Context:

The National Medical Commission (NMC) Bill, replaces the 63-year-old MCI with a new oversight body. The Bill also puts a cap on fees on 50 per cent of seats in MBBS and PG colleges.

In a nation of billion-plus people with woefully inadequate access to healthcare and an acute shortage of qualified doctors, getting a seat at a medical college is often seen as a sure-fire way to prosperity.

Owners of private medical colleges have for years sought to exploit this heavy demand by charging exorbitant fees, often with the blessings of the Medical Council of India (MCI).

The Medical Council of India, the country’s regulator for medical education and practice, has been accused of corruption in granting recognition to medical colleges.

In 2016, Supreme Court in its judgment on MCI:

The Supreme Court in its judgment dated April, 2016, while placing an oversight committee for MCI, had mandated a period of one year for the government to undertake reforms in regulation of medical education and set up appropriate systems in place.

Thus, achieving high growth in healthcare to meet the growing needs is an area of high priority. Reforms in medical education are necessitated and will have to be undertaken sooner than later.

However, the needs of medical profession namely professional autonomy and identity have to be appropriately addressed while holding the professionals accountable.

One of the primary responsibilities of the MCI is to regulate medical education in the country. The NITI Aayog suggested the creation of NMC in August 2016.

The proposed bill has suggested forming an NMC, which will be a policy-making body for medical education. Scrapping MCI might not be the right move in the long term.

National Medical Commission Bill:

The NMC will be 29-member body which would comprise of 20 members selected through nomination, and nine through election.

• The new National Medical Commission Bill has the provision for making national standards in medical education uniform by proposing that the final year MBBS exam be treated as an entrance test for post graduation and a screening test for students who graduated in medicine from foreign countries. This exam will be called the National Exit Test (NEXT).
• At present, different medical colleges have different MBBS exam patterns. The NMC’s proposal is to ensure a uniform national pattern for final year MBBS exam so that all medical graduates who get the licence to practise conform to uniform national standards and quality. This bill seeks to establish uniform standards for medical education.
• The medical colleges will have to conform to standards the NMC will lay down. Once they conform and are permitted to operate, there would be no need for annual renewals.
• Perhaps the stand-out provision of the bill is its intent to cap fees on 50% of seats in MBBS and PG courses at private medical colleges. This seems to be a good interim measure, given the state-created squeeze on seat supply.
• However, price caps should not get institutionalized as a matter of policy. What the government needs to do is set up a large number of new medical colleges.
• Simultaneously, it must allow private players, as many as possible, to set up colleges with permits granted in an open and transparent manner.

An increase in the number of seats, along with scrupulous regulation, would do a better job of solving the sector’s problems than price caps, which are inherently arbitrary and could distort the dynamics of medical education in the long term.

What are the changes in the 2019 Bill?

On the National Licentiate Examination, the Committee (in 2018) recommended that the relevant clause be redrafted “so as to make the final year MBBS examination as the licentiate examination”.

There are two crucial changes, following the recommendations of the Parliamentary Standing Committee on Health and Family Welfare (109th report in 2018).

• One, it has dropped a separate exit examination.
• Two, it has dropped the provision that allowed practitioners of homoeopathy and Indian systems of medicine to prescribe allopathy medicines after a bridge course.

What the Bill provides was Four Autonomous Boards:

The structure is in accordance with the recommendations of the Group of Experts headed by Ranjit Roy Chaudhury, set up by the Union Health Ministry to study the norms for the establishment of medical colleges.

The National Medical Commission Bill of 2019 proposes to have four autonomous boards to take care of its different functions:

• Under-Graduate Medical Education Board to set standards and regulate medical education at undergraduate level.
• Post-Graduate Medical Education Board to set standards and regulate medical education at postgraduate level.
• Medical Assessment and Rating Board for inspections and rating of medical institutions and
• Ethics and Medical Registration Board to regulate and promote professional conduct and medical ethics and also maintain national registers of (a) licensed medical practitioners and (b) Community Health Providers (CHPs).

NEXT would also serve as the screening test for doctors with foreign medical qualifications in order to practice in India.

The Bill marks a radical change in regulatory philosophy; under the NMC regime, medical colleges will need permission only once for establishment and recognition.

Concerns that need Correction in the bill:

• 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.
• 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.
• The bill allows private medical colleges to charge at will, nullifying whatever solace the NEET brought.
• 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.
• 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.
• Standards have been laid down for MCI courses, but not for NBE courses which are often run in private hospitals and nursing homes.

Conclusion:

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.

It is crucial now for the Centre to work amicably with States, and the Indian Medical Association, which is opposed to the Bill, taking them along to ease the process of implementation. The problem of brain drain should be addressed.

At any cost, it must avoid the creation of inflexible roadblocks as happened with NEET in some States.

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

It also removed, rightly, a proposal in the older Bill for a bridge course for AYUSH practitioners to make a lateral entry into allopathy.

The clearance of these hurdles, then, as recalled from experience, become fraught with legal and political battles, leaving behind much bitterness. NEXT will have to be a lot neater.