The National Medical commission bill of 2019 presented to have four autonomous boards to take care of its different functions:
In here a new class of medical practitioners were introduced in the bill called Community health practitioners who were to given license to practice modern medicine at mid-level to those “connected with modern scientific medical profession”, the criteria for which would be specified later. Their number would be one-third of the total number of licenced and registered medical practitioners.
According to the bill the admissions and licencing will happen through National Eligibility cum Entrance Test (NEET) for undergraduates and postgraduates “super-speciality” medical education, while providing for another one, national Exit Test (NEXT) for granting “license” to practice and admission to postgraduate “broad-speciality courses”.
Until yet all admissions are through the NEET and no licensing is required for practice but a medical practitioner has to register with the state medical council for this.
The bill also presented for National Medical Commission to “frame guidelines for the determination of fee and other charges” for 50% of seats in private medical institutions and deemed to be universities which is currently determined by the state government for 85% seats in such institutions and others are for management.
National Medical Commission have other powers too like permission to establish new medical colleges, increase the number of seats, start post- graduate courses , recognition of medical qualifications in and outside India etc.
The Statement of object and reasons of the bill says the Indian Medical Council has failed to keep pace with time and various loopholes had crept into the system with serious detrimental effects on the medical education and by implication, on delivery of quality health services.
After the scrutiny of a parliamentary panel conformed the restructuring and revamping of the regulatory system of medical education and practice.
It has also recommended separation of functions by forming four autonomous boards and appointment of regulators through selection rather than election.
The Indian Medical Association (IMA) – the apex body representing the medical fraternity in India which had earlier opposed the government takeover of the MCI had four major concerns:
The first one is over the CHPs being allowed to practice modern medicine. The bill does not define who they are or what qualifications they hold and yet they are to be given licenses to the extent of 1/3rd of the total number of licensed medical practitioners in India. It will definitely have a detrimental effect on the modern medicine as it will open the door for persons with inadequate training, putting patients at risk and lowering standards of healthcare.
Fraternity fears those with some connections with modern medicine like pharmacists, practitioners of other systems of medicines with a bridge course, ophthalmologists and even existing healthcare workers at the primary health centres may get license to practice modern medicine.
Around 68,000 medical graduates pass out of more than 500 medical colleges every year. As only 23,000 of them qualify for post-graduation courses, the rest (45,000) end up looking for jobs or do coaching to qualify for PG.
“Here the government is providing a clear opportunity for unqualified or partially qualified persons to practice though the qualified ones are available and frustrated because of unemployment”, this is another attempt of government to add unqualified or partially qualified as earlier Bill proposed by them was withdrawn due to mass protests.
The IMA’s second major objection is to the proposed National Exit Test (NEXT) for giving both licenses for practice (to those who have already cleared the MBBS exam) as well as for admission to post-graduate “broad-specialty courses”.
Fraternity thinks the two objectives can’t exist together since the level of knowledge and training required for both are very different. While for practicing medicine, a minimum level of competence is required (passing the MBBS), admission to post-graduate courses calls for a higher level of competence and only the cream of the profession gets selected.
‘In the last NEET exam, only 70,000 of 1.43 lakh candidates qualified for post-graduate courses. What will the rest 73,000 qualified MBBS doctors do? They will not be licensed to practice, thus defeating the very objective of providing greater number of trained health manpower’
The third major objection is to “frame guidelines” to determine fees and all other charges for 50% of seats in private medical institutions and deemed to be universities (the MCI did not have such powers)
At present state governments “regulate” fees for 85% of such seats and the rest (15%) are for the management to decide. “Now the National Medical Commission proposes to only frame guidelines for regulating fees for 50% of seats.
This will definitely increase the cost of medical education making it the thing of only rich to afford neglecting mass students to have medical education.
The IMA has another (fourth) major objection. This is about the power, the Bill gives to the central government to give policy and other directives to the NMC and its autonomous boards which will be binding and final. This is contradictory to the very concept of autonomy of the four boards. The central government has also been empowered to give directives to state governments for implementing provisions of the Bill, which will also be binding, reflecting the anti-federal character of the Bill.