The National Medical Commission Bill, 2017 seeks to replace the Medical Council of India (MCI), an association tainted by corruption charges. But are we exchanging one flawed system for another? If there are complaints that the election process at MCI was rigged, the selection process proposed in the NMC Bill 2017 is vulnerable to the same pressure. If medicos were in complete control of MCI, the NMC Bill 2017 swings to the other extreme. The proposed NMC Bill has a 25-member commission appointed by the central government, of which 20 will be appointed by the search committee chaired by Cabinet Secretary, leaving only five members to be elected by and from the medico community.
Various associations have submitted representations to the standing committee on health tasked with seeking public opinion on the NMC Bill 2017. It is hoped that each objection is debated and the Bill fine-tuned if necessary. As expected, this exercise is turning out to be a turf war between medicos and ministry mandarins.
The Alliance of Doctors for Ethical Healthcare (ADEH) say that a “technocratic, bureaucratic NMC is no solution to the ailment of the outdated, degenerate Medical Council of India.” It warns that the Bill will result in further privatisation of medical education as it seeks to allow for-profit organisations to open up medical colleges as well as regulating fees for just 40 per cent of the seats, instead of mandating that 40 per cent seats should match the fees in government hospitals and even the remaining seats should have marginal increases.
This suggestion is ideal but unrealistic as for-profit organisations will seek profits. If our objective is to increase supply (of doctors and therefore medical colleges and seats) then there has to be sufficient but reasonable incentive for organisations to put in the resources to meet this demand. Who decides the range of fees, is the crux of the matter.
Dr KK Aggarwal, National President, IMA, finds fault with the NMC’s proposed composition, structure, and alleges that it aims to hand over power to administrators rather than medicos.
There is no doubt that the Bill seeks to plug the gaps in India’s healthcare ecosystem. For instance, it seeks to address India’s poor doctor: patient ratio by introducing bridge courses for practitioners of homeopathy and other systems of medicine, so that they can step in to fill the gaps.
The intention may be noble, but the manner in which it has been proposed has raised the hackles of even the homeopathic community. It is tucked away under the Miscellaneous section, as Clause no 49, which provides for joint sittings of the Commission, Central Councils of Homeopathy and Indian Medicine to enhance interface between their respective systems of medicine. Such meeting shall be held at least once a year. The joint sitting may reside on approving educational modules to develop bridges across the various systems of medicine and promote medical pluralism.”
The Indian Institute of Homeopathic Physicians (IIHP) opposes the proposed bridge course for AYUSH doctors in the NMC, 2017 saying it would encourage back door entry of quacks and that they would prefer to maintain the ‘purity’ of homeopathic practice. But it is a reality that with the dearth of doctors and nurses from the allopathic field, especially in the rural areas, AYUSH practitioners step in and fill the gap. Although this is refuted by the IIHP and other AYUSH associations, the proposed bridge course would bring this practice out in the open, and this cadre can be utilised in a more regulated and efficient manner.
The NMC Bill has thus succeeded in uniting practitioners of different systems of medicine, though their criticism varies. While the Central Council of Indian Medicine (CCIM) supports the proposal, it does so because it hopes that the bridge course will allow AYUSH practitioners to address the gaps as they are not allowed to use anaesthesia, radiology, ultrasound, MRI and so on. CCIM representatives feel that if they are allowed to do this, they would “remain an ancient medicine but with modern advances.” But, this does not seem to be the intention of the bridge course as described by in the proposed NMC Bill 2017.
The call for reform of the MCI was first voiced by former Prime Minister Manmohan Singh in his 2009 Independence Day speech. It has taken almost a decade to have a replacement, but observers say that the same flaws remain. Do we go back to the drawing board for (yet another) fresh Bill? Or go ahead with the NMC Bill 2017, and work on fixing the flaws via various amendments? After all, some regulation is better than none.