The National Medical Commission (NMC) Bill has been passed by both Houses of Parliament, heralding a new era in medical education in India. While the Bill has been largely well-received, three clauses in particular have drawn considerable criticism from some sections of the medical fraternity.
Perhaps the most debated provision in the NMC Bill is Clause 32, which, according to critics, amounts to institutionalising quackery.
India’s doctor-population ratio of 1:1,655 is sub-par, compared with the WHO standard of 1:1,000. Additionally, there is a severe scarcity of doctors in many areas, as reflected in the urban to rural doctor density ratio of 3.8:1. This is despite higher salaries offered to doctors through policies like ‘you quote, we pay’. As stated in the Report of the Expert Committee, led by (late) Ranjit Roy Chaudhury, constituted by the government in 2014: “many of the products coming out of medical colleges are ill-prepared to serve in poor resource settings like Primary Health Centre”.
Studies have shown that the poor largely seek health services from informal providers, who are often no worse at diagnosing a condition accurately than formally trained personnel. Accusing the NMC Bill of legalising quackery in the context of the Medical Council of India’s (MCI’s) repeated failures to even “produce a competent basic doctor” is disingenuous, to say the least.
Community health providers (CHPs) will be given a limited licence to deliver preventive and primary health services, including screening the population for non-communicable diseases at the 1,50,000 health and wellness centres to be operationalised in the country by 2022. Adequate safeguards have been put in place. The proposed NMC, which will have an overwhelming representation of doctors, will determine the qualifications of CHPs through regulations, which will be finalised following extensive consultations.
States like Chhattisgarh and Assam have experimented with community health workers, yielding good outcomes, say independent evaluations. This provision will also perhaps pave the way for development of other cadres, like nurse practitioners, who provide primary health services such as the prescription of specified medicines, in several countries.
Medicine is a profession that deals with human lives. The MCI has failed to ensure that only high-quality graduates enter the system. The National Exit Test (NEXT) will be a final-year undergraduate examination to assess whether all doctors possess a common minimum level of knowledge and skills. It will also streamline admission to postgraduate courses and counselling, as students will be able to gain their MBBS degree, a license to practice and admission to postgraduate courses through a single examination.
Concerns have been expressed that NEXT will be reduced to a multiple-choice exam. Given that it will come into effect only after a three-year window, there is ample time for defining the precise contours of the exam to ensure adequate weightage for theoretical and clinical skills.
Critics are accusing the NMC of “making medical education a preserve of the rich” by favouring private medical colleges. Ironically, this was the case under the MCI which devalued merit in admission by allowing black money and capitation fees to flourish. As noted by the Chaudhury Committee Report, corporate hospitals and doctors with private practices comprised more than 50 per cent of the MCI’s membership. This ensured that the focus was on revenue targets, leading to exploitation of hapless patients.
Around 50 per cent of the total MBBS seats in the country are in government institutions with nominal fees. The NMC will regulate 50 per cent of the remaining seats, implying that nearly 75 per cent of medical seats in India will be accessible at a reasonable fee. Further, States will be able to determine the fee for even the remaining seats in private medical colleges through individual MoUs, along with merit-cum-means scholarships to deserving students.
Moreover, the Medical Assessment and Rating Board (MARB) under the NMC will rate institutions on quality of education/training imparted. These ratings, coupled with the transparency accorded by the NEXT, will ensure that fees are regulated through market forces. After all, no student would be willing to pay high fees to an institution that is rated poorly by the MARB or whose graduates underperform in the NEXT.
As noted by the Chaudhury Committee, the MCI has reached a point of degeneration, where a piecemeal reform approach will fail to build a 21st century medical education system. The “innards” of the system needed to be changed, and this is precisely what the NMC Bill has done. – Business Line