India faces an unenviable challenge of tackling the dual burden of diseases and lack of qualified health personnel. The intrusive, non-transparent, infrastructure-obsessed and unpredictable regulatory regime put in place by the Medical Council of India (MCI) has ensured that we can address neither the issue of quantity nor quality of medical professionals being churned out by our medical education system.
The MCI and The Dental Council of India (DCI) have been repeatedly under the scanner as some of its members were accused of taking bribes in order to fast-track accreditation. Experts at NITI Aayog have proposed replacing only the compromised MCI and not the DCI with a new National Medical Commission (NMC), outlined in a draft Bill known as the National Medical Commission Bill, 2016.
Some standout features of the NMC Bill:
* The government, under the National Medical Commission (NMC), can dictate guidelines for fees up to 40% of seats in private medical colleges. This surely will give students relief from the exorbitant fees charged by these colleges, and is a standout feature of the Bill.
* The Bill also has a provision for a common entrance exam and licentiate (exit) exam that medical graduates have to pass before practicing or pursuing PG courses. For MBBS, students have to clear NEET, and before they step into practice, they must pass the exit exam. With a clear roadmap once cleared will ensure a higher standard of care.
* Recognized medical institutions don’t need the regulator’s permission to add more seats or start a PG course. This mechanism will reduce the discretionary powers of the regulator. India does need many more post-graduates passing out to cater to the needs of healthcare.
* Earlier, medical colleges required the MCI’s approval for establishment, recognition, renewal of yearly permission or recognition of degrees, and even an increase in the number of students they admitted. Under the new Bill, the powers of the regulator are reduced to establishment and recognition. This means less red tape, but also less scrutiny of medical colleges.
* Transparent and pro-active disclosure by the medical institution with regard to fees, facilities, faculty and infrastructure. A mandatory assessment and rating of medical colleges on annual basis to be carried out and published in order to enable prospective students to make an informed choice.
But some key concerns remain. The NMC Bill seems to have paved the way for the back door entry of practitioners of traditional medicine into the domain of allopathic doctors via the Bridge Course. This decision merits a deeper and more scientific discussion. The rationale that Allopathic doctors are not available in remote areas, needs to be addressed at the medical education stage, but even that takes time because it takes years before a full-fledged doctor is turned out into the community.
Some traditional practitioners also are unhappy that the Bill that proposes a “bridge course” for their community to practice allopathy. Instead of popularizing traditional medicines, this move encourages many traditional practitioners to gravitate towards allopathy.
But the fact remains how the DCI has been so benevolently let off the hook? Especially when there are surplus dentists passing out in herds from mushrooming dental colleges with meagre job opportunities, forcing many to work in call centres. Alleging rampant corruption in the DCI, the CBI has named its president, Dr Dibyendu Mazumdar and former secretary Dr S K Ojha, among others in an FIR.
The Niti Aayog, in the current bill, talks about replacing the current Medical Council of India with a primarily nominated team (the Medical Commission) with bureaucrats who will be ruling the roost. This seems like the same old wine in a new bottle. The very preamble of the NMC Bill states that “principle of the “regulated” electing the “regulator” is flawed and creates a conflict of interest, therefore MCI should be discarded”. By this argument however, the Bar council should not regulate advocates, ICAI should not regulate Chartered Accountants and so on and so forth. There must an equal proportion of elected representatives.
The NMC will frame policies for governance of medical education in India. No specific mention on a clear roadmap to revamp our abysmal public health care systems. There is an urgent need to beef-up the public health system. For long, the public health system has languished and the space abdicated by the government has been occupied by private players. We need to realize that the quality of care delivered in the public system is far from desirable. The government should increase the budget spent on health care which at the current moment is so sparse, so that fewer people are dependent on private facilities. If public primary care is good, there will be less need for tertiary care centers.
The structural differences between the proposed NMC and MCI are enormous.
The NMC will split the selection, advising, and actual accreditation process into three separate boards. By dividing power, the hope is to create a system of checks and balances. However, as per the current Bill, all members of the accreditation board are supposed to be ex-officio members of the advisory board. This defies the logic of good governance. Instead of creating different boards to watch and observe each other, the NMC will instead create a single potentially corrupt body. That’s why all members of the accreditation board must exit from the advisory board.
Clearly, the NMC Bill needs a more open and scientific discussion keeping patient interest at the centre. We have yet to see what further changes are done in the bill before it sees the light of the day. The journey of a thousand miles begins with the first step. The NMC bill purports to be only that – a first step.
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