National Medical Commission Bill, 2019: A Reform in Medical Education and Practice?

Modi government, after an initial effort during the previous Lok Sabha, has again made an attempt to replace the Medical Council of India (MCI) with a National Medical Commission (NMC) to regulate medical education and practices in India. The National Medical Commission (NMC) Bill, 2019 was passed by Rajya Sabha and Lok Sabha in spite of several protests by the doctors across the country. Harsh Vardhan, the Union Health Minister, mentioned this bill as one of the biggest reforms which will end inspector raj of the MCI [1].

The bill proposes for the constitution of four autonomous boards under NMC. These are: (i) Under-Graduate Medical Education Board, (ii) Post-Graduate Medical Education Board, (iii) Medical Assessment and Rating Board, and (iv) Ethics and Medical Registration Board which will also maintain national registers of (a) licensed medical practitioners and (b) Community Health Providers (CHPs). The CHPs are a new class of medical practitioners (one-third of the total medical practitioners) who will practice modern medicine. This is actually a new version of the “bridge course” which was proposed in the original Bill. Dr RV Asokan, secretary-general of the Indian Medical Association (IMA), said that this may open the door for persons with inadequate training in modern medicine to practice, putting patients at risk and lowering standards of healthcare, especially in the rural areas [2]. In this way, the government is trying to wash its hands from the responsibility of providing universal healthcare to all. This attempt to fill up the shortage of doctors will open a new legal system of producing ‘qualified medical quacks’.

Moreover, “currently, fee for 50% seats in private medical colleges (for MBBS) is for students that come through the Centre’s NEET exam and fees are regulated by the government. State governments decide for the other 35% which is higher but still manageable. The remaining 15% is what is called the ‘management quota’ where the fees are really high,” Dr Asokan said [3]. As per the new bill, the government would decide the fee for 50% seats only. This means that the management will decide the fees for the rest of the 50% seats, raising the cost of medical education several times. Besides, in the present system, medical colleges required the MCI’s approval for establishment, recognition, renewal of the yearly permission or recognition of degrees; whereas, as per the new bill, the powers of the regulator are reduced to establishment and recognition, meaning that recognized medical institutions don’t need the regulator’s permission to add more seats or start new PG courses. This move clearly indicates that the aim of the government is to encourage the private medical colleges and gradually privatize the entire healthcare system. The common National Eligibility and Entrance Test (NEET) will also favor students who are predominantly urban, rich, and upper caste, and who can afford the private tuition classes and highly priced coaching centers needed to score well in such exams. Thus, medical education will be made selectively available to privileged social elites [4].

The bill has also a proposal for a common final year exam for MBBS students, known as the National Exit Test (NEXT), which will give both licenses for practice (who have cleared the MBBS exam) as well as for admission to post-graduate (PG) courses. However, the two objectives can’t be matched since the level of knowledge and training required for both are very different; “and undermining the value of first, second and third year subjects is also not appropriate,” said Dr. Harjit Singh Bhatti, ex-president, Resident Doctors Association, AIIMS [3]. The fate of the students, who do not clear the test, will also remain uncertain. Moreover, the attempt will incentivize MBBS graduates to move to urban areas and pursue post-graduation. They may also try a little more and prepare for PG entrance exam outside India. India has already become the largest source of physicians in the United States and the United Kingdom, second largest in Australia, and third in Canada [4]. This, in effect, will hamper the delivery system of health services, especially in rural India.

The NMC bill was created in response to increasing criticism of the functioning of the MCI by several stakeholders, including the Supreme Court [4]. Many of its members have been accused of taking bribes in exchange for granting accreditation to the aspiring medical colleges. However, the formation of NMC would replace an elected body (MCI) with one where representatives are ‘nominated’. While MCI was an autonomous body with two-third of its members being directly elected by the medical fraternity, NMC will have government nominated chairman and members, and the board members will be selected by a search committee under the Cabinet Secretary. Also, the power the Bill gives to the central government to give policy and other directives to the NMC and its autonomous boards will be binding and final. The central government has also been empowered to give directives to state governments for implementing provisions of the Bill, reflecting its anti-federal character. This shift from the elected MCI to the nominated NMC is a shift from a democratic system towards an autocracy.

 

 

REFERENCES

[1] Bakshi, G. (2019, August 02). Rajya Sabha Passes National Medical Commission Bill, 2019. Retrieved August 22, 2019, from Jagran Josh: https://www.jagranjosh.com/current-affairs/national-medical-commission-bill-know-what-is-next-bridge-course-and-nmc-structure-1563876643-1

[2] Mohanty, P. (2019, August 14). National Medical Commission Bill 2019: What is it and why is the medical fraternity opposed to it? Retrieved August 22, 2019, from Business Today: https://www.businesstoday.in/opinion/columns/national-medical-commission-bill-2019-medical-education-in-india/story/367328.html

[3] Kohli, N. (2019, July 20). Indian Medical Association gears up for ‘war’ against bill to replace MCI. Retrieved August 22, 2019, from The Week: https://www.theweek.in/news/india/2019/07/20/Indian-Medical-Association-gears-up-for-war-against-bill-to-replace-MCI.html?fbclid=IwAR11w7_9z7k03Jegnch_4XbZr9tfkBZXN98qsmqpqc4KPRVSQKwuQ2xGPNg

[4] Mazumder, P. (2018). National Medical Commission Bill, 2017: A Shattered Hope? Economic and Political Weekly, Vol. LIII, No. 5, pp. 12-15.

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