NMC In And MCI Out To Debug Medical Ecosystem

In a landmark decision with far reaching consequences, the Union Cabinet on December 15, 2017 cleared the much-awaited National Medical Commission (NMC) Bill, 2017 to usher in landmark reforms in the medical education field. It thus puts to rest the controversy-ridden Medical Council of India (MCI). It must be clarified here that the MCI is a statutory body for establishing uniform and high standards of medical education in India. The Bill for the formation of the new apex medical regulator is likely to be placed in the outgoing winter session of Parliament.

To recapitulate, the draft Bill was proposed by a four-member Niti Aayog Committee in 2016. It was modified by a Group of Ministers constituted to relook it in July 2017. It has been awaiting approval since last few months. MCI has often been criticized for massive corruption and a lack of any accountability.

According to a Parliamentary Standing Committee report on health submitted in 2016, it would lead to great social, financial and political cost if unchecked. It said that, 'The MCI as the regulator of medical education in the country has repeatedly failed on all its mandates over the decades.'

While craving for the exclusive indulgence of my esteemed readers, let me inform them that the Union Law and Justice Minister Ravi Shankar Prasad while interacting with reporters after the Cabinet meeting informed them that, 'The MCI will be replaced, and a National Medical Commission Bill has been brought. This is to correct the whole medical ecosystem.' It is a reform that is long overdue. So no prizes for guessing that Centre had to ultimately bring in this long-awaited Bill.

For my esteemed readers exclusive indulgence, let me also inform them that according to Government sources, the National Medical Commission Bill 2017 envisages a four-tier structure for the regulation of medical education with a 20-member National Medical Commission at the top comprising a Chairperson, nine ex-officio members, 10 part-time members and five elected donors. It will regulate medical education with the Government having the right to give binding directions. The draft 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.

To put things in perspective, the draft Bill also proposes a common entrance exam and licentiate exam, which all medical graduates will have to clear to get practicing licences. As per the provisions of the draft Bill, no permission would be needed to add new seats or to start postgraduate courses. The deterrence for non-compliance with maintenance of standards is in terms of monetary penalty.

Needless to say, the draft Bill is primarily aimed at bringing reforms in the medical education sector which has been under scrutiny for corruption and unethical practices. Without a doubt, the new structure will certainly ensure that the Government has more leverage. This will also prevent the system from descending inexorably into the present state, where the MCI and the Government are often at loggerheads on many issues. This only serves to hinder the progress that is imperative for taking forward the medical education sector.

Let me now outline some anticipated benefits of new legislation. They will make sure that medical education is delivered in a much better and transparent manner. They are as follows: -

1. It will mark the end of heavy handed regulatory control over medical education institutions and a shift towards outcome-based monitoring.

2. It will pave the way for introduction of a national licentiate examination. This will be the first time that such a provision is being introduced in any field of higher education in the country, as was the introduction of NEET and common counseling earlier. Certainly, this will herald many landmark changes in the medical education field. It will ensure that every candidate who completes five years of MBBS course will have to clear a national licentiate examination to become a medical practitioner or get entry into post-graduation studies. Presently, we see that a candidate clears National Eligibility Cum Entrance Test (NEET) to get admission in a medical college, completes five years course and gets registered in the State Medical Council to practice medical profession. It must also be brought out here that the national licentiate examination will bring even those students who do medical education abroad at par with those who graduate from Indian institutions.

3. It also is unquestionable that opening up the medical education sector will lead to significant addition in the number of under graduate (UG) and post graduate (PG) seats and substantial new investment in this infrastructure sector.

4. It will ensure that there will be better coordination with AYUSH systems of treatment.

5. It will also ensure that there will be regulation of up to 40% seats in medical colleges to enable all meritorious students to have access to medical seats irrespective of their financial status.

6. It is clearly stipulated that no permission would be needed to add new seats or to start postgraduate courses.

7. The deterrence for non-compliance with maintenance of standards is in terms of monetary penalty. Monetary penalty under the NMC is defined as up to 10 times the annual tuition fee, whereas MCI would just refuse renewal permission and admission in case institutions did not meet requirements.

8. It also cuts down on the number of permissions needed to start and recognize undergraduate and post graduate courses.

9. It also tend to open up the medical education sector thus leading to a significant addition in the number of undergraduate and postgraduate seats and enable 'substantial' new investment in the infrastructure sector.

10. Compared to MCI which was a primarily elected body with nominees from the State or Centre - NMC will rather have a 'hybrid structure' with a few non-medical members and primacy for selected members.

Truth be told, the National Medical Commission Bill 2017 once enacted will substitute the present Indian Medical Council Act, 1956. It will usher in many landmark changes apart from the key ones highlighted above. The National Medical Council aims to get around various problems afflicting the present dispensation by having autonomous boards to perform the various functions of regulating undergraduate medical education; postgraduate medical education; assessment and rating; and ethics and medical registration.

It needs no rocket scientist to conclude that the primary object behind ensuring the separation of the selection function from the accreditation one is that the huge avenues currently available for corruption and minting money will considerably go down! It is noteworthy that the new Bill also does away with the annual renewal previously needed for medical colleges which undoubtedly was another major source of minting money! A government official on condition of anonymity rightly told journalists that, 'This is the end of heavy handed regulatory control over medical education institutions and a shift towards outcome based monitoring is one of the prominent aims of the Bill.'

To be sure, Dr Naresh Trehan who is Chairman of Medanta and one of the most eminent doctor of India very rightly said that, 'We have been demanding for a medical commission for long. This is a positive development.' The 25-member Commission will have a Chairman, a Member Secretary and 12 ex-officio members comprising the Presidents of the four autonomous boards, the Director General of Health Services, the Director General of the Indian Council of Medical Research, the Director of the All India Institute of Medical Sciences, New Delhi, and nominees of the Post Graduate Institute of Medical Education and Research, Chandigarh, the Jawaharlal Nehru Institute of Post Graduate Medical Education and Research, Puducherry, and the North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong. It will also have 11 part-time members of which five will be doctors who are elected to the Commission.

According to a statement from the government, it was revealed that between 16 and 22 members of the Commission will be doctors. The selected members are to be picked by a search committee to be headed by the Cabinet Secretary. Law Minister Ravi Shankar Prasad said that there will be four autonomous boards for conducting undergraduate and postgraduate education, assessing and accreditating medical institutions and registration of practitioners under the National Medical Commission.

Going forward, he also said that the four-tier structure for the regulation of medical education will have a 20-member National Medical Commission at the top and it will have five elected and 12 ex-officio members. There will also be a Medical Advisory Council which will be constituted by the Central Government. This Medical Council will basically be advisory and will meet minimum once a year. It will serve as the primary platform through which the states will put forward their concerns before the NMC. This will overall help a lot in building the agenda in the medical education and training industry.

All said and done, a very resurgent effort seems to have been made by the Centre to really infuse a fresh lease into our moribund medical education system which has become infested with so many shortcomings. How it works out on the ground once this landmark Bill is passed and becomes a law yet remains to be seen. But an attempt at good beginning has certainly been made.

It is widely anticipated that NMC in and MCI out that has been done will go a long way to debug our medical ecosystem and bring about radical changes in our medical education system. As for instance, as pointed above, it intends to put an end to 'heavy handed regulatory control' and it also aims to make it easier for colleges to manage undergraduate and postgraduate courses apart from other goals! The Bill very rightly aims to move towards outcome-based regulation of medical education rather than process oriented. It will ensure proper separation of functions within regulator by having autonomous boards, create accountable and transparent procedures for maintaining high standards in the medical education and taking it to further greater heights! Let’s hope so fondly!