The Weekly Dose: A new law for doctors, for better and for worse
A pathbreaking bill is traversing through Parliament, which, once it becomes law, will transform the landscape for doctors and medical students in India.
Tectonic shifts are underfoot in the fields of healthcare and medical education. As I write this, a pathbreaking bill is traversing through Parliament, which, once it becomes law, will transform the landscape for doctors and medical students in India.
A few years ago, the Standing Committee on Health and Family Welfare discovered the obvious: many newly graduated doctors are not competent enough to practice independently, and unethical practices continue to mushroom. The Medical Council of India (MCI) - which governs medical education and the setting up of new medical colleges - was also found to have outlived its use: an understatement. In the recent past, it has only made news when yet another of its office-bearers was found accepting a bribe, and when - during MCI inspections - private medical colleges were found to have paid ‘patients’ to occupy hospital beds, and hurriedly flown in ‘permanent’ faculty members, to pass the MCI inspectors’ muster.
What is the National Medical Commission Bill, 2017?
It is an Act of Parliament which proposes to replace the MCI with a statutory body to be newly constituted, called the National Medical Commission (NMC). The latter will be charged with creating ‘a medical education system that ensures availability of adequate and high quality medical professionals, that encourages medical professionals to adopt the latest medical research in their work and to contribute to research, that has an objective periodic assessment of medical institutions and facilitates maintenance of a medical register for India and enforces high ethical standards in all aspects of medical services.’
Who will be part of the National Medical Commission?
This is extremely relevant, as we shall see. A search committee constituted by the Central Government will advise the latter on the appointment of the NMC’s Chairperson and Secretary. Its 10 ex-officio members will include directors of reputed Central Government health institutes such as Delhi’s AIIIMS and Mumbai’s Tata Memorial Centre, and the presidents of the NMC’s new boards, also appointed by the Centre (more on these later).
Its fourteen part-time members will include only six nominees from the states (on a rotating basis), and only five nominees elected by practicing doctors.
While the Chairperson and Secretary will have fixed, non-renewable terms of four years each and the ex-officio members will be part of the NMC for as long as they hold the office by virtue of which they are its members, members nominated by states will have only a two-year tenure.
Medical education is a subject on the concurrent list of the Constitution; the Centre and states are supposed to share power over it. The numbers mentioned above indicate a definite bias towards Central control of the NMC, leaving states with little influence. The Centre can even dismiss the entire NMC on certain grounds for a six-month period, which can be indefinitely extended, potentially allowing the Centre to assume total control of medical education and registration.
What differentiates the NMC from the MCI?
The Act empowers the Centre to appoint non-doctors as members of the NMC: ‘experts and professionals of integrity and outstanding ability, who have special knowledge of, and experience in...medical education, public health, management, health economics, quality assurance, patient advocacy, health research, science and technology, administration, finance, accounts and law’. Three such individuals will be part of the NMC, and more can be appointed by the latter to assist in its work.
Non-doctors having the power of administration over doctors is bound to be a contentious issue. On one hand, the MCI (full of doctors) was infamous for protecting its own, and the inclusion of independent outsiders from other fields will bring context and relevant expertise to the NMC. But many doctors claim that non-doctors do not and cannot understand the medical profession, and do not possess the competence to regulate healthcare personnel. As I understand it, even the member-secretary of the NMC need not be a doctor.
After ceasing to hold office in the NMC, no member can accept employment in any capacity from a private medical college in whose affairs he has had a direct or indirect influence, for one year. MCI office-bearers were known for clinging to their posts long after they had lost credibility; the Centre may dismiss any member of the NMC if he commits certain well-defined violations, such as acquiring a financial interest in something that can influence his NMC work.
The Act also mandates compulsory annual disclosure reports by medical institutions on all matters of interest to stakeholders, including students and faculty. Additionally, the NMC is tasked with making public the National Register of qualified doctors, which will help identify and weed out quacks.
Changes in medical education
The NMC will set up separate boards for undergraduate and postgraduate education, with three members each, one of whom will be a non-medico. Each board is supposed to meet once a month, and has an extensive list of duties which I doubt can be performed by such a small group of people. At a time when bookish knowledge predominates in medical education, the boards are supposed to design a competency-based curriculum - a welcome change.
At present, some states regulate the fees of a certain percentage of seats in their private medical colleges; the NMC will take over and be empowered to decide the fees of only 50% of such seats, creating the possibility of a bidding war to study in institutions which avail of state subsidies, that will become even more inaccessible to economically disadvantaged students.
Finally, the Act proposes a National Exit Test (NEXT) for MBBS students, which will serve both as an exam to qualify as a doctor, and as an entrance exam for post-graduate courses. The Centre has proposed that the final-year MBBS exams be considered as the NEXT. This has several problems: presently, the final MBBS exam has both theory and practical components (which any post-graduate entrance exam should have, but doesn’t at present) which are highly subjective; should the NEXT be an MCQ-based exam (as current entrance exams are), it won’t solve the problem of students neglecting to learn clinical skills and swotting obscure facts. If the NEXT becomes a nation-wide common theory exam followed by practicals, how will thousands of answer-papers be uniformly corrected, and what is to stop medical colleges from showering marks on incompetent students in practical exams, to create a reputation for producing the most students who crack entrance exams?
The questions are many, and the bill is almost law. After over fifty years of the MCI, the medical profession is in for a massive shake-up.