The National Medical Commission (NMC) Bill 2019 was passed by the Lok Sabha on July 29 and the Rajya Sabha on August 1. Reading this important Act, which will decide the future course of medical education and medical ethics in this country, one gets a feeling that it offers little when compared to the Indian Medical Council Act 1956 (which saw multiple amendments), that led to the formation of the Medical Council of India (MCI), a body which was accused of rampant corruption. The NMC Act, in the garb of change, has some provisions which are far more problematic than those in the amended MCI Act.
The constitution of the medical commission as proposed in the Act has issues of subjugating federalism at multiple levels. The nomination of important functionaries of the NMC will rest exclusively with the Centre: This will give rise to nepotism and the promotion of a lackey culture, that had infested the MCI. Even the Medical Advisory Council, proposed in the Act, has nominated members from the states, thereby reducing the role of states to being consultative.
The other contentious point in the NMC Act is the creation of a cadre of Community Health Providers with the limited licence to practice medicine at the mid-level. This provision is a means to promote quackery within the scientific practice of medicine. In recent times, anti-scientific remarks by the political leadership of the country have already significantly eroded scientific temper. By providing the licence to practice medicine in such manner, the credibility the scientific community will be further eroded among citizens. There is no doubt that at the current doctor-patient ratio of 1:10,189 (WHO recommendation is 1:1,000), India is in dire need of doctors. Successful models incorporating allied healthcare professionals/alternative systems into allopathic medical practice are present throughout the globe, but their involvement — and quality — is thoroughly regulated. The NMC Act does not propose any means to ensure this. Also, there is ambiguity on which alternative health professionals will be allowed a licence.
The Act has proposed a common exit examination — National Exit Test (NEXT), at the end of the MBBS course. This test shall be held to grant a licence to practice and will also be the basis of admission to postgraduate courses. It appears that this provision is based on the premise that exit examinations produce good students. This premise has been under scrutiny the world over. More so, evaluating an MBBS student at the end of the final year through multiple choice questions (MCQs) is not a good idea: Existing evidence from across the world clearly favours subjective clinical evaluation as the best means to evaluate an upcoming doctor. It would have been better if a common exit exam had been held after ensuring that the level of medical education throughout the country is uniform.
Besides failing to address people-centric issues like recommendations for retention of doctors in rural health services, the NMC Act appears to heavily favour private medical colleges. Allowing the private medical colleges to “sell” 50 per cent seats is a serious threat to healthcare. It sets a dangerous precedent of usurping deserving students from becoming doctors merely on the basis of money.
The NMC Act fails to learn from the 65 years of experience with the MCI. A robust law would have been one that would have taken out medical education from the silos of traditional blocks and incorporated a culture of democratic practice in the field. Medical pedagogy is different from non-medical education. It is dependent on both didactics as well as clinical training. Evaluation of doctors should be a logically-regulated moral process, not a cruel retribution.
This article first appeared in the August 20 print edition under the title ‘Bad Prescription’. The writer is professor of orthopaedics, AIIMS, New Delhi and author of Announcing the Monster. Views are personal