penalty
• The new commission will also have the power to frame guidelines for fees for up to 50% seats in private colleges and deemed universities

Checks and Balances:

• The NMC bill was floated to ensure transparency with the division of powers.
• Under the NMC  three independent boards-Search and Selection Committee (SSC), Medical Advisory Council, and the National Medical Commission- will operate with autonomy from the others, thereby creating a mechanism for check and balances.

Uniform quality of doctor throughout the country:

• The final MBBS examination would be held as a common exam across the country. This would serve as an exit test, called the National Exit Test (NEXT), and would be a prerequisite to practice Allopathy.
• The common exam is expected to ascertain uniform quality of doctors throughout the country.

Will expand the health workforce

• The first draft of the Bill proposes to streamline various AYUSH and Homeopathic practitioners and create an integrated healthcare model where the state governments decide the modalities of the provision.
• Under this mechanism, less specialised health workers are trained to strengthen and expand the health workforce. This will reduce the scarcity of doctors

Issues/challenges with the bill

1. Against democratic spirit:

• • The NMC Bill, aimed at replacing the existing Medical Council of India, will have a 25-member commission nominated by the Union government.
  • This will cripple the democratic functioning of the medical profession by making it completely answerable to the bureaucracy.

2. Dominance of doctors:

• Two-thirds of the members in the NMC are medical practitioners.
• Expert committees have recommended that the regulator should consist of more diverse stakeholders in order to reduce the influence of medical practitioners in regulating medical education and practice.

3. No full-proof protection against Corruption:

• It is not clear how the National Medical Commission, consisting of members who are all nominated in various ways by the government and the health bureaucracy, will be kept free of corrupting influences.
• If a system of democratic representation can be twisted to serve vested interests, there is no guarantee that a body consisting entirely of nominated members will be free of corrupting influences.

4. No requirement for renewal:

• There is no requirement for periodic renewal of the licence to practice.  Some countries require periodic testing to ensure that practitioners remain up to date, fit to practice, and give good care to patients

5. No provision of an appellate body:

• In cases of professional or ethical misconduct by medical practitioners, the practitioners can appeal a decision of the NMC to the central government.
• It is unclear why the central government, and not a judicial body, is the appellate authority.

6. Will promote Expensive Private medical education:

• The National Medical Commission Bill takes forward the move to legitimise profit-making in medical education by proposing that the fees in private medical colleges for 50% of the seats be regulated, thereby allowing the charging of exorbitant fees for the remaining 50% seats.
• Clearly, the Bill embodies a vision for medical education that does not include higher public investment but, rather, clears the way for converting medical education into a lucrative profit-making venture.

7. Anti-federal:

IMA has called the proposal of centrally-administered common exam anti-federal. It has asserted that the bill marginalises state governments, state medical councils and state health universities.

Way Forward

• Increase number of doctors more doctors and imparting proper training in their respective fields
• Presence of public and private healthcare to remotest of regions
• 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.