- IT’s Input
- Amendments proposed in National Medical Commission Bill
- Significance of the Bill
- Are the demands of the medical fraternity justified?
- Why MCI was replaced with IMC?
- Way Ahead
[RSTV The Big Picture] National Medical Commission Bill, 2019
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- Recently, the National Medical Commission Bill, 2019 was passed in parliament which replaced the existing Indian Medical Council Act, 1956 and reform the medical sector, in the wake of corruption allegations against the Medical Council of India (MCI).
- However, Resident doctors at government hospitals, including All India Institutes of Medical Sciences (AIIMS), went on an indefinite strike to protest the Bill.
- Among the problems raised by the medical community is Section 45 of the bill, that allows the government to override any suggestions of the National Medical Commission.
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.
Community health providers:
- Under the Bill, the NMC may grant a limited license to certain mid-level practitioners connected with the modern medical profession 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.
Significance of the Bill:
- The National Medical Commission Bill, 2019, made through the consultative mechanism, is the improved version of a report submitted by the experts in 2014, recommending National Medical Commission in place of MCI.
- The bill separates medical education from medical profession. It also introduces parity across all various players associated with medical sectors.
- The MCI was elected body (elected by some doctors who, in turn, were regulated by the MCI itself) while the newly formed body of NMC is more of representative body (out of 25 members of NMC, 21 are doctors).
- The provision of four sub boards under NMC, duly controlled by governing/advisory body, shows the right type of diversification (in terms of diverse backgrounds of board member), which was absent in MCI.
- Costing of medical education has a share of the private sector around 50-60% which was addressed by the bill. As per the Bill, the fees up to 50% of the seats in private medical institutions and deemed universities will be determined by NMC. Hence, the bill provides financial incentives for private medical institution by allowing them to decide fees for rest 50% of the seats. However, these will be done through consultative mechanism with government.
- In UK, there are nearly 40 types of specialists (such as nurses, pharmacists etc.), who with certain amount certification, can prescribe medicines as well as conduct small medical procedures. However, in India, a nurse with 30 years of experience in ICU is not legally permitted to even dispense medicines to patients. The bill sought to change this situation by providing mid-level practioners to precise prescribe specified medicines.
- Moreover, The Bill increases the reach of mid-level practitioners connected with the modern medical profession to practice medicine. Hence, it is another way of mainstreaming those professional sitting in villages doing mid-level practicing in illegal manner.
- The bill suggests for uniform National Eligibility-cum-Entrance Test (NEET) for admission in medical education. This will create a single measuring indicator to allow doctors to enter in medical profession without.
- Aberration has been done away with the National Exit Test (NEXT) exam and it eases the total system of regulation.
Are the demands of the medical fraternity justified?
- When the first draft of the bill had come, the Indian Medical association (IMA) had raised objections.
- The draft had suggested bridge course for AYUSH (Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy) practitioners which IMA was not ready to accept. This suggestion was dropped from the bill on the call of IMA.
- The previous bill had suggested a licentiate exam over and above the PG exam (a person has to give licentiate exam to practice MBBS along with the final MBBS exam of college), which was also objected by the IMA. As a result, the government recommended the final year exam to be a uniform national exam.
- Moreover, the demand of replacing IMA with MCI was also considered in the bill.
- Thus, the final draft of this bill has been framed with complete concerns of Indian Medical Association.
Why MCI was replaced with IMC?
- Medical Council of India has contributed in development of medical education in India, but the member of this body were elected and not chosen by the government.
- In 1995, government did not have enough funds to invest in medical education and profession, hence, it called for the private investments in medical sector. This phenomenon changed the various constraints of IMC with which, it failed to deal with overtime.
Constraints faced by IMCs:
- Private medical colleges feel that there should be separate exam for them.
- The high level excellence colleges like AIIMS feels that there should be separate exam mechanism for them.
- Various constrains from the state level regulatory boards controlling their medial regulatory mechanism.
- Inability to reach the ‘Doctor population ratio’ of 1:1000 due to lack of investment capacities.
- There is lack of infrastructure at the Primary healthcare center (PHC) level having poorly trained doctors.
- The NEXT exam will act as licensing exam, post graduate entrance exam (by replacing NEET PG exam) and foreign medical graduate examination. However, if a MBBS person fails to cleat NEET, will he/she get another chance to apply for PG or does his/her MBBS is valid or not? The Bill does not clarify these issues.
- As per bill, any foreign medical graduate can have MBBS license by just passing the NEXT exam, however, it will be disrespectful for the Indian doctors who have worked so hard to get those seats by passing the robust (and strict) course of Indian medical course.
- It is a much needed bill. India is the only nation in the world which is dominated by MBBS profession as far as prescription rights on drugs are concerned.
- Government needs to make a proper training and curriculum guided by the universities.
- In nutshell, the better communication with the students and professional of medical background and catering their problems effectively is the way forward.