New Delhi: The National Medical Commission’s (NMC’s) proposal to make Heads of Department (HoDs) in medical colleges step down every three years faces an uncertain future after the Postgraduate Medical Education Board (PGMEB), an autonomous statutory board under the commission, recommended that the provision be revisited following strong opposition from stakeholders.
The proposal, published as a draft amendment to the Postgraduate Medical Education Regulations (PGMER) 2023, sought to replace the long-standing practice of the senior-most professor serving as HoD until retirement with a mandatory three-year rotational system. Under the proposed rule, the post would rotate among eligible professors and associate professors in a department based on seniority.
Feedback sought by the NMC, however, suggests the idea found only limited support. Of the 421 responses received specifically on the proposed HoD rotation clause, 249 stakeholders — nearly 59 per cent — opposed it, while 172 supported it, according to a detailed note prepared by the PGMEB and reviewed by ThePrint.
The board has recommended against enforcing rotation solely on the basis of seniority and instead suggested a merit-cum-seniority framework that preserves institutional discretion in selecting department heads.
The PGMEB said stakeholders had raised concerns ranging from disruption of academic and research continuity and administrative inefficiency to the risk of workplace friction and erosion of institutional autonomy. It also noted that institutions such as the All India Institute of Medical Sciences (AIIMS) rely on performance, peer recognition and administrative capability, rather than fixed-term rotation when selecting HoDs.
The NMC, however, says the matter remains under discussion. “No final decision has been taken in the matter. The proposed amendment is still under active discussion with stakeholders,” NMC Chairman Abhijat Sheth told ThePrint.
Why NMC proposed the change
India has more than 800 medical colleges, offering nearly 1.3 lakh MBBS seats. Every department in these colleges — from medicine and surgery to dermatology and radiology — is headed by an HoD, who oversees faculty deployment, patient-care responsibilities, postgraduate training, examinations and research activities.
Under the existing system, the post typically goes to the seniormost eligible professor, and remains with them until retirement or superannuation from the role.
The NMC’s draft amendment sought to change that. It proposed that the post of HoD be rotated every three years among eligible professors and associate professors in a department, based on seniority.
The idea itself is not entirely new. Variants of rotational headship have been discussed in the past, including at premier institutions such as AIIMS, Delhi and Postgraduate Institute of Medical Education and Research (PGIMER) Chandigarh, following recommendations made by a committee headed by Dr V.K. Paul. However, the model was never formally implemented there. The latest proposal marked the NMC’s first attempt to introduce a uniform framework across medical colleges nationwide.
Supporters of the proposal argued that rotational headship would promote more democratic governance, reduce concentration of power and create clearer pathways for leadership succession. According to the PGMEB note, it could also widen leadership opportunities for younger faculty members and encourage more transparent administrative practices.
Dr Amrinder Singh Malhi, assistant professor in the department of radiodiagnosis and interventional radiology at AIIMS, Delhi, told ThePrint that much of the resistance appears to come from “traditionally entrenched administrative structures and senior groups” uncomfortable with leadership transitions. According to him, younger and mid-career faculty members are increasingly supportive of rotational and accountable leadership models because they prevent excessive concentration of authority and allow a larger pool of academics to take on leadership responsibilities.
Malhi argued that rotational leadership could improve accountability while ensuring that department leadership is not concentrated in the hands of a single individual for prolonged periods. At the same time, he favoured a merit-cum-seniority framework with safeguards to ensure continuity and stability in departmental functioning.
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Why so many oppose mandatory rotation
The PGMEB’s review note suggests the opposition was driven less by resistance to change and more by concerns over how academic leadership should be selected.
Among the most common concerns raised by stakeholders was that seniority alone should not determine who heads a department. Many argued that leadership positions should take into account factors such as administrative ability, teaching experience, research output and institutional requirements.
Stakeholders also warned that compulsory three-year rotations could disrupt long-term academic planning and research projects, many of which extend well beyond a single leadership term. The board noted that leadership stability is often crucial for maintaining research collaborations, postgraduate programmes and departmental strategy.
Another concern was that mandatory rotation could result in relatively junior associate professors effectively supervising senior professors, creating administrative and hierarchical tensions within departments.
