Q) National Medical Commission Bill, 2019 has replaced the Medical Council of India with NMC to regulate medical education and practice in India. Why is the Medical Council of India replaced? Discuss the salient features of the NMC Bill 2019. Mention various concerns raised against the bill. Why is there a need to regulate medical education in India?
Ans) India has suffered from the problem of inappropriately trained doctors since a very long time. Decades back, the Mudaliar Committee Report (1959) pointed out that doctors had neither the skills nor the knowledge to handle primary care and infectious diseases that were a high priority concern at the time. The NMC will help to frame policies for regulating medical institutions and medical professionals, assessing the requirements of healthcare-related human resources and infrastructure, and ensuring compliance by the State Medical Councils of the regulations made under the Bill.
Concerns with Medical Council of India:
- MCI has repeatedly been found short of fulfilling its mandated responsibilities.
- MCI is an elected body where its members are elected by medical practitioners themselves, i.e., the regulator is elected by the regulated.
- MCI is solely dominated by doctors. Since medical education is a diverse stream, MCI should include diverse stakeholders such as public health experts, social scientists, and health economists.
- As per MCI regulations, a college is required to be inspected 25 times to get final recognition. This establishes an Inspector Raj
- Medical education and curricula are not integrated with the needs of our health system.
- Many of the products coming out of medical colleges are ill-prepared to serve in poor resource settings like Primary Health Centre and even at the district level.
- Medical graduates lack competence in performing basic health care tasks like conducting normal deliveries; instances of unethical practice continue to grow due to which respect for the profession has dwindled.
- There are no tools available to Indian regulators under the proposed framework to hold makers of sub-standard medical device manufacturers to account.
Features of the NMC Bill, 2019:
- The Bill proposes to set up a medical commission, both at the national and state level, within three years of the passage of the legislation.
- The Bill has a provision for setting up a Medical Advisory Council by the Centre. The council will act as a channel through which the states/Union Territories can convey their views and concerns to the NMC.
- The bill Regulate medical institutions and medical professionals
- The bill Assess the requirements of healthcare-related human resources and infrastructure
- The legislation talks of conducting a uniform National Eligibility-cum-Entrance Test (NEET) for admission to under-graduate medical education in all medical institutions regulated under the Bill.
- The Bill proposes to hold the National Exit Test for the students graduating from medical institutions to obtain the licence for the practice. The test will also allow students to take admission into postgraduate courses at medical institutions under this legislation.
- The Bill says that the NMC will have the authority to grant a limited licence to certain mid-level practitioners connected with the modern medical profession to practice medicine.
- It Ensuring compliance by the State Medical Councils
- The bill Frame guidelines for determination of fees for up to 50% of the seats in private medical institutions and deemed universities
Concerns raised against NMC bill:
- As the members of NMC are to be nominated by the Union government it may lead to favouritism and bureaucratic interference.
- The bill reduce the accountability of NMC and make it virtually an advisory body by giving discretionary powers to government.
- the term Community Health Provider has been vaguely defined in the Bill.
- There are no penalties or prosecution to punish for the harm already inflicted on patients due to negligence or worse, intentional wrongdoing by the manufacturer.
- Relying only on the NEXT as the principal substitute is to abdicate governance.
- The bill will allow anyone with limited exposure to modern medical system to recommend medicines.
- The NMC Bill allows the commission’s ethics board to exercise jurisdiction over state medical councils on compliance related to ethical issues.
- It has been argued that a single exam is being accorded too much weightage, and it can have an adverse impact on the career of medical aspirants.
- While the bill seeks to address issue relating to quality and standardisation, there remain unanswered questions on the design, definition and the transparent execution of the bill and some of its provisions.
Need for regulating medical education in India:
- The primary issue in Indian healthcare is availability of doctors.
- There is a need to ensure that doctors are appropriately trained and skilled to address the prevailing disease burden
- to ensure that medical graduates reflect a uniform standard of competence and skills
- To ensure that only those with basic knowledge of science and aptitude for the profession get in.
- The issue of standardization and high quality with uniformity across the country need to be addressed.
- to ensure ethical practice in the interest of the patients
- to create an environment that enables innovation and research
- To check the corrosive impact of the process of commercialization on values and corrupt practices.
- In recent times, the excessive reliance on a battery of diagnostic tests is reflective of commercial considerations and weak knowledge.
The government needs to explain things and open up more communication channels to listen to the grievances of the concerned people. The regulatory body should be constituted in such a way that it is able to achieve parity across all players so that the standard of the doctors coming out should roughly be similar.