The Indian Medical Association and experts list a bunch of problems the Bill may introduce in the health sector if passed by the Rajya Sabha
The Indian Medical Association (IMA) went on a nationwide protest on July 31, 2019 against the National Medical Commission (NMC) Bill that was passed in the Lok Sabha on July 29.
However, there is hardly any effect of the protest in Delhi as doctors in All India Institutes of Medical Sciences and other hospitals are working. Earlier, the Delhi branch of IMA had even supported the bill.
IMA secretary RV Asokan said the doctors were only on emergency duties and the protest was mostly successful.
Emergency services were kept out of the ambit of the protest while all other services, including outpatient department (OPD) and inpatient department (IPD), were hit.
The Bill is to be tabled in the Rajya Sabha on August 1. The Federation of Resident Doctors Association and Resident Doctors Association announced that if the Bill is tabled in the current shape, they would completely shutdown medical services, including emergency care.
However, there are certain sweeping provisions in the Bill that has led doctors to take to streets several times since it was passed by the Union Cabinet last year.
Centralisation of power
The Bill seeks to replace the existing Medical Council of India, the regulator of medical education and the profession. It mentions the formation of a 25-member NMC, which will be the over arching body on medical education and research and for the practitioners.
The members of the commission will be appointed by a search committee formed by the central government. The Centre could also remove the chairperson or any other member. Though the commission will have a secretariat, but the secretary would be appointed by the government.
“It is complete abandonment of federalism and autonomy of medical education. The Centre would appoint everyone in all these important bodies and even adjudicate on dismissals. Bureaucracy will have a much upper hand,” said T Sundararaman, former executive director of National Health Systems Resource Centre and dean of School of Health Systems at Tata Institute of Social Sciences.
“And there is no provision of election for all the chief posts of these multiple bodies. This is something very grave,” he added.
The Bill also comprises creation of a Medical Advisory Council that will advise the commission. It will accommodate one member from each state and Union territory.
“States have been reduced to mere advisory roles from being in governance mode. Why do all the members of the commission need to be ex-officio members of the advisory board? Just because they are appointed by central government? This is an obsession with centralisation of power,” said Sundararaman.
The IMA is also worried if the scale of the commission would make matters worse. “This advisory council will comprise more than 100 members, including 24 members of the commission. Would it ever be possible to reach a consensus on any issue with such an overwhelmingly large body? This will hit the decision making at the top,” said Asokan.
Education in danger
Another grave concern is that the commission will frame guidelines on fees determination of only 50 per cent of seats private medical colleges. The Union health minister Harsh Vardhan, in the Lok Sabha, clarified that medical education is a “concurrent subject” and the state governments are free to decide on the rest of the seats in private medical colleges.
“It is like putting ball in the court of the states. Moreover, it is unlikely that the states will take the cudgels to decide for the rest of the seats. Even if they do, it might not stand legal scrutiny. It may lead to a no-holds barred situation for private medical colleges and that’s grave,” warned Sundararaman.
The Bill also mentions that National Exit Test, which is to gain a licence to practise after MBBS, can also serve as an entrance examination to post-graduate level.
The government has left a lot of room for confusion into this and IMA believes that this ambiguity will spell doom.
“It seems that those who don’t clear the exam will not be allowed to practise at all, which is huge. Last year, 1.15 lakh students undertook PG entrance exam but only 80,000 qualified. The others are still practising as MBBS doctors. This bill would altogether stop that,” said the IMA secretary.
“It will lead to acute shortage of doctors when our country is already facing so,” Asokan added.
This is when MBBS students are already taking a very rigorous final-year exam. “If at all, an exit exam was to be given, it should have been made voluntary and grade-based. So if a MBBS practitioner wants grade-accredited, s/he could have taken it, as is the precedent in some countries,” said Sundararaman, who has also been the director of Chhattisgarh’s State Health Resource Centre.
So far, medical colleges were only inspected for approval by the Medical Council of India (MCI), but this responsibility has now been entrusted upon Medical Assessment and Rating Board.
But now, according to the Bill, not only can members of the board inspect, but it may “hire and authorise any other third party agency or persons for carrying out inspections”.
This will append the corruption of which the MCI was accused, said Asokan.
However, Sundaraman differs. “If it is decided that a trained team of auditors will do it, it may not prove to be a bad provision because with doctors’ designated bodies conducting inspection we didn’t have a fool-proof experience of being corruption-free either. We will have to wait and watch,” he said.
Another concern the critics raised is the provision of community health providers (CHPs) who would be allowed to practise as doctors with limited licence to work as modern scientific medical professional at mid-level. However, the government failed to define who would be those CHPs.
IMA vehemently opposed this step as this would legalise quackery. “Considering the huge shortage of doctors, this may be a good step but it has to be heavily regulated and ensured that they only work in the public sector. The moment they are allowed to go into private sector, it would lead to corruption and defeat the purpose,” said Asokan while adding that the definition and other regulations should have been clearly spelt out.
He also appreciated the provision of creation of four autonomous boards — UG Medical Education Board, PG Medical Education Board, Medical Assessment and Rating Board and Ethics and Medical Registration Board.
Overall, while Harsh Vardhan had said in the Lok Sabha that the Bill would be a milestone in weeding out corruption, it may not be, said Sundaraman.
“The worst part is that we have no scope of election and all important members who would be government appointees would be necessarily able to clean the mess is somewhat a far-fetched imagination,” he added.
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