You called the National Medical Commission Bill a historic legislation in Parliament, but doctors have been very upset about it. What do you have to say to those who did not get a direct audience with you but still nurture doubts about many aspects of the Bill?
The National Medical Commission Bill, 2019 is in line with Hon’ble Prime Minister Narendra Modiji’s vision of providing universal healthcare to each and every citizen of India. I have no doubt that the NMC Bill, 2019 will go down in history as the biggest reform of the 21st century in the field of medical education. The Bill is student-friendly and aims to rid medical education of vested interests that were subverting qualitative improvements in this sector. The Medical Council of India (MCI) was plagued by corruption and had become the reason for the diminishing respect of medical profession in the country. Replacing it with the NMC has been one of the greatest achievements of my life.
As I have been an ENT surgeon for 35 years, I would like to assure all doctors that if they haven’t already realised the benefits of the Bill, they will definitely realise the benefits of this change in the near future. The reluctance to accept the need for change is natural and human, sometimes there are vested interests in maintaining a status quo. All this is now a thing of the past as NMC Bill has been passed and has become a reality. It opens up new horizons for the medical fraternity. I am honoured to have been a part of piloting this Bill and setting medical education free of corruption.
The Bill has a provision for a limited licence to practice modern medicine which some people say is actually the contentious bridge course with a different name. What do you say to concerns that it will encourage quackery?
The provision for a cross-pathy bridge course has been completely deleted in the NMC Bill. The provision for Community Health Providers is confined to professionals related to modern medicine only and having the qualifications prescribed by NMC. These qualifications will be prescribed in regulations that will be framed after careful analysis of the proficiencies required by CHPs and the curriculum of the allied health professionals being considered. They will be finalised after public consultation and debate. Quacks will have no role in this scheme of things and the punishment for quackery has actually been enhanced to up to one year imprisonment and fine of Rs 5 lakh.
There are concerns that the provision of fee fixation for just 50 per cent seats would end up compromising merit as only those who can pay will be able to afford the rest of the seats.
Please understand that there was no provision for fee fixation by MCI. In view of this glaring omission, the Hon’ble Supreme Court had to appoint committees in each state to regulate the fees until a system was evolved and set in place. Now, NMC Bill has introduced fee regulation by the government for the first time. It is unprecedented, of course, and a most welcome step to my mind.
In a federal polity, it is not appropriate for the central government to assume control of 100 per cent seats. States are free to bring state amendments about the remaining 50 per cent seats as per need, since medical education is in the concurrent list.
However, directly and indirectly through the states, the central government does have the power to regulate fee structure in all medical colleges. I think that is a cause enough for celebration as it ends the misery of students who were at the mercy of a corrupt system.
The main problem in medical education is the demand and supply gap. How will the Bill tackle that?
The NMC Bill simplifies procedures and eliminates repeated inspections of colleges. NMC is also mandated to reduce the cost of medical education, thereby facilitating setting up of more medical colleges. Our government has already increased 28,000 MBBS seats and 17,000 PG seats in the past five years, which is a record of sorts. We have rationalised teacher-student ratio, simplified physical infrastructure requirements of medical colleges, taken a number of steps to increase the availability of faculty and reformed the process of inspections of colleges. The result has been that the approval percentage of new colleges has gone up very significantly (from 21 per cent to 50 per cent) after formation of the Board of Governors of MCI and 37 new colleges were approved this year as against 21 last year. We hope to see an era of even more rapid growth with the setting up of NMC. If we are able to maintain this trend, then we are hopeful of achieving doctor-population ratio of 1:1000 within the next 7-8 years.
On the final year MBBS examination being the licentiate exam, PG entrance the screening test for foreign graduates, there are some who feel that standards of medical education across states are not uniform and, therefore, such a system would end up giving undue advantage to students from some states
On the contrary, it will ensure uniformity of standards throughout the country. All citizens of India need to be treated by good doctors, not only citizens of a few states.
Leaders from Tamil Nadu have been agitating in Parliament against NEET, demanding that it is discriminating against rural Tamil-speaking students. How would you address their concerns?
This issue has already been decided by the Supreme Court.
Despite a relaxation in norms that used to bar profit-making sometime back, only a few private hospitals have come forward to open medical colleges. Why? That is a vast medical education infrastructure waiting to be tapped. How do you intend to rope them in?
The major reason for hesitation on part of private hospitals to go ahead and set up medical colleges was the arbitrary, unpredictable and rent-seeking approach of MCI. However, things will change incredibly now. NMC is proposed to be totally transparent and objective in its approach and genuinely interested persons will have no reason to refrain from investing in medical education infrastructure. This will help us to tap the vast medical education infrastructure already available and encourage private hospitals to set up medical colleges and add to the number of MBBS seats in the country.
Are you also mulling a speciality-specific, common exit exam for PG students?
I think this is a very difficult proposition. Unlike MBBS, where a single exit exam can be conducted, there are over 30 broad specialities at the PG level. An exit exam would, therefore, be quite complicated at the PG level. Of course, the experts in NMC have to take a call on this and a host of other issues connected to medical education after widespread consultation and debate and we cannot indulge in speculation at this juncture.
How will you stop medical brain drain? The best Indian doctors work abroad.
I have no doubt that doctors working in India are among the best in the world. Those who go abroad also excel there and earn a good name for our country. Instead of trying to stop our doctors from going abroad, we would prefer to focus on increasing the number of seats in the country and improving working conditions in the country. We would like to welcome OCI doctors and even foreign doctors to come to India and engage in practice, teaching and research. Given the size of our population and the vast opportunities that our country presents, I have no doubt that we will see a net brain gain rather than brain drain in the years to come.
I congratulate the Hon’ble Prime Minister Shri Narendra Modi ji, who is our guiding light, for his vision on universal healthcare, the ambitious targets that he has set forth for us to achieve and most of all for the PM Jan Arogya Yojana which is popularly called Ayushman Bharat that has already benefited crores of citizen from the economically weaker section and changed their lives. I am a mere footsoldier and here to implement Modiji’s dream of a disease-free, healthy India. Notwithstanding the steep challenges ahead, I am committed to ensuring good health for each and every Indian. I believe in the lines of Robert Frost .