National Medical Commission Act 2019

President Ramnath Kovind has a signed the National Medical Commission Bill 2019 approved by both the houses of the parliament to reform the medical sector in India with the focus on reforming medical education.

Features of the Act

• The Act seeks to repeal the Indian Medical Council Act 1956.
• The Act seeks to replace the Indian Medical Council with the National Medical Commission (NMC).
• The NMC will be a 29-member body which would comprise of 20 members selected through nomination, and nine through elections.
• The NMC will have the following boards — Undergraduate Medical Education Board, Postgraduate Medical Education Board, Medical Assessment and Rating Board and Ethics and Medical Registration Board.
• The standards of medical education would be set by the — Undergraduate Medical Education Board, Postgraduate Medical Education Board.
• The Rating Board will facilitate the process of granting permissions to new medical colleges, and rank them.
• The Act seeks to set standards for Medical Education in the country by proposing that the final year MBBS exam be treated as an entrance test for PG and a screening test for students who graduated in medicine from foreign countries.
• The Act proposes for an exit exam (a common final year exam) NEXT for everyone for getting a license to practice medicine in the country and for getting admissions to post-graduate medical courses.
• The Act caps fee on 50 per cent of the seats in MBBS and PG colleges.
• The Act makes it clear that the NEET and NEXT would be applicable to Institutes of National Importance (INIs) like AIIMS to have common standards in the country.

Why the government is keen on regulating Medical Education Sector?

• 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.
• 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 commercialisation on values and corrupt practices.

Whether the Act Passed by the Parliament addresses the objectives mentioned above?

Quality of Education

The National Medical Commission has the potential to be more nimble in setting curricula, teaching content, adding new courses and providing the much needed multisectoral perspectives.  The NMC has the potential to link the disease burden and the specialities being produced.

For example,  In the UK, it is the government that lays down how many specialists of which discipline need to be produced, which the British Medical Council then adheres to. Whereas in India, the MCI was operating independently. This gap can be bridged by the NMC.

If the right people are brought in, the NMC can encourage and incentivise innovation and promote research by laying down rules that make research a prerequisite in medical colleges.

Curbing Unethical Practice and Commercialisation

The National Medical Commission Act allows differential pricing with freedom for the college managements to levy market-determined fees on 19,000 students, under the management quota. This is admission for those with the ability to pay. There are colleges that are rumoured to arrange admission and the degree for a fee.

The Act seeks to tackle the commercialisation and corruption in the entry by making the admissions to the medical education institutions through NEET. Further to ensure the quality of the doctors coming out of the Medical Institutions a common exit exam NEXT has been proposed.

The rules of the Medical Commission of India (MCI) required a college to be inspected 25 times to get final recognition. This led to a rent-seeking exercise and inspector raj. With the National Medical Commission will do away with this rent-seeking behaviour and inspector raj.

Lack of Autonomy

The Act allows extensive discretionary powers to the government to set aside decisions of the NMC. This reduces the NMC virtually to an advisory body.

As the commercialisation of medical education set in in the 1990s, the amendment of the MCI Act in 1993 reduced the autonomy of the MCI  making it subservient to government. The NMC Act has now been taken to another level.

Why doctors are Opposing the Act?

The doctors are strongly opposing the Act. The concerns of the medical fraternity against the Act are:

Community Health Provider

Section 32 of the Act that provides for licensing non-medical persons or Community Health Providers to practise modern medicine at mid-level as Community Health Provider. The central government will frame regulation for this effect.

The Medical fraternity is seeing this as an attempt to provide a background entry for a similar provision which the government forced to withdraw. The provision which was withdrawn provided that by clearing a bridge course those practising alternate medicine could practise modern medicine.

NEXT

The NMC Act condenses final year MBBS exam, Licentiate exam. and PG NEET into one examination. This eliminates any opportunity to reappear for PG selection. They argue that the current NEET-PG should not be scrapped.

No law is perfect. It is dependent upon the people who interpret and implement it. Under the NMC Act, the government has arrogated to itself an unprecedented power to appoint people in the various arms of the proposed structure. The quality and integrity of these people will then define the future of the health system in India. Hence due diligence must be exercised in appointing various office bearers under NMC.