On Thursday, Rajya Sabha passed the National Medical Commission (NMC) Bill that seeks to overhaul the medical education regulation infrastructure. Since then, doctors have struck work in Delhi and other cities. What is the Bill about and why is it controversial?
An earlier version of he NMC Bill was introduced during the previous Lok Sabha and later referred to the Parliamentary Standing Committee on Health and Family Welfare. It lapsed with the dissolution of that Lok Sabha. In the current session, the Bill was reintroduced with changes based on the Committee’s recommendations. After Lok Sabha passed it, it was sent to Rajya Sabha with two new amendments and passed. It is now headed back to Lok Sabha, where the government enjoys a brute majority.
Licence to practice
Section 32 of the NMC Act 2019 allows the proposed NMC, which will replace the Medical Council of India, to grant “limited licence to practice medicine at mid-level as a community health provider”. The Indian Medical Association (IMA) sees it as encouraging quackery. In a letter to Prime Minister Narendra Modi on July 30 calling for the Bill to be redrafted, the IMA wrote: “We are deeply concerned about granting non medical ‘persons connected with modern scientific medical profession’, licence to practise modern medicine… This is nothing but legalising and promoting quackery in India… Who will guarantee that these ‘legalised quacks’ will work in villages only?… National Medical Commission Bill will open the floodgates for licencing 3.5 lakhs ‘legalised quacks’. This amounts to ‘licence to kill’.”
Doctors have expressed concerns about the licence mentioned in Section 32 being another name for a contentious “bridge course”. Such a course has been proposed in the original version of the Bill. It would have allowed practitioners of homoeopathy and Indian systems of medicine to go on to practice allopathy. In the new Bill, the bridge course has been dropped as per the recommendations of the Parliamentary Standing Committee on Health and Family Welfare, which wrote: “The Committee is of the view that the bridge course should not be made a mandatory provision in the present Bill. However, the Committee appreciates the need to build the capacity of the existing human resources in the healthcare sector, to address the shortage of healthcare professionals so as to achieve the objectives of the National Health Policy, 2017… The Committee, therefore, recommends that the State Governments may implement measures to enhance the capacity of the existing healthcare professionals including AYUSH practitioners, BSc (Nursing), BDS, B Pharma etc to address their State specific primary healthcare issues in the rural areas.”
The original Bill had proposed a licentiate examination for doctors, and the IMA had expressed concerns about it then too. The new Bill proposes a single exit exam – the final MBBS exam, which will work as a licentiate examination, a screening test for foreign medical graduates, and an entrance test for admission in postgraduate programmes. It also provides for just one medical entrance test across the country
In the letter, IMA wrote: “The Bill condenses final year MBBS exam, Licentiate exam. and PG NEET into one examination. This effectively removes the opportunity to reappear for PG selection. Moreover, the examination being objective in nature, increases the workload and stress level of the students manifold. Allowing foreign medical graduates to take the same examination will be an injustice… The current system allows medical graduates to practise irrespective of the status of his/her PG NEET.”
Arguments in favour
Dr K S Reddy, president of the Public Health Foundation of India and former professor of cardiology at AIIMS, said: “The NMC Bill opens the path to a long-awaited reform of medical education… Mid-level health workers like Community Health Providers are very much needed but their training programmes, competencies and roles have to be clearly defined to differentiate them from medical graduates. The Allied Healthcare Professionals Bill, which is to be examined by the Standing Committee, is the right place to position them. A common exit examination is needed for standardisation and postgraduate course selection but must be preceded by a college-level testing of practical clinical skills as a qualifier for the theory-based NEXT (National Exit Test).”