The need for a new act replacing the Medical Council Act was, no doubt, of utmost importance. But rushing through this current bill using its brute majority is fraught with considerable dangers. The government may claim that this bill has had a long consideration and been placed before the Parliamentary Standing Committee, but there are significant changes that needed further consultation and dialogue. Even members of Parliament let alone the general public and medical professionals required more time to understand the implications of various clauses and respond to it meaningfully.
Diluting the federal system
Firstly, the NMC bill clearly reflects almost complete abandonment of our federal structure and an obsession of centralising every detail of both medical education policy and professional regulation, and all the means of implementation. The bill proposes a structure with 25 members in NMC out of which 14 will be nominated by the central government, six by the state government, and five to be elected from the profession. There is skewed representation from the states in the commission despite health being a state subject and medical education a congruent subject. Even the advisory body who will be involved in the nomination of NMC members will be appointed by the central government.
Open doors to commercialization of medical education sector
The NMC open flood gates for privatisation of medical education. The bill states that NMC can frame guidelines to determine fees and other charges with respect to 50% of seats in private medical institutions and deemed to be universities, implying that for the remaining 50%, there would be no regulation. Furthermore, for the latter 50% of seats, the NMC does not indicate as to what the principles of fee decision will be, enabling private medical colleges to levy market determined fees on students under the management quota. In other words, the bill, through the idea of differential pricing, gives ample space for admission to those who have the ability to pay. Students spending lakhs to become doctors may resort to unethical practices to recoup their investment.
The NMC does not mention anything on obligatory provisions of access and affordability to underserviced populations and aspirants.. These are just off the agenda. The focus is put only on promoting privatisation of the sector and completely misses out on addressing the basic problems of quality of education.
NEET and NEXT: Will it bring transparency in medical education?
The bill claims to ensure fair procedures of admission into medical education by proposing a common national examination including NEET (National Eligibility cum Entrance Examination) and NEXT (National Exit Examination) – The proposition again reflects the government’s obsession for centralising everything possible. There are claims that NEET will keep corruption in medical education under check and will serve as an important means of ensuring the meritorious get admission. But the fact that NEET is based on one board’s syllabus which is imposed on all students (coming from different state boards) and follows an MCQ format that requires specific skill sets and practices to perform within limited timeframe is quite different from the usual examination format in senior secondary exams, leaving students with no resort but to take assistance from medical entrance coaching institutions. It will thereby boost the coaching industry which only wealthier students can afford while students from economically disadvantaged and rural backgrounds with no access to coaching or any additional support will lag behind. This will not help in prioritizing suitable candidates from under-served areas – which is a great necessity considering the highly skewed availability of human resources in rural and poorly accessible areas.
Moreover, the bill proposes a common final-year MBBS examination, National Exit Test (NEXT), before an individual starts practicing medicine and for seeking admission to post-graduate medical courses and for enrolment in the state register or the national register. Though the exact format for the exam is not known so far, however, if it is an MCQ format (same as for NEET), it will not be enough to test skills, clinical capabilities and patient interaction. A final year student passes through different subjects in phases and combining all into a single examination does not make sense.
Providing mid-level healthcare providers or legalising quackery:
NMC Bill brings in another clause which is being most vehemently opposed by the doctors. The bills gives provision to issue limited licence to practice at mid-level as a community health provider to persons connected with ‘modern scientific medical profession’. Though the government claims this provision as an interim arrangement till the doctor population is scaled up to the required level in India, the government will need to have a mechanism for tight regulation and supervision to check malpractices and ensure quality healthcare in India. As accused by the medial fraternity of legalising quackery, even if it is not the intent of the government, there is certainly a fear that a poorly qualified healthcare provider could get generated who would then proceed to enter to the highly competitive, almost predatory urban markets for healthcare in the longer run.
Moreover, the bill has been fairly disappointing as it remained silent on crucial aspects such as mechanisms to curb unethical practices and corruption, which was one of the major reasons for scrapping Medical Council of India.
(The author is Programme Coordinator– Health, Oxfam India )