The resentment against the National Medical Commission (NMC) Bill is far from over as the Indian Medical Association (IMA), the largest body of doctors and students in the country, has decided to hold a protest march with all representatives of the medical fraternity from Nirman Bhawan to Jantar Mantar to press for amendments.
IMA leads the dissent
According to the national president of Indian Medical Association (IMA) Santanu Sen, the march named as ‘Delhi Andolan’ will culminate in a Chhatra Sansad (students’ parliament). He said the government had failed to address concerns raised by the medical fraternity.
The Bill provides for setting up of a leaser inspection-oriented National Medical Commission (NMC) in place of the Medical Council of India (MCI) and repeal of the Indian Medical Council Act, 1956.
“The Bill, if passed in its present form, will only legalise quackery by empowering the community health providers to practise medicine, endangering the lives of people,” Sen told media.
“The decision to couple National Exit Test (NEXT) and National Eligibility cum Entrance Test (NEET) lacks clarity and is absurd,” he said.
“This will prevent more than 50 percent of the qualified MBBS graduates from practising modern medicine and give rise to quackery as the government will allow the quacks, who are hardly 30 percent of the total doctor’s population to practise under the pretext of ‘Shortage of Doctor’,” Sen said.
The IMA national president said the association at all costs is against the decision as this will also increase health safety concerns of the common people.
“The government in its wisdom is refusing licence to qualified MBBS graduates coming out of our medical colleges every year, but promoting indirect quackery,” he said.
The other clause includes a provision to fix the fee of private medical colleges capped to 50 percent of the seats which has been further diluted to framing guidelines only.
Sen claimed that under the new legislation medical education in the country will become expensive, placing the lower socio-economic groups in great disadvantage.
The Federation of Resident Doctors Association (FORDA) has also threatened to launch a nationwide protest against the Bill. It has termed the NMC Bill as “black law” in a letter to President Ram Nath Kovind urging him to push for withdrawing of the Bill by Government of India.
On Saturday, resident doctors and students at All India Institute of Medical Sciences (AIIMS) New Delhi organized a symbolic protest by wearing black badges to work against the National Medical Commission (NMC) Bill and termed it “anti-poor”.
They were seen wearing black badges in ICUs, emergency block, wards and operation theatres. Protests were being organized in various parts of the country against the Bill on the call of the Indian Medical Association (IMA).
Some doctors even burned a copy of the bill as a mark of opposition outside the AIIMS on July 23. Copies of the proposed legislation were burnt outside the IMA headquarters also in Delhi and it’s 1,700 branch offices on July 25, while students in many medical colleges observed hunger strike.
The medical fraternity including medical practitioners and students across the country have been opposing the Bill robustly ever since it was introduced in Lok Sabha on July 22 by Minister of Health and Family Welfare Harsh Vardhan.
DMA joins the chorus
The Delhi Medical Association has expressed strong reservations over the National Medical Commission Bill as it has urged that elected members should be given “more representation” in the proposed NMC.
The DMA members demand “more representation” be given to the elected representatives of the medical fraternity, they said in a statement.
“The provision of giving licences to persons related to the field of modern medicines and allowing them to practice as community health workers under certain circumstances and places will lead to the creation of a new force of quacks which will be difficult to control,” the association said.
The DMA felt that the NMC “consisted of nominated members mainly rather than elected members.”
Online petition against the Bill
A Chandigarh-based Medicos Legal Action Group (MLAG) has started an online campaign through a petition on change.org.
The petition has been addressed to Chairman Parliamentary Standing Committee on Health, Ram Gopal Yadav urging him to amend the NMC Bill. It has also highlighted suggestions and objections to the proposed legislation. The petition has already received more than 86,000 signatures from the supporters. The petitioner has set a target of 150,000 signatures to be able to press for the change.
Why the medical fraternity is opposing the NMC Bill?
The Bill seeks to repeal the Indian Medical Council Act, 1956 to replace the 85-year-old Medical Council of India (MCI) with the NMC.
Several portions of the Bill did not fare well with medical professionals, who wanted those parts altered or removed. However, the government retained these clauses after minimal window-dressing, thereby ignoring their demands. One such provision is the proposed six-month-long bridge course for para-medical professionals, and AYUSH and homeopathic practitioners.
AYUSH is an acronym for the non-allopathic, alternate systems of medicine that are practiced in India. To ensure the propagation of such indigenous practices, the Centre set up the Ministry of AYUSH in November 2014.
The course is aimed at granting ‘certain mid-level practitioners connected with the modern medical profession’ limited license to prescribe medicines and work in rural healthcare centers.
Despite concerns raised by doctors that the clause would promote quackery, the government retained it. Moreover, a Parliamentary Standing Committee that examined the Bill had also asked the Ministry to drop the provision.
However, minor alterations were undertaken to change the language but retain the original idea, pushing it forward with the explanation that it is a move aimed at bridging the gap in the existing doctor-patient ratio.
An earlier version of the Bill had suggested a two-year bridge course for AYUSH doctors to be permitted to prescribe modern medicine, which was met with vehement opposition from doctors.
The clause empowers an individual, who has taken the six months training, with rights similar to those of a licensed doctor (who holds five years of rigorous education and training), including prescribing medication.
Another problem with the Bill is the reduced autonomy vested in the proposed replacement commission, which will not be an elected body.
This is intended to reduce the monopoly of doctors who place personal vested interests above public interest, the PRS Legislative Research observed.
However, the counter-argument put forth is that this would subject the medical regulator to excessive bureaucratic control, with major decision-making powers in the hands of the Centre.
National Medical Commission Bill:
- The bill provides for the constitution of four autonomous boards entrusted with conducting undergraduate and postgraduate education, assessment and accreditation of medical institutions and registration of practitioners under the National Medical Commission.
- Composition of National Medical Commission: It will have government nominated chairman and members, and the board members will be selected by a search committee under the Cabinet Secretary. There will be five elected and 12 ex-officio members in the commission.
- As per the Bill, the government, under the National Medical Commission (NMC), can dictate guidelines for fees up to 40% of seats in private medical colleges. The bill also has a provision for a common entrance exam and licentiate (exit) exam that medical graduates have to pass before practising or pursuing PG courses. For MBBS, students have to clear NEET, and before they step into practice, they must pass the exit exam.
- Recognised medical institutions don’t need the regulator’s permission to add more seats or start PG course. This mechanism is to reduce the discretionary powers of the regulator.
- Earlier, medical colleges required the MCI’s approval for establishment, recognition, renewal of the yearly permission or recognition of degrees, and even increase 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.
Significance and the need:
- The Bill seeks to regulate medical education and practice in India.
- The Bill attempts to tackle two main things on quality and quantity: Corruption in medical education and shortage of medical professionals.
- The Bill aims to overhaul the corrupt and inefficient Medical Council of India, which regulates medical education and practice and replace with National medical commission.
Why is Medical Council of India being replaced?
- The Medical Council of India has repeatedly been found short of fulfilling its mandated responsibilities.
- Quality of medical education is at its lowest ebb; the current model of medical education is not producing the right type of health professionals that meet the basic health needs of the country because medical education and curricula are not integrated with the needs of our health system.
- Medical graduates lack competence in performing basic health care tasks like conducting normal deliveries; instances of unethical practice continue to grow due to which respect for the profession has dwindled.
- Compromised individuals have been able to make it to the MCI, but the Ministry is not empowered to remove or sanction a Member of the Council even if he has been proved corrupt.