New Delhi: The National Medical Commission (NMC) Bill, 2019 was passed by the Lok Sabha Monday and introduced in the Rajya Sabha Thursday.
The Bill aims to repeal the existing Indian Medical Council Act, 1956, and replace the Medical Council of India (MCI) with a new body — National Medical Commission.
The medical fraternity has, however, raised objections to the Bill, and doctors across the country went on a strike Wednesday, with more hospitals joining Thursday. The strike was called by the Indian Medical Association.
ThePrint explains the provisions of the Bill, the reasons behind the doctors opposing it, and its pros and cons.
Provisions of the Bill
The Bill aims to set up a National Medical Commission with 25 members. These members will be appointed by the central government on the recommendation of a committee.
The members will include a chairperson, who must be a senior medical practitioner and academic with at least 20 years of experience, 10 ex officio members and 14 part-time members.
The ex officio members will include the presidents of the undergraduate and postgraduate medical education boards, the director general of Indian Council of Medical Research, and a director of one of the AIIMS, among others.
Part-time members, on the other hand, will include experts from the field of management, law, medical ethics, etc. and nominees of states and union territories.
Compared to the present 70 per cent figure of elected representatives in the Medical Council of India (MCI), only 20 per cent members of the NMC will be elected representatives.
Unlike MCI, whose decisions were not binding on state medical councils, the NMC Bill allows the commission’s ethics board to exercise jurisdiction over state medical councils on compliance related to ethical issues.
Also, while action can be taken against the MCI president only on the direction of a court, the NMC Bill enables the central government to remove the chairperson or any other member of the commission.
Why doctors are against NMC
The opposition to the Bill is centred around three major factors.
Section 32 of the Bill empowers the commission to “grant limited licence to practise medicine at mid-level as Community Health Provider”.
Critics argue that the term ‘Community Health Provider’ has been vaguely defined, and this will allow people without sufficient medical background to practise medicine.
The second bone of contention is the National Exit Test (NEXT) proposed by the Bill. Currently, admissions to postgraduate medical courses are done through NEET-PG (National Eligibility cum Entrance Test for Postgraduate). However, NEXT has been conceptualised as a single test, which will act as a common final-year undergraduate medical exam and be used for granting medical licence as well as admission to postgraduate courses.
Medical practitioners are currently required to register with a state medical council to practise, but they are not required to give any test to obtain a licence.
It has also been argued that a single exam is being accorded too much weightage, and it can have an adverse impact on the career of medical aspirants.
Thirdly, the Bill allows the commission to “frame guidelines for determination of fees and all other charges in respect of fifty per cent of seats in private medical institutions and deemed to be universities”. This increases the number of seats for which private institutes will have the discretion to determine fees. At present, in such institutes, state governments decide fees for 85 per cent of the seats.
There have also been suggestions to put a cap on the fees charged by unaided medical institutes.
NMC Bill may help curb corruption in MCI
Some of the provisions of the Bill, however, may prove to be helpful in fighting corruption, which had affected MCI.
Unlike MCI, the members of NMC will have to declare their assets at the time of assuming office and when they leave. They will also have to submit a conflict of interest declaration.
The members will have to serve a two-year cooling-off period after their tenure, which, however, could be waived by the government if required.
Also, the World Health Organization prescribes a doctor to patient ratio of 1:1,000, but as reports indicate, India is far from achieving that target. Allowing ‘Community Health Providers’ to practise medicine is likely to plug this shortfall to some extent.
The author missed the most important criticism of the NMC Bill. Under MCI, every new medical college needed to have infrastructure and staff before getting temporary recognition to admit students as well as permanent recognition after 5 successful inspections. Also, the staff salaries are determined by MCI.
Under the NMC, there is no preconditions or license approval or permissions on the infrastructure and staff required or the salaries they are paid. Anyone can open a medical college in a shed and higher a couple of teacher with meagre salaries and declare themselves as an ongoing medical college. Of course, there will be inspections under NMC but the inspection team or the NMC committee will not penalise or withdraw recognition. They will simply put their inspection reports on website for students to analyse and decide whether they want to join such a college. The college can still be run by the management and you will put out incompetent doctors.
College managements can go the other way too under the same set of rules. They can have good infrastructure and pay hefty salaries for teachers and incentives for patients by fleecing the students [since they can decide any amount of fees for 50% students] and then they can simply auction the degrees without proper training or examinations resulting in incompetent doctors.
PLEASE NOTE THAT THE NMC DOES NOT DO INSPECTIONS OF EXAMS CONDUCTED IN COLLEGES.
Once these half-baked doctors give NEXT and fail the exam, then the government will be forced to relax the pass criteria because after 5 years of training, the student cannot change his college unless he does the whole training programme of 5 years again [Already happened with medical colleges like Fathima Medical College, Cuddapah, Andhra Pradesh].
Or the government will cancel the NEXT exam completely leaving the final exam again in the hands of the college management.
Please discuss the NMC BILL in detail with medical professionals who are aware of the problems. The media needs to study the matter with greater interest and put out in the public domain as well as actively participate in this. The number of doctors are very few in the country and no government will listen.
If the media as well as the common people are not going to listen to actual medical professionals just like the central government, then there is no choice but for medical professionals to take extreme steps.
These extreme steps are to protect the public from quacks and incompetent degree holders in the future.
PLEASE UPDATE YOUR ARTICLE WITH THE INFORMATION I HAVE PROVIDED. YOU CAN READ THE WHOLE NMC BILL AND REALISE IT FOR YOURSELF. PLEASE INVOLVE YOUR EDITOR AS WELL AS OTHER NEWS OUTLETS. THERE ISN’T MUCH TIME.
Biggest issue is that NMC allows all without setting criteris to have community health providers to become doctors in rural areas, why not set criteria to do that, how will doctors who work nearly 5.5 years of their life to get a doctor degree warm up to competition who do bridge course of 2 years? So Govt is now recommending quacks in rural areas to prescribe medicine to less fortunate people of villages?