Will new medical commission degrade education?

The National Medical Commission Bill 2019 has been passed by both Lok Sabha and Rajya Sabha despite stiff resistance from Opposition parties. Though Union Health Minister Harsh Vardhan claims that the Bill is the biggest reform in the history of medical education in India, the Indian Medical Association has expressed its reservation.

The Bill seeks to form a new National Medical Commission (NMC) that will play the role of the disbanded Medical Council of India (MCI) which was alleged to have indulged in large-scale corruption.

The NMC comprises a chairperson and 33 members. Most of them are nominated members. Two third of the members would be from the medical fraternity. Their tenure is for four years, not extendable.

Members of the NMC include: (i) the Chairperson, (ii) Presidents of four boards set up under the NMC, (iii) Director Generals of the Directorate General of Health Services and the Indian Council of Medical Research, (iv) five Directors of medical institutions including  AIIMS, Delhi and JIPMER, Puducherry, (v) five members (part-time) to be elected by the registered medical practitioners, and (vi) 19 members appointed on rotational basis from amongst the nominees of the states and union territories in the Medical Advisory Council.

The Bill proposes to have four autonomous boards to take care of its different functions:

(i) Under-Graduate Medical Education Board to set standards and regulate medical education at the under-graduate level

(ii) Post-Graduate Medical Education Board to set standards and regulate medical education at the post-graduate level

(iii) Medical Assessment and Rating Board for inspections and rating of medical institutions and (iv) an Ethics and Medical Registration Board to regulate and promote professional conduct and medical ethics and maintain national registers of (a) licensed medical practitioners and (b) Community Health Providers (CHPs).

Each board will have a president and two members. While the MCI functioned autonomously, the new NMC will function under the central government’s purview.

An advisory committee will be set up to guide the NMC. Proper representation in the commission will be given for the states and union territories.

Licensing private medical institutes. This will be a one-time affair not needing renewal every year. Introducing new courses and post graduate studies, increasing the number of seats to be given to the respective colleges.

Government quota in private institutions is 50 per cent. The remaining seats would go into a management quota that may be filled by the institution (fees are not fixed for this).

MBBS students have to sit for the National Exit Test (NEXT) to qualify for practice as doctor or to apply for the post graduate studies. Those who have studied alternative medical courses like siddha, ayurveda, unani and homeopathy can also prescribe allopathic

medicines provided they have completed a bridge course.

National Medical Commission has received a mixed response from the stakeholders for this move.

C S Rex Sargunam, president, Tamil Nadu Health Development Association, said, “We at Indian Medical Association oppose National Medical Commission. It is unacceptable to nominate members for the commission rather electing them democratically. Of course, we needed a reform in the earlier MCI. But offering 50 per cent seats to private institutions will only degrade medical education. It has only paved the way for children of wealthy families who have secured low marks in NEET to find an easy way to get into medical education. It will keep private medical institutions’ cash registers ringing. How can you expect quality medical care from doctors, who come through such a medical stream?” Tamil Nadu BJP president Dr Tamilisai Soundararajan, in a press statement said, “Shortage of doctors in rural areas is a long-time pending problem. More than 40,000 people die of snake bites. According to the World Health Organisation, the doctor-people ratio should be 1:1,000. Due to shortage of qualified medical professionals, quacks have grown in large numbers and are playing with people’s lives. The central government has put an end to this menace, finding a solution to this problem. Earlier, MCI was the centre of all corruptive practices but now due freedom has been given to the private institutions. The licence system has been abolished paving way for opportunities to a lot of people to study courses in medical colleges, it is a milestone in medical history.” Why reform was necessary

Talks of reforming the Medical Council of India began as early as 2003, when Atal Bihari Vajpayee was Prime Minister, but the Parliamentary Standing Committee was against it. The MCI had earned widespread displeasure after allegations of malpractice and bribery surfaced. As it enjoyed a great degree of autonomy, the government could not do much at the time.

In 2017, the National Medical Commission Bill was tabled in Parliament by the then Minister J P Nadda and was passed in the Lok Sabha but could not get through the Upper House.

The then president of MCI, Ketan Desai, was caught red handed by the CBI when he received a bribe of Rs 2 crore as the first instalment to start a medical college in Punjab. Investigations showed that Ketan Desai collected bribes amounting to Rs 10 crore to Rs 20 crore to grant permission for opening a medical college and Rs 30 crore for license renewal.

There were reports that even H D Deve Gowda, when he was the Prime Minister, had to bribe Ketan Desai to get permission for his close kin to start a medical college. It was also found that he helped private institutions forge documents to open colleges.

Raids conducted in Ketan Desai’s office and residence in 2010 revealed a stash of Rs 1,800 crore in cash and 1,500 kg of gold and silver. Following this, MCI was dissolved in the same year. As an ad-hoc arrangement the MCI was run by a team of members under the Supreme Court guidelines.

Indians were well known in the medical profession even during British rule. Though MCI was started in 1934, after a series of amendments post-independence, it took final shape in 1956. It was declared that MCI would be an autonomous body since the government felt that it should not be subjected to

political interference.

It was a statutory body that ensured the standard of medical colleges, granted permission to start medical colleges, was responsible for recognition and accreditation of medical colleges, conducted qualifying examinations for those pursuing medical education in foreign countries and wished to practice in India. It also maintained the doctors’ registry. It was the fulcrum of medical profession in the country. It was also a democratic body as only those who were in the medical profession voted and elected the administrators of the council.

Complaints against the MCI started coming only post 1990 when it started granting permission to private enterprises to start medical colleges, which were charging exorbitant fees structure from then on corrupt practices started taking root in the council.

Earlier, MBBS graduates had to serve in primary health centres in villages for three years if they had to sit for post graduate courses. But now, they can sit for the NEXT exam to qualify for PG courses and need not serve in PHCs. This will lead to a shortage of doctors in PHCs. Moreover, students will concentrate more on preparing for the NEXT rather than MBBS studies.

Doctors and medical students all over the country unanimously are against the NEXT exam. It will not be equal to the experience of working in rural PHCs and government hospitals.

Also the decision to permit those who have studied alternative medical courses like siddha, ayurveda, unani and homeopathy to prescribe allopathic medicines, if they had completed a bridge course, will result in dire consequences. It only dilutes the quality of medical service.

Alternative medicine

T Velayudham, national secretary, Indhiya Siddha Maruthuva Kazhagam, said, “If alternative medical practitioners are allowed to prescribe allopathic medicines they will lose their individuality and the speciality of the respective streams will get disrupted. I take pride in the medical stream that I follow. I never recommend allopathic medicines to my patients”.

A person, who believes that Siddha has a cure for all kinds of diseases, will not be able to support any another medical stream.  Just because there is a gross mismatch of doctors and patients, one cannot do whatever they want, it will only lead to disaster. Earlier, only those in the medical field were appointed to the leadership position but now those with the political influence and who are not connected with medicine are being appointed in the  administrative cadre and it does not augur well for the department.

Speaking in the Assembly and addressing media, TN Minister of Health, C Vijayabaskar, had this to say, “The NMC has infringed on the rights of state government by snatching the state’s quota of 35 per cent in private medical institutions and giving it to the institutions itself. We oppose the NEXT exam. There are one lakh medical doctors in the state. TN is a well developed state in the medical field. There is no talk on proper representation in the commission for Tamil Nadu. Hence, TN opposes this Bill as it is against federal principle”