Dr KK Aggarwal
National President IMA, Padma Shri Awardee
The Union Cabinet recently rendered another blow to the medical profession with the approval of the draft National Medical Commission Bill, 2017. The NMC will "cripple" the democratic functioning of the medical profession by making it completely answerable to the bureaucracy.
It is time that the powers-that-be took urgent notice of this crisis and acted accordingly. The medical profession is currently facing the darkest hour. Not only are patients slowly losing faith in doctors and the profession as such, but are also becoming violent against doctors with the slightest provocation. This bill is only an addition to these existing woes and will exacerbate the situation for the medical fraternity and the students of medicine.
The structure of the NMC
The federal character of MCI is not found in the NMC. All the state governments have representation in MCI. Only five states in rotation will have representation in NMC as a result of which it will take two decades for a state to re-enter NMC. The Cabinet has cleared NMC Bill with a 25-member commission appointed by the central government. Of these members, 20 will be appointed by the search committee chaired by cabinet Secretary. Nomination will be done for 12 ex-officio and 6 part-time members. Three of these will be from disciplines such as management, law, medical ethics, health research, consumer or patient rights advocacy, science and technology, and economics. Only five will be elected by the registered medical practitioners from amongst themselves from such regional constituencies.
In effect, it would resemble a situation where the whole parliament is getting dissolved in favor of 25 nominated ministers by the President of India with only five elected members of parliament, one from each zone of the country with no powers to be re-elected.
The chairperson, secretary, and members shall hold office for a term not exceeding four years and shall not be eligible for any extension or reappointment and will retire by age 70. This will lead to a possible backdoor entry of bureaucrats after retirement.
In the MEDICAL ADVISORY COUNCIL, the Chairperson of the Commission shall be the ex-officio Chairperson of the Council and hence will have no autonomy. Every member of the Commission shall also be the ex-officio members of the Council. Each Board shall be an autonomous body and shall consist of a President and two Members, all nominated by the search committee. The commission will be more of an appellant body for aggrieved decision of an Autonomous Board within sixty days.
The four autonomous boards
The bill provides for the constitution of four autonomous boards entrusted with conducting undergraduate and postgraduate education, assessment and accreditation of medical institutions and registration of practitioners under the NMC.
UGME and PGME boards The UGME Board will grant recognition to a medical qualification at the undergraduate level and PGME Board shall grant recognition to the medical qualification at the postgraduate and super-specialty levels. Both boards may seek directions from, the Commission, as necessary. Any recommendations for UG and PG courses shall be made by the three-member committee under the control of the central government.
MAR board This Board shall grant permission for establishment of a new medical institution, carry out inspections of medical institutions for assessing and rating. It can also hire and authorize any other third-party agency or persons for carrying out inspections of medical institutions and for assessing and rating them, as required. It also has the power to impose monetary penalty (first time, second time, and third time in ascending order) against a medical institution for failure to maintain the minimum essential standards specified by the UGME Board or the PGME Board. All the three monetary penalties imposed shall not be less than one-half, and not more than ten times, the total amount charged. Such variation of 50% to 10 times will be the root cause of future corruption. It can also be used as a political action to favor or destroy someone. It will also become necessary to seek prior permission of the MAR Board to establish a new medical college.
EMR board This board shall maintain a National Register and regulate professional conduct and promote medical ethics. The EMR Board or State Medical Council shall also give an opportunity of hearing to the medical practitioner or professional concerned before taking any action, including imposition of any monetary penalty against such person. There will also be a separate National Register for licensed AYUSH practitioner who qualifies the bridge course (Homeopathy or a practitioner of Indian medicine).
Plight of medical students
It has been proposed to conduct UG-NEET in English or other languages with common counselling. There will also be a uniform National Licentiate Examination operational within three years with no PG NEET and with common counselling. This makes it seem like there will be one common licentiate exam. The addition of another exam indicates the height of insensitivity to the plight of medical students who even otherwise undergo a long and tortuous academic career replete with highly competitive exams.
The NMC allows private medical colleges to charge at free will nullifying whatever solace NEET brought. The government can fix fee for only 40% of the seats in private medical colleges. No medical college will survive if there is state central dispute in the fee structure. Up to 40% will give a wide margin for corruption.
Determining who is a qualified medical professional
As per the bill, any person who qualifies the National Licentiate Examination shall have his name and qualifications enrolled in the National Register or a State Register, as the case may be (prospective). Foreign medical graduates shall also have to qualify the National Licentiate Examination only. The Commission, however, may permit a medical professional to perform surgery or practice medicine without qualifying the National Licentiate Examination, in such circumstances and for such period as may be specified by regulations. It also indicates that a foreign citizen who is enrolled in his country as a medical practitioner in accordance with the law regulating the registration of medical practitioners in that country may be permitted temporary registration in India for such period and in such manner as may be specified by regulations. Any person who contravenes any of the provisions of this section shall be punished with fine which shall not be less than one lakh rupees, but which may extend to five lakh rupees. The Central Government can approve the grants of such sums of money as it may think fit. This will be credited to a fund called the “National Medical Commission Fund" which shall form part of the public account of India.
The course structure
One a year, there will be a joint sitting of the Commission, the Central Council of Homoeopathy and the Central Council of Indian Medicine. This will decide on the approval of specific educational modules or programs that may be introduced in the UG and PG courses across medical systems. This discussion will also entail developing bridges across the various systems of medicine and promote medical pluralism.
Handing over power to administrators
The central government has the power to dissolve the commission if it has persistently defaulted in complying with any direction issued by them. The central government may, by notification, supersede the commission for such period, not exceeding six months, as may be specified in the notification. Anywhere else in the world, the medical profession is bestowed with reasonable autonomy with patient care and safety as the main benefits of such autonomy. Regulators need to have autonomy and be independent of the administrators. The NMC will be a regulator appointed by the administrators under their direct control.
It is not the first time that the government has made such a move. In 2005, the then Union health minister, Dr Anbumani Ramadoss, tried unsuccessfully to bring about a legislation to dissolve the MCI and set up another council under the control of the Health Ministry, which was rejected. That scenario is repeating itself today, with the difference that the union cabinet has given its approval to the draft NMC. The Parliament has a larger role to play in protecting the interest of the medical profession of the country. It is time to act.