Introduction :- 

The ordinance amends the Indian Medical Council Act, 1956 and provides for the supersession of the MCI for 1 year till National Medical Commission Bill is cleared in the Parliament. In the interim period, the central government will constitute a Board of Governors, which will exercise the powers of the MCI. The Board of Governors (BOG) has 7 members with one of these members as the Chairperson of the Board (NITI Aayog Member Dr. V. K. Paul).

Various committees such as Ranjit Roy Chaudhury committee (2015), Lodha Panel (2016) and Arvind Panagariya have previously suggested scrapping of the MCI. An oversight committee to oversee the MCI, set up on the direction of the Supreme Court recently resigned citing instances of “non-compliance of their instructions by MCI.” Recently Indian Medical Council (Amendment) Ordinance, 2018 was issued dissolving the Medical Council of India (MCI) and replacing it with a Board of Governors (BOG). 

National Medical Commission Bill, 2017 :-

The Bill sets up the National Medical Commission (NMC) which shall replace the MCI (Medical Council of India) as top regulator of medical education in India. It will:

• have 25 members.
• frame policies for regulating medical institutions and medical professionals.
• recognize medical qualifications.
• determine fees for some seats in private medical institutions and deemed universities.

A Medical Advisory Council (MAC) will be set up to provide a platform to states/union territories to express their views and concerns. Four autonomous Boards have been set up under the supervision of the NMC.

• Under-Graduate Medical Education Board (UGMEB)
• Post-Graduate Medical Education Board (PGMEB)
• Medical Assessment and Rating Board (MARB)
• Ethics and Medical Registration

A National Eligibility-cum-Entrance Test (NEET) will be conducted for admission to under-graduate medical education in all medical institutions regulated by the Bill. State Medical Councils will be set up which will have a role similar to the NMC, at the state level. There will be a National Licentiate Examination for doctors to obtain a licence to practice after graduation The Bill allows practitioners of Ayurveda and other traditional Indian systems of medicine the licence to prescribe allopathic drugs after they have passed a ‘bridge course’

Arguments for scrapping MCI :- 

• Allegations of corruption: There have been multiple allegations of bribery against MCI office bearers. In fact the MCI president himself was arrested for allegedly accepting a bribe.
• Opaque functioning: The opaque accreditation process to medical colleges is one of the major arguments against MCI.
• Separation of functions: The MCI has been criticised for concentration and centralisation of all regulatory functions in one single body as it regulates both medical education as well as medical practice.
• Conflict of Interest: The MCI members are elected from the same medical fraternity that they have to control. So there is a clear conflict of interest and the MCI has become an exclusive organisation “by the doctors, for the doctors and of the doctors”. It is heavily influenced by corporate hospitals and meanwhile also provides them with accreditation and assesses their quality.
• Lack of emphasis on medical ethics: The present focus of MCI is only on licensing of medical colleges and no emphasis is given to the enforcement of medical ethics in education.
• Rising cost of Medical education: It has failed to stop the sale of medical seats in private colleges for a high capitation fees.
• Lack of sufficient manpower: It failed to produce sufficient number of doctors. India has 1 doctor for every 1674 people against WHO norm of 1 for every 1000 people. Shortage of teachers in medical colleges also remains a major challenge.

Issues with implementation of the new structure :- 

• Autonomy: Critics argue that the autonomy of medical education will entirely go into the hands of the government with MCI getting scrapped. Having nominated members may lead to the chief qualification being proximity to the government of the day.
• Issues with the NMC bill: Fee Capping Dilemma: The NMC will determine fees for up to 40% of the seats in private medical colleges and deemed universities. There have been various arguments on fee capping by experts: Some experts say that fees should be capped to enable access to medical education for all. On the other hand, some suggest that fee capping would discourage entry of private colleges.
• Need of diverse stakeholders: 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. Against federal setup: Previously, all the State governments had representation in MCI while in the NMC bill, only few States in rotation will have representation.
• Appellate authority: In cases of professional or ethical misconduct by medical practitioners, the practitioners can appeal against decision of the NMC to the central government. It is unclear why the central government, and not a judicial body, is the appellate authority.
• Renewal of license: 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.
• ssues with the bridge course: While some emphasise the need for greater integration between traditional and modern schools of medicine, others consider this step harmful for the independent development of AYUSH.

Way Forward :-

The government has shown a conciliatory approach by accepting some amendments to the Bill as suggested by the Parliamentary Standing Committee:

• Removing the National Licentiate Examination provision: Final MBBS Examination to be held as a common exam across the country and would serve as an exit test called the National Exit Test (NEXT).
• Removing the provision of Bridge course for AYUSH practitioners.
• Fee regulation for 50% seats (bill had 40%) in private medical institutions and deemed universities.
• Hence, the government must now move urgently on passing the NMC Bill in the parliament. The larger goal of a revamp should be to improve both medical practise and medical education in the country.