The PGMEB further observed that rigid rotation could weaken institutional autonomy by limiting colleges’ ability to appoint department heads according to their own requirements. It also warned that automatic rotations could increase internal politics rather than reduce it.
The board concluded that a merit-cum-seniority framework, supported by periodic performance reviews and institutional discretion, would be preferable to a mandatory rotation policy.
A contrarian view was offered by Dr Kabir Sardana, head of dermatology at Delhi’s Ram Manohar Lohia Hospital. “The head of department is an administrative post in the government of India as per the Gazette of 2019 which overrides the NMC . You cannot have a junior person sitting on a senior position. This is a standard rule of the government of India, except at the level of Secretary, “ he told ThePrint.
Sardana also questioned whether the NMC should be regulating what he described as a service matter. He pointed out that institutions such as AIIMS, Delhi and PGIMER, Chandigarh have never implemented mandatory rotational headship despite years of discussion around the idea. This is when they are not even under the purview of NMC
“Even the AIIMS hierarchy and the government of India which supersedes views of the association does not feel it is useful,” he said.
According to Sardana, fixed-term leadership could discourage HoDs from taking difficult administrative decisions or pursuing long-term institutional goals because they know they will be replaced after a fixed tenure regardless of performance. In fact, there are lacunae in any system that involves both faculty and facilities and no HOD would be interested in taking any stand
“You will create administrative paralysis,” he said, adding that some senior faculty members at premier institutions have previously resigned rather than serve under what they viewed as diminished administrative arrangements.
“It is commendable the NMC has taken feedback and decided to consider a stand back as probably they have unknowingly invaded into an order which has no administrative or legal sanctity as evidenced by the stay granted by Supreme Court in this matter in 2022,” he added.
The Karnataka case
Even as the NMC was consulting stakeholders on the proposal, a parallel legal battle over the same issue was unfolding in Karnataka, one that has now reached the Supreme Court, and could have implications far beyond the state.
The dispute began after Karnataka’s autonomous medical colleges adopted a common by-law in December 2023 mandating rotation of HoDs every three years. The rule was applied retrospectively, and at the Karnataka Institute of Medical Sciences (KIMS), Hubballi, it cost two serving professors their posts: Dr Anche Narayana Rao Dattatri, head of pharmacology, and Dr Gurushantappa Yalagacchin, head of general surgery.
Dattatri and his co-petitioner challenged the by-law before the Dharwad bench of the Karnataka High Court. A single-judge bench ruled in their favour, holding that the by-law could not override the NMC’s 2022 Teachers Eligibility Qualifications Regulations. Under those regulations, HoD posts, being administrative in nature, must follow seniority, and the doctors were ordered reinstated.
The state government appealed, and within weeks a division bench reversed the single judge’s order. It held that the single judge had erred in treating the HoD’s post as purely administrative, and that KIMS’ rotational by-law served a legitimate purpose: encouraging diverse perspectives within departments, which the court found neither arbitrary nor in conflict with NMC regulations.
Dattatri then approached the Supreme Court, which granted a stay on Karnataka’s rotational policy in April 2024. Later that year, in November 2024, the court also made the NMC a respondent in the case, given its potential implications for medical institutions across the country.
Before the court, the NMC reportedly argued that while the HoD’s post may technically be administrative, the decision on whether to rotate it should be left to individual institutions. At a hearing on 19 May 2026, the Karnataka government counsel argued that the NMC’s newer 2025 regulations don’t classify HoD as an administrative post at all, a position Dattatri’s side was set to contest on the ground that the 2022 regulations should still apply since the 2025 rules are silent on the question. With the presiding judge due to retire at the end of June 2026, the matter was adjourned to 11 August 2026, to be heard afresh by a new bench.
Dattatri told ThePrint he was not opposed to merit-cum-seniority based appointments. “I have no problem with merit being made a criteria,” he said. “However, selection criteria should be notified in well in advance and there should be a transition period to allow the doctors to fulfill the same,” he said.
What he opposed, however, was the “mechanical” rotation that mandates that senior professors should automatically make way for junior colleagues without regard to institutional needs, individual performance or continuity in departmental functioning. He also objected to the retrospective implementation of the Karnataka by-law, arguing that sudden removal of serving HoDs was unfair.
(Edited by Nardeep Singh Dahiya)
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