- What is the aim of the NMC bill 2019?
- Challenges faced by the bill
- India and the medical challenges it faces
- Government initiatives to increase doctors in rural areas
- Way ahead
- IT’s Input
- Amendments proposed in National Medical Commission Bill
[Editorial Notes] The National Medical Commission Bill: Challenges and Way forward
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- The national medical commission bill 2019 is facing major resistance from, medical fraternity even after being passed by the Lok sabha.
What is the aim of the NMC bill 2019?
- The Bill aims to provide for a medical education system that improves access to quality and affordable medical education, ensures availability of adequate and high quality medical professionals in all parts of the country.
Challenges faced by the bill
Community Health Provider
- Under the Bill, the NMC can grant a limited license to certain mid-level practitioners connected with the modern medical profession to practice medicine.
- The Indian Medical Association has raised concerns over the term ‘Community Health Provider’ as it allows anyone connected with modern medicine to get registered in NMC and be licensed to practise modern medicine.
- In other words, persons without medical background are becoming eligible to practise modern medicine and prescribe independently.
National Exit Test (NEXT)
- The bill seeks to establish uniform standards National Exit Test (NEXT) as i) an entrance test for post-graduate courses ii) a screening test for those who obtained a degree in medicine from abroad and iii) an exam to obtain the MBBS license for practice.
- As per medical groups, merit should be the determining factor in securing a PG seat and the current NEET-PG should not be scrapped.
Private colleges Fee regulation
- NMC would regulate fees and all other charges for 50% of the seats in private medical colleges and deemed universities. The IMA demand that there should be capping on the fee charged by the unaided medical institutions.
- As per the Bill, of 25 members proposed for the NMC, only five would be elected which means the non-elected members would be either government officials or those nominated by the government.
- There is criticism that representation of IMC should be more from democratically elected members than nominated.
India and the medical challenges it faces
- In Healthcare sector, India as a whole has a huge shortage of specialists.
- There is adequate number of doctors in both Kerala and Tamil Nadu, whereas in Bihar and the northern States, there is an acute shortage.
- The number of doctors in urban and rural have huge difference as a large number of doctors tend to cluster in urban areas.
- Moreover, doctor-population ratio (WHO has promulgated desirable doctor–population ratio as 1:1,000) has no meaning if there are no qualified doctors in India.
- Moreover, due to the changed Perceptions of patients preferring only specialists and avoiding partially trained people, the idea of providing short-term training to community health providers may not work.
Three broad reasons why the public policy has been weak
- There is inadequate investment even though many states have taken initiatives in this regard
- The incentive structures have been very weak and MMBS professionals are not ready to move to rural areas.
- The nature of work that a doctor in a primary health-care setting is expected to do in a rural area is very different from the kind of training he gets as an MBBS doctor.
Government initiatives to increase doctors in rural areas:
- By using incentives for practice in rural areas.
- By using bond. Once a person is trained to be MBBS with government support, he/she has to serve for a certain number of years after his/her MBBS or after your post-graduation in-service,
- By having post-graduation seats. The government reserves post-graduation seats specifically for those candidates who work for a certain number of years with the government (in rural areas).
- The critics’ major concerns are that six months period is insufficient and there must also be a focus on quality. However, nurses, if trained well along with strong regulations, can be a great asset.
- India has been able to have a proper training programme that really enables young doctors to go and work in rural areas. However, Chhattisgarh and Assam did work on having a three-year-trained physician such as LMPs (Licentiate Medical Practitioners).
- Thus it would be adequate to have three-year-trained public health practitioners, who would really address all our infectious diseases and public health requirements of the rural poor.
- However, a continuous redesign, a strong evaluation framework and a strong regulatory governance framework is extremely important.
Amendments proposed in National Medical Commission Bill
Constitution of the National Medical Commission:
- The Bill sets up the National Medical Commission (NMC) by replacing the current Medical Council of India (MCI). Within three years of the passage of the Bill, state governments will establish State Medical Councils at the state level.
- The NMC will consist of 25 members appointed by the central government.
Functions of the NMC include:
- Framing policies for regulating medical institutions and medical professionals.
- Assessing the requirements of healthcare related human resources and infrastructure.
- Framing guidelines for determination of fees for up to 50% of the seats in private medical institutions and deemed universities which are regulated under the Bill.
Medical Advisory Council:
- Under the Bill, the central government will constitute a Medical Advisory Council which will be the primary platform through which the states can put forth their concerns before the NMC.
- Further, the Council will advise the NMC on measures to determine and maintain minimum standards of medical education.
The Bill sets up autonomous boards under the supervision of the NMC. These boards are:
- The Under-Graduate Medical Education Board (UGMEB):Responsible for formulating standards, curriculum, guidelines, and granting recognition to medical qualifications at the undergraduate
- Post-Graduate Medical Education Board (PGMEB): Same work as UGMEB, but at post-graduate level.
- The Medical Assessment and Rating Board (MARB):MARB will have the power to levy monetary penalties on medical institutions which fail to maintain the minimum standards as laid down by the UGMEB and PGMEB. The MARB will also grant permission for establishing a new medical college, starting any postgraduate course, or increasing the number of seats.
- The Ethics and Medical Registration Board:This Board will maintain a National Register of all licensed medical practitioners, and regulate professional conduct. Only those included in the Register will be allowed to practice medicine.
- The Bill proposes a uniform National Eligibility-cum-Entrance Test for admission to under-graduate and post-graduate super-specialty medical education.
- The bill seeks to establish uniform standards for medical education by proposing that the final year of MBBS exam, known as National Exit Test (NEXT), be treated as an
- i) An entrance test for post-graduate courses
- ii) A screening test for those who obtained a degree in medicine from abroad.
- iii) An exam to obtain the MBBS license for practice.