The National Medical Commission (NMC) would be a good alternative to the tainted Medical Council of India (MCI) that has been facing severe criticism over the alleged corruption, experts tell Youth Ki Awaaz. They unanimously noted that the NMC bill, currently tabled in the Parliament’s ongoing monsoon session, would make the role of medical regulator more patient-centric than the existing doctor-centric model.
“There’s a gross corruption and mismanagement involved in terms of college accreditations and maintaining uniform quality of medical education in the country. We needed some strong reforms and NMC is in the larger interest of a populous country like India,” pointed out Dr. Shamika Ravi, a senior fellow at Brookings India and author of ‘Restructuring of Medical Council of India’.
The proposed bill, however, hasn’t gone down well with the doctors. Highlighting the bureaucratic overreach in appointing members to the advisory board, Indian Medical Association (IMA) has called the NMC bill undemocratic.
According to IMA President Dr. KK Agarwal, “By dissolving a democratically elected body of 150 medical professionals and replacing it with a body of 25 members of which 20 will be nominated by the government is undemocratic. It’s a clear indication that government is hell-bent to take control over the medical profession.”
According to medical experts and industry insiders, MCI is a failed institution and there was a pressing need to revamp the regulatory mechanism of medical education and practice. The Parliamentary Health Committee in its March 2016 report noted that MCI has failed on all accounts to act as a neutral regulator.
The Niti Aayog had also pointed out that the medical regulator had failed to produce doctors suited to meet the Indian context.
Commenting on the deep-rooted corruption in MCI and why private doctors are up in arms against the NMC bills, a Jaipur-based medical representative under the condition of anonymity told YKA, “MCI is a body of corrupt doctors that want to safeguard their interests. Doctors right during the graduation or post-graduation courses become part of doctor-pharma nexus. Officially IMA and MCI have issued guidelines to discourage this nexus. But, that’s eyewash.”
The proposed NMC bill is a resultant of two-year-long deliberations with the medical experts, policymakers, and various stakeholders.
1.) Checks and Balances:
The NMC bill was floated to ensure transparency with the division of powers. Under the NMC three independent boards-Search and Selection Committee (SSC), Medical Advisory Council, and the National Medical Commission- will operate with autonomy from the others, thereby creating a mechanism for check and balances.
But according to IMA’s President Dr. KK Agarwal, “Whatever changes they are suggesting through NMC, they can easily bring them by amending MCI. All we want is dismiss NMC and amend MCI. The autonomy of the medical profession shouldn’t be comprised by bureaucratic control.”
2) Integrated Health Care Model
The first draft of the Bill proposes to streamline various AYUSH and Homeopathic practitioners and create an integrated healthcare model where the state governments decide the modalities of the provision.
Many fear the integration of the AYUSH doctors will legitimise the quackery.
However, according to experts, the integration of Homeopathy, Ayurveda and other alternative medicinal practitioners is in line with WHO-approved ‘Task Shifting’ mechanism to address the scarcity of doctors. Under this mechanism, less specialised health workers are trained to strengthen and expand the health workforce.
3.) Fee Structure And Exit Exams:
The NMC bill proposes that the government will determine and regulate the fee structure of 50% of the seats in private medical colleges. The government has claimed that it will provide the students from poor background to pursue medical education which was earlier impossible due to high fee structures of the medical institutions.
“Not everyone is part of the creamy layer that makes to the government colleges. And the high fees of private colleges was a deterrent for the medical aspirants from the poor background. While it is still to be seen how much of this translates into reality, it’s a positive step from the government to make medical education in private institutions accessible to all,” said Dr. Jayesh Sheth, founder, and chairman at Foundation for Research in Genetics and Endocrinology, Institute of Human Genetics.
But, the public statement issued by IMA said, “Reservation of 50% of the seats for the rich, who can pay, is denial of equitable opportunities and hence is certainly anti-people.”
Furthermore, after the amendment, the Cabinet has approved that under NMC the final MBBS examination would be held as a common exam across the country. This would serve as an exit test, called the National Exit Test (NEXT), and would be a prerequisite to practice Allopathy. The common exam is expected to ascertain uniform quality of doctors throughout the country.
IMA has called the proposal of centrally-administered common exam anti-federal. It has asserted that the bill marginalises state governments, state medical councils and state health universities.
While the NMC bill aims to cure the medical practice in India, there are widespread apprehensions on its success. This is the second attempt by the Centre to replace MCI in last decade.