Context

• Union Health Minister Harsh Vardhan introduced the National Medical Commission (NMC) Bill in Lok Sabha. An earlier version of this Bill was introduced in the 16th Lok Sabha, and had passed the scrutiny of the Parliamentary Standing Committee on Health and Family Welfare. However, that Bill lapsed at the end of the term of the last Lok Sabha. Once the NMC Bill is enacted, the Indian Medical Council Act, 1956, will stand repealed. The existing Act provides for the Medical Council of India (MCI), the medical education regulator in India.

Why is Medical Council of India being replaced?

• The Parliamentary Standing Committee on Health and Family Welfare examined the functioning of the MCI in its 92nd report (in 2016) and was scathing in its criticism: “The Medical Council of India, when tested on the above touchstone (of producing competent doctors, ensure adherence to quality standards etc) 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; many of the products coming out of medical colleges are ill-prepared to serve in poor resource settings like Primary Health Centre and even at the district level; 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.”
• The Committee also said it was “shocked to find that 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. In a day and age when the need for sturdy systems and enhanced transparency based regimes are being increasingly emphasized, such state of affairs indicate that the MCI has not evolved with the times. Such state of affairs are also symptomatic of the rot within and point to a deep systemic malice”.

How will the proposed National Medical Commission (NMC) function?

• The NMC Bill provides for the constitution of a 25-member NMC selected by a search committee, headed by the Cabinet Secretary, to replace the MCI. The Bill provides for just one medical entrance test across the country, single exit exam (the final MBBS exam, which will work as a licentiate examination), a screening test for foreign medical graduates, and an entrance test for admission in postgraduate programmes.
• The Bill proposes to regulate the fees and other charges of 50 per cent of the total seats in private medical colleges and deemed universities. A medical advisory council — which will include one member representing each state and Union Territory (vice-chancellors in both cases), chairman of the University Grants Commission, and the director of the National Accreditation and Assessment Council — will advise and make recommendations to the NMC.
• Four boards — dealing with undergraduate and postgraduate medical education, medical assessment and rating board, and the ethics and medical registration board — will regulate the sector. The structure is in accordance with the recommendations of the Group of Experts headed by Ranjit Roy Chaudhury, set up by the Union Health Ministry to study the norms for the establishment of medical colleges.
• The Bill marks a radical change in regulatory philosophy; under the NMC regime, medical colleges will need permission only once — for establishment and recognition. There will be no need for annual renewal, and colleges would be free to increase the number of seats on their own, subject to the present cap of 250. They would also be able start postgraduate courses on their own. Fines for violations, however, are steep — 1.5 times to 10 times the total annual fee charged.

What are the changes in the 2019 Bill?

• There are two crucial changes, following the recommendations of the Parliamentary Standing Committee on Health and Family Welfare (109th report in 2018). One, it has dropped a separate exit examination. Two, it has dropped the provision that allowed practitioners of homoeopathy and Indian systems of medicine to prescribe allopathy medicines after a bridge course.

What is the so-called “bridge” course?

This was one of the most contentious provisions of the Bill with even ruling party MPs criticising it.

• On the bridge course, the Committee (in 2018) had said it was of the view that the “bridge course should not be made a mandatory provision… However, the Committee appreciates the need to build the capacity of the existing human resources in the healthcare sector, to address the shortage of healthcare professionals so as to achieve the objectives of the National Health Policy, 2017. The Committee feels that every State has its own specific healthcare issues and challenges. The Committee, therefore, recommends that the State Governments may implement measures to enhance the capacity of the existing healthcare professionals including AYUSH practitioners, B.Sc (Nursing), BDS, B.Pharma etc to address their State specific primary healthcare issues in the rural areas.”

What did the panel say about exit exam?

• On the National Licentiate Examination, the Committee (in 2018) recommended that the relevant clause be redrafted “so as to make the final year MBBS examination as the licentiate examination”.