Recently Dr Harsh vardhan union health minister gave a long explanation regarding the NMC bill and its implementation. Now why was this explanation required?
The reason why this explanation was required was primarily the discontent in medical fraternity as soon as the bill was introduced in Rajya Sabha. Thousands of doctors staged protests all across India, calling it a dark hour in Indian medical history.
MCI which was under constant government scanner for alleged corruption and misconduct relating to medical education and professional medical practice ultimately succumbed to National Medical Commission (NMC) on 29 July. Essentially, this bill opens up the gate way for setting up NMC in place of the MCI to regulate all aspects related to medical education, medical practice and exams in India.
In the past, suggestions for replacing MCI with one or two new bodies for regulation of medical education and medical practice respectively were made a decade ago by the Yashpal Committee and the National Knowledge Commission. Now after 63 year of its inception, MCI which was formed based on Indian Medical Council Act (1956) finally will give way NMC over the next couple of years.
Is NMC the only way forward?
After Dr Harsh vardhan’s clarification about the bill, the Medical associations which was vehemently opposing this bill is now at least giving this bill a patient hearing. The points of concern here are the following:
1) Will this bill encourage quackery? As clarified by Dr Harsh vardhan, the proposed 6 months “bridge course” which would allow Ayush, homoeopathy, physiotherapy and professional belonging to unrecognised medical sector to work as community medical worker is now done away with. Now, the proposal says that it will be on the lines of countries like the USA where ‘practitioner nurses’ are allowed to dispense few drugs (say around 10) as a first-aid measures in areas where there is otherwise a poor doctor density like PHCs or CHCs. The only condition from medical fraternity here is that there should be strict regulation and implementation of this law in terms of geographical area allotment and medical expertise limitation for these nurses.
2) Secondly, common final-year MBBS exam, to be called National Exit Test (NEXT), for admission to PG courses and also for obtaining a practicing licence is again based on lines of Licensing exam conducted in USA or UK. The big next step here is regarding the standardization of syllabus, exam frequency and pattern of examination and the validity of score of this exam.
3) Third important issue here is pertaining to students carrying Medical degrees from Countries like US, UK, Canada, Australia and New Zealand who are presently approved by MCI in the ‘first list’ (permitted to practise in India without any licensing exam). Under the new bill will there be a need for them to take up licensing exam to practice in India? (Which looks to be a quite logical step)
4) Another important controversy pertaining to NMC was regarding stopping the practice of yearly inspections at medical colleges. The initial view regarding this was that it would turn out to be a great disaster as would lead to lowering of level of education and infrastructure of medical colleges. However as Dr Harshvardhan clarified that a dedicated committee under NMC would not only supervise but also give a ranking to all medical institutions across India thus making sure that proper rules are followed.
5) Another important issue here which still needs clarification as of today is regarding sharing of power between state medical council and NMC. It is still not very clear and we guess we have to wait till formal formulation of NMC till this becomes clear (Section 45 of the NMC bill, empowers the Centre to overpower any suggestion of the NMC pertaining to professional conduct, ethical matters, regulations and education)
6) One area of NMC bill that needs clarity is regarding the regulation of fee structure. NMC plans to determine fees in 50% private medical college seats (earlier most states had their own committees to fix the fees). Now it is still not very clear if the remaining 50 percent of seats will be regulated by local management or state committees (or both).
7) The final authority regarding the regulation of number of seats per medical college is also not clear so far. How and who would decide the number of seats needs clarification? (NMC or state) Dr Harshvardhan has successfully answered almost all the shortcomings of NMC bill that had initially led to a countrywide protest in India. Without a doubt, still a lot of work is to be done especially relating to implementation, constitution and regulation of NMC as the supreme governing body in India.
Another big question pertaining to NMC which raised many eyebrows was regarding its members. Now Dr Harshvardhan has clearly told that 21 out of 25 members will be senior medical professionals and their membership will be for 4 years.
With the passing of NMC bill, we are planning to add another 1-1.25 lakh community health providers (CHP) to our existing system as practitioner nurses with the hope of improving our doctor to patient ratio from 1:1,596 to around 1:1,200.
No doubt this Bill attempts to set up a regulatory body with a cleaner image in place of the MCI which was often caught up in corruption allegations. Let’s hope NMC will bring transparency in medical regulations of India but it is equally important to set predefined rules, details of final framework, standard operating procedures and modalities for NMC to make it a successful regulator.
(Writer is Dr Himanshu Tyagi, Senior Consultant, Spine Surgeon, Artemis Hospital. Views expressed are a personal opinion.)