On Tuesday the 2nd of January 2018, thousands of doctors from across the country joined the heated protest against the proposed National Medical Commission (NMC) bill. The bill was brought forth with the aim of replacing the Medical Council of India (MCI), which is mired in severe allegations of corruption, with a National Medical Commission, so that the medical ecosystem of the country could be transformed for the better. After facing stiff opposition from most of the medical fraternity, the bill was sent to the standing committee for reconsideration. Here, we examine some really disconcerting aspects of the bill in it's current form, which shall merit serious consideration in the process of creating a more acceptable version of it.
Adequate stakeholder participation is imperative in the decision-making process. When we aim to frame policies for the blind, the disaster-affected, or the mentally ill -- our primary stakeholders are none other than the blind, the families of the disaster-affected, and psychiatric patients themselves respectively. Even though the decisions pertaining to the medical profession are undeniably of interest to the entire society, the primary stakeholders are none but doctors. Taking this as a given, doctors deserve adequate representation in the committee.
Further, the committee would indispensably need a squad of highly experienced doctors from different medical specialties and disciplines (including primary care) to be able to make favourably balanced decisions–decisions by which it shall govern and regulate the whole of the medical profession in India. With all due respect, the role of such doctors cannot reasonably be assigned to professionals from other esteemed spheres. As the current composition of the NMC stands, the number of doctors in it is witheringly small.
As the current composition of the NMC stands, the number of doctors in it is witheringly small.
Another problematic aspect is the dissolution of the democratic process of appointing members. The chairperson of the proposed NMC along with the presidents of the four autonomous boards, who are supposed to be highly experienced persons with a solid background in medicine, are to be selected by a Search cum Selection Committee constituted by the central government. This stands in complete contrast to the democratic electoral process followed for the MCI, whereby any doctor from any part of the country could contest and vote. Here too, the stakeholder debate is equally applicable. Stakeholders getting to elect their representatives is the basis of democracy. The right of our citizens to vote isn't curtailed when a minister faces allegations of corruption, neither is the parliament dissolved after a parliamentarian is indicted for a hideous crime.
Another problematic aspect is the dissolution of the democratic process of appointing members.
The NMC bill is premised on the assertion that there is always an ab initio conflict of interest in a process whereby the regulated elect their regulators. And there is indeed some truth to it as well. Allowing a regulated fraternity the explicit authority to elect it's regulators is unacceptable when the workings of the profession concerned are of high relevance to the laity of the country. But the same in no way justifies complete brushing off of the rights and interests of the regulated professionals and total subversion of the democratic model of professional bodies.
The NMC should, therefore, comprise of both elected and nominated members to ensure balanced representation of stakeholders. Further, the same should equally apply to other self-regulated professional bodies like the Bar Council of India.
The bill also proposes a Medical Advisory Council (MAC) to be assigned to serve a purely advisory role to the NMC. But whereas the four separate boards dealing with undergraduate education, postgraduate education, accreditation, and licensure have been accorded the 'autonomous' status, the MAC includes NMC members as it's ex-officio members, and is headed by none other than the NMC chairperson. This, to be honest, is absurd and defies logic. The views and suggestions of such a council can hardly be expected to be upright and free from prejudice, when the committee it is meant to advise and observe directly influences it's functioning. For there to be a scope for unprejudiced, uninfluenced suggestions, the MAC shall need to be free from NMC influence.
There is also a serious problem with the make-up of the MAC. By envisioning it's member doctors representing states and union territories to 'either be a vice-chancellor of a health university or a person not below the rank of professor from amongst the faculty of a medical institution with the state'–the bill denies representation to the legions of medical practitioners who don't serve in academic or administrative capacities, like those practising in private clinics and hospitals. This becomes all the more important since the same members shall be part-time members of the NMC on a rotational basis.
By envisioning it's member doctors representing states and union territories to 'either be a vice-chancellor of a health university or a person not below the rank of professor from amongst the faculty of a medical institution with the state'–the bill denies representation to the legions of medical practitioners who don't serve in academic or administrative capacities.
On one hand, the bill proposes a National Eligibility cum Entrance Test (NEET) to achieve uniform standards in medical training, since the quality of medical education varies unduly across medical colleges. On the other hand, it allows medical colleges the liberty to increase their intake capacity without the NMC even bothering to ensure beforehand whether or not they possess the requisite manpower, infrastructure, and other resources. It also allows medical colleges to evade noncompliance for up to three times in return of a monetary penalty. It has been reiterated time and again that an exit exam alone would prove incapable of ensuring uniform standards in medical education, and it is imperative that measures to standardise and improve the quality of medical training are taken at the grassroots level (i.e. medical colleges). This is a matter of serious concern, something which cannot be comfortably given a pass under the rhetoric of an 'outcome based regulatory philosophy', which the NITI Aayog claims in it's tweet.
Further, to keep the NEET from becoming an extra burden on MBBS students, certain changes in the MBBS curriculum and the pattern of MBBS exams are highly warranted, including moving on to a more application based learning culture and reducing the rigour of university examinations. The current NMC bill doesn't touch on this important point.
Perhaps the most dismaying aspect of the bill is it's support for a bridge course, which would allow non-MBBS doctors to practise modern medicine after undergoing a short term course in allopathy.
Perhaps the most dismaying aspect of the bill is it's support for a bridge course, which would allow non-MBBS doctors to practise modern medicine after undergoing a short term course in allopathy. Anybody would be able to foresee that this could have serious repercussions. Allopathic medicine is as colossal as they come, and to become an MBBS doctor requires undertaking a rigorous and weary academic journey. To expect a non-allopathic medical graduate to be able to imbibe enough of modern medicine from a short term course, and further go on to practise both their skills with the highest degree of expertise, would be farfetched thinking. Also, with a bridge course to allopathy in place, courses in other forms of medicine like ayurveda and homeopathy would soon be relegated to the status of stepping stones and backup routes to an MBBS degree. One might as well consider the idea of a short term course in allopathy to train dedicated allopathic primary care providers for the rural sector, but a bridge course is a strict no-no.
Also, with a bridge course to allopathy in place, courses in other forms of medicine like ayurveda and homeopathy would soon be relegated to the status of stepping stones and backup routes to an MBBS degree.
On the positive side of things, an overhaul of the country's apex statutory body of medicine offers an opportunity to correct another prominent shortcoming of the MCI. Dominated by postgraduate specialist doctors, the MCI has little or no representation from India's pool of primary care practitioners, and is almost synonymous with being the 'specialist' council of India. Realizing India's dire need of a robust primary healthcare system, the standing committee should give this point serious consideration. In it's current form, however, the NMC bill seems to be as besotted with the charm of specialties as the MCI.
The NMC bill looks positive and constructive in it's spirit to increase accountability among medical administrators, and to ensure participation of stakeholders from all walks of life. It is, however, unpalatable in it's current form, and needs some major amendments to keep from becoming an issue of perennial contention.
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