National Medical Commission Bill: Govt ignored key advices

The National Medical Commission (NMC) Bill, which had doctors and educationists take to roads against it, doesn’t include some of the key recommendations of the parliamentary standing committee that studied it.

The Bill, which was first tabled in Lok Sabha on December 29, 2017, was then studied by a 31-member Parliamentary Standing Committee headed by Rajya Sabha member Ram Gopal Yadav. The committee submitted its report to Parliament on March 16, 2018.

While debating the Bill in Rajya Sabha on July 31, 2019, Union Health and Family Welfare Minister Harsh Vardhan said it had been approved by the committee. But, the committee’s recommendations on the clauses that later became a bone of contention were ignored by the government.

Of the 56 recommendations, 40 were accepted, nine were rejected and seven were partially accepted. “The major problem is with the partial acceptance because in doing so they have killed the spirit of the recommendations of the committee,” said Jairam Ramesh, a member of this committee. The Congress parliamentarian debated on the Bill in the Rajya Sabha.

No second chance

The standing committee had opposed the National Exit Test (NEXT). According to the Bill, it would serve three purposes — final-year MBBS examination, a licentiate exam for getting permission to practise and entrance exam for admissions to PG courses.

The Bill, however, has no scope for improvement if a student fails. Earlier, there existed an improvement exam for those who failed the final-year test.

“Unless the exit exam is carefully designed, there is apprehension that a sizeable number of MBBS doctors who have passed their university-level examinations, may be debarred from practice on disqualifying the exit exam. This will not only undermine the sanctity of university examinations but also put an extra pressure on the system when the country is already facing a shortage of doctors,” said the committee.

This is important since the doctor-patient ratio in India is already abysmally low. As against the WHO recommendation of one doctor per 1,000 people, the ratio in India is 1:11,082.

The committee believed NEXT would result in a population of mismatched and unhappy doctors who have nowhere to go.

“This exam will put undue stress on students, especially those who come from backward sections of the society and cannot afford private guidance/tuitions for it. They may not be able to crack the multiple-choice questions (MCQ),” the committee had said.

The committee had serious reservations against the proposed MCQ format of the examination. All those reservations were completely ignored by the government.

The report had said, "Final-year MBBS exam should be designed consider not only the cognitive domain but also the assessment of skills with practical problems/questions on case studies and a strong tilt towards primary healthcare requirements. Making provision for final-year MBBS exam as the licentiate examination would test both theoretical and clinical aptitude of students."

Unbridled fees

Another controversial clause of the Bill is regulation of fee of more than 35,000 seats in private medical colleges. The Bill says the proposed NMC can frame guidelines on fees determination of only 50 per cent of seats in private medical colleges. The recommendation of the committee, was however, that it must be regulated for at least 50 per cent of the seats.

Not only was the phrase “at least” done away with, but also the recommendation that the commission be allowed to cap the fee. The Bill, instead of letting the NMC “regulate” the fees, only permits it to “frame guidelines”.

Although, on being opposed in the Rajya Sabha, Vardhan did say that a cap could be fixed, but no amendment was made in the Bill. 

Quack doctors

The Bill’s Section 32 talks about the concept of community health providers (CHP), who would be given ‘limited license’ to practise at ‘primary and preventive level’. The IMA opposed this clause, saying it would “legalise quackery” as the Bill not only failed to define CHPs, but also did not detail as to how they would practise modern medicine.

This section was not a part of the version of the Bill submitted to the standing committee. Instead, it had a provision to allow Aysuh doctors to practise as modern medicine practitioners after undertaking a bridge course.

“Thank God the government did away with the concept of bridge course but it replaced one dangerous cocktail with another dangerous cocktail. It is wrong to say that the Bill has approval of the Committee as the CHP clause was never a part of the version submitted to us,” said Ramesh.

Absolutely ignored

Another major objection raised by the committee was on appellate jurisdiction.

“The committee thinks giving appellate jurisdiction to the Centre does not fit into the constitutional provision for separation of powers,” said the standing committee.

It recommended: “A Medical Appellate Tribunal should be constituted comprising a chairperson, who should be a sitting or retired Judge of the Supreme Court or a chief justice of a high court, and two other members. It will have an appellate jurisdiction over the decisions taken by the commission.”

This too was ignored.

The committee also suggested that a minimum compulsory period be set to reign in the brain drain of Indian doctors. “A large number of doctors who study in government medical colleges with the taxpayers’ money leave the country at the first-given opportunity. In all such cases, a minimum compulsory period of working within the country be prescribed before such doctors can be allowed to serve outside the country,” it had recommended. 

This wasn’t accepted either.

“Wish the government would have listened, if not to us, to the committee at least. We would not have needed to resort to frequent strikes causing hardship to patients then,” said IMA Secretary RV Asokan.

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