Mediating medical intervention
The National Medical Commission Bill requires scrutiny and correction before being finalised
The Medical Council of India (MCI), responsible for regulating medical education in the country, has relentlessly been accused of corruption. One of its office bearers even suffered the ignominy of being sent behind the bars and is still facing trial in two cases. To eliminate corruption in the MCI, the UPA government in 2001 amended the Act and acquired the rights to institute an inquiry in case of any complaint of corruption. The rights to grant permission to start a new college or a new course came to the government, of course, on the recommendation of the MCI. But the clamour to cleanse the medical education system remained unabated. In this backdrop, the NDA government tabled the National Medical Commission Bill, 2017 in the Parliament on December 29, which sought to replace the MCI with National Medical Commission.
The Preamble of this Bill does make decent declarations, like, it is intended to create a world-class medical education system that would ensure the adequate supply of high-quality medical professionals at both undergraduate and postgraduate levels, encourage medical professionals to incorporate the latest medical research in their work and provide for objective periodic assessments of medical institutions. It also mentions that it would facilitate the maintenance of a medical register for India and enforce high ethical standards in all aspects of medical services.
Why then within hours of it being tabled in the Lok Sabha, did resentment among private sector doctors, a community not less than a million, hit the roof? Their representative organisation Indian Medical Association (IMA) termed the Bill as 'anti-poor' and 'pro-corruption'. It sounded an alarm, if the Bill is passed as it is, the quality of medical education would deteriorate and corruption will increase. At the call of the IMA, private sector doctors went on a 12-hour strike across the country on January 2. Realising the prospects of an unprecedented chaotic situation, given the private sector share in health care is 75-80 per cent, the government didn't think twice before sending the Bill to the Parliamentary Standing Committee to address the doctors' objections. Meanwhile, the opposition to its various provisions has become shriller.
Various provisions of the Bill make it clear that the remedy offered by the National Medical Commission Bill is worse than the disease. Various associations of doctors across the country along with veteran professionals maintain that the Bill is non-representative, autocratic and against the federal policy of the country. The IMA claims that several provisions in the Bill create opportunities for corruption, even as it gives private medical colleges unrestrained freedom to make more money, no matter how expensive medical education becomes with lower standards. This indeed is being seen as a gross injustice to the brilliant young population of our country.
The Bill enables NMC to grant approval to start medical colleges even without inspection of whether norms and standards are being complied or not. It has been assumed that the colleges would comply in fear of penalty. There are, of course, stiff penalty provisions against any wrongdoing. The proposed Commission can levy a huge fine from Rs 5 crore to Rs 100 crore. But, this huge range leaves immense scope for bargaining which may breed corruption, whereas under the current system of regulation the MCI can keep the approval suspended till the compliance is achieved. This apart, it is obligatory for the MCI to carry out inspection every year for the first five years and thereafter, once every five years. This creates enough pressure on colleges to ensure requisite infrastructure, faculty, and standards.
Another absurdity in the Bill is related to the manner in which a private medical college can start a new course on its own without seeking previous permission of the government in consultation with the MCI. The college managements are being given the right to exercise their own discretion to start a new course, whereas, in the existing system, the MCI ensures that the college first has suitable faculty and facilities like training in a hospital.
The provision of fee-fixation in private medical colleges has also been found objectionable. The proposed NMC would be authorised to fix fees maximum up to 40 per cent only of the total number of seats. The scope for variation to the lower side even in this 40 per cent limit again creates a ground for bargain and can breed corruption. Fees for the minimum 60 per cent seats, anyway, would be determined by private medical colleges themselves. What would be the impact of all this on the common people? It will make the medical education even costlier. And yet, there would be no guarantee of the quality.
Another thing that is deeply agitating the minds of medical students along with the doctors, is the compulsion of passing the Licentiate examination after attaining the MBBS degree to become eligible to practice. This is purportedly prescribed to eliminate candidates with dubious merit irrespective of them acquiring the MBBS degree. It is feared that this will become a tool to punish pass-outs, not the medical colleges, which offered sub-standard education and whose examination system failed to weed out the non-meritorious. This provision becomes even more bizarre when it is found that the Bill is allowing AYUSH (Ayurvedic, Homeopathic, Unani) doctors to get the right to practice modern medicine just after passing a six-month bridge course.
Most medical professionals hold that modern medicine and AYUSH are two different sciences, with different diagnostics and treatments. Why should they be mixed up? AYUSH should be promoted independently with research to develop a sound evidence base. If this is done, enormous growth potential will be unleashed. But the way it has been dealt with in the Bill, it is not going to enhance the prestige of AYUSH and would instead make people the scapegoat. Doctors ridicule the move as promoting 'mixopathy'.
An even more important issue is who should regulate medical education. General practice worldwide is that professions that require exclusive expertise and competence should be regulated by professional experts in the respective fields. In India also, this is an accepted norm. That is why we find the Bar Council of India regulating advocates, Institute of Chartered Accountants of India is doing so for CAs, Institute of Cost and Works Accountants of India (ICWAI) for cost and works accountants, Institute of Company Secretaries of India for company secretaries, Council of Architecture for architects and Medical Council of India for doctors. It is, therefore, legitimately being questioned why demolish MCI alone and replace it with a nominated National Medical Commission?
The MCI is a doctors' representative body which comprises 200 elected members from among the doctors and medical professionals, seven members from each state; but in the 25-member proposed NMC, 20 would be nominated and five would be elected, making it indisputably a body of nominated persons.
It is hoped that the Parliamentary Standing Committee would modify the Bill adequately to address the concerns of the doctors, medical professionals, educationists, and consumers. Call it a Commission or Council, it should be an autonomous, transparent and representative body. It has been suggested that elected members should not be less than 70 per cent and the government must fix the fees for all the seats whether it is a private college or government institution. Criteria for starting a new medical college or a new course by an existing college should be strictly adhered to and there should not be any relaxation in inspections. The Licentiate examination should be ruled out altogether as the contents of this test can easily be accommodated as a part of the MBBS curriculum. And last but not the least, the AYUSH doctors should not be provided with the facility of lateral entry into the modern medicine practice via a short duration.