Sumant Narain, a civil servant and ex-director in Health in NITI Aayog, stands for the enacted National Medical Commission (NMC) Bill, 2019. He elucidates how enacted NMC Bill will be a step towards the reformed Medical education which is a subject matter of continuous reforms.

Highlights of the National Medical Commission Bill, 2019:

  • The NMC Bill, 2019 will replace the Indian Medical Council Act, 1956.
  • The Bill focusing on medical education will ensure:
    1. Availability adequate of high-quality medical professionals,
    2. Adoption of the latest medical research practices by medical professionals,
    3. Periodic assessment of medical institutions and
    4. Effective grievance redressal mechanism.
  • The Bill will replace Indian Medical Council by the National Medical Commission (NMC) consisting of 25 members at the national level and will establish State Medical Councils at the state level.
  • The Bill also provides for the constitution of Medical Advisory Council to aid and advice the NMC determining and maintaining minimum standards of medical education.
  • The Bill also helps in setting up following autonomous boards:
    1. the Under-Graduate Medical Education Board (UGMEB)
    2. the Post-Graduate Medical Education Board (PGMEB)
    3. The Medical Assessment and Rating Board (MARB)
    4. The Ethics and Medical Registration Board (EMRB)
  • The Bill will provide admission to under-graduate and postgraduate super specialty medical education in all medical institutions through a platform of uniform National Eligibility-cum-Entrance Test (NEET) and National Exit Test (NEXT).
  • The NEXT will allow students graduating from medical institutions to obtain the license for medical practices in India.

Major concerns over the NMC Bill, 2019: There are five primary concerns in various fora over a few clauses in NMC Bill:

    1. National Eligibility-cum-Entrance Test (NEET)/National Exit Test (NEXT): Many doctors and trainee doctors objected for the common NEET exam for admission to the UG and PG courses. There was also an objection for the NEXT examination considering it as a burdensome thing after completing the course by taking admissions through a separate examination.
    2. Empowering of community health providers for limited practice: With 70% of the Indian population residing in villages, only 27000 doctors serve to 6,50,000 villages of the country. Thus, comparing the ratio of patient to doctor availability, there is a great need of community health providers. Though the NMC Bill allowed for the community health providers to practice medicine, there is a major concern of limited practices allowed in the field.
    3. Regulating fees in private colleges for only 50% seats: The NMC Bill has provisioned for admissions in the college as well as regulations over the fees for poor and marginal students. But the regulation providing for fees in private colleges has been provided only for 50% seats. 
  • Reducing no. of elected representatives in the Commission: The Medical Council earlier had an elected representative. Whereas the National Medical Commission proposed under the NMC Bill has provisioned for a search committee and reduced the number of elected representatives in the commission.
  • Overriding powers of the Centre: The health is a subject under the State List under Schedule VII of the Constitution of India. Taking the responsibility for the national level health policies in the country, the Centre has included some centralizing provisions in the NMC Bill, which overrides the Central powers over the state powers.

Resolving the concerns:

  • On Examinations: 
  1. The Bill provides for a single NEET exam consolidating multiple exams at the undergraduate level which also will help in avoiding multiple counseling processes.
  2. The National Exit Test (NEXT) will be for final year students in graduation, which will clear away for post-graduation entry and will also licentiate medical practice after graduation.
  3. It will help in reducing disparities in the skill sets of doctors obtaining their degrees from different institutions in the country.
  4. Following a ‘One Nation - One Exam’ in the medical education system, NEXT will help in establishing a single platform for medical standards and licentiate exam for graduates across the world.
  • Community Health Providers:
  1. As per the recent report by the Organisation of Pharmaceutical Producers of India (OPPI) released at the Fifth Healthcare Access Summit, nearly 75% of dispensaries, 60% of hospitals and 80% of doctors are located in urban India, serving only 28% of the Indian populace.
  2. Whereas, the ratio of doctors in urban-rural areas presently is 3.8:1.
  3. With 70% of the Indian population residing in villages, only 27000 doctors serve to 6,50,000 villages of the country. 
  4. As per the recent study by WHO, nearly 80% of allopathic doctors practicing in rural areas are without medical qualification.
  5. The NMC Act will help in addressing this gap with modern medicine professionals and community health providers. 
  6. It also specifies the qualification criteria to maintain quality in primary and preventive health care.
  • Capping of fees:
  1. There is no provision for fee regulation in the Indian Medical Council Act, 1956.
  2. So till now, there was a resort to capitation fee-driven discretionary management quotas in private medical colleges.       
  3. The NMC Act will remove the discretionary quota by using a transparent fee structure.
  4. The National Medical Commission, through the Act, will frame guidelines for determining not only the fee structure of private colleges but also other charges of 50% of poor and meritorious students.
  5. The NMC Act will also provide for the rating of colleges along with the fee regulation through market forces which will incentivize to attract private investors.
  • Elected representatives in the Commission:
  1. The NMC Bill provides for a transparent search and selection processes for both elected and nominated representatives both in search committees and the Commission itself. 
  2. The Commission will also have representation from State Medical Councils and Universities.
  3. This will bring transparency, accountability, and quality in the governance of medical education in the country.

Overriding Powers of the Centre: The Central Government is responsible for the national level of health policies in the Country. Thus, it should have the power of directing NMC to align with its policies. In public emergencies like Kolkata Doctors issue, citizens expect the Government to address issues. Thus, the Government should be the final decision making authority with aid and advice by the NMC. Other features in the NMC Bill:

  • The Bill provides for the establishment of the Diplomate of National Board’s equivalence to NMC-recognised degrees.
  • The NMC Bill will also provide for a medical pluralism involving community health providers.
  • It will also help in improving skill sets and the number of doctors in rural areas.
  • The Bill provides for stringent punishments for unqualified medical practitioners or quacks.
  • There is a uniform regulatory platform through reasonable monetary penalties to the withdrawal recognition to colleges in case of non-compliance with the norms. 

Conclusion: There is a great scope in reforms of medical education in order to usher in improvements in the Indian healthcare system. The NMC Act will be a serious attempt towards the professional medical practices and health care system in India. Through the act, the Government is aspiring for a transparent, accessible and affordable medical education system in India which will lead to better healthcare outcomes. It would be a step towards the possible reforms in the future.