The week gone by was mired by the abrogation of Article 370 and Article 35A of the Constitution. We have seen mixed reactions from the people – some showcasing this as a historic moment while others criticising it. Amid this hullabaloo, we forgot about our doctors, who went on strike albeit against the national medical commission (NMC) Bill.
Although the Bill is all set to become an Act, it has seen a lot of protests from all corners. The Union health minister, Harsh Vardhan, tried to mollify the doctors. To an extent, he was successful in convincing them. The Indian Medical Association called for another strike on 8th August. However, it was postponed, considering the crisis-like situation in Jammu & Kashmir, heavy floods in North East, Karnataka, Maharashtra and other parts of the country.
The Bill was a contentious issue even during the previous regime. Similar protests happened in January last when the Lok Sabha cleared the Bill. It could not be placed before the Rajya Sabha. The Modi government did not find it important to revisit the Bill by giving a proper hearing to those who went on strike. Unfazed by the medical fraternity, the Bill was again presented for discussion.
During the recently concluded monsoon session of Parliament, it was cleared by both the Houses. After obtaining signature from the President, the Act would be notified for implementation. Now the question is: what is wrong with the Bill? Why were these doctors not convinced even after having a discussion with the health minister? Let us find out.
The Bill aims to repeal the existing Indian Medical Council Act, 1956 and replace the existing scam-tainted Medical Council of India (MCI) with a new body to be called the National Medical Commission (NMC). The commission will have 25 members to be appointed by the Central government on the recommendations of a committee.
The chairperson of the commission shall be a person with at least 20 years of experience in the medical field. The other members shall comprise 14 part-time members and 10 ex-officio members with representations from different medical colleges, medical education boards, the Director of AIIMS and the Director-General, Indian Council of Medical Research.
The part-time members shall comprise people with expertise in the field of management, law, medical ethics etc. Unlike the MCI in which 70 per cent of the members are elected representatives, the NMC will have only 20 per cent members as elected representatives. In other words, the Central government will have more say in the functioning of the commission as it can appoint people to suit its own whims and fancies.
As of now, the decisions taken by the MCI are not binding upon state medical councils. The new Bill has given power to the commission’s board of ethics to exercise control even on the state medical councils. However, the board will only have say on matters relating to compliance with the ethical code of conduct.
What if the chairperson of NMC is at fault? The Centre can remove not only the chairperson but also the members. In the present scenario, the government does not have such a power. Only the court can remove the president of the MCI.
However, the doctors have raised their voice largely against three main issues. One, Section 32 of the Bill provides that the commission can grant “limited” license to practice at mid-level as community health provider. The doctors have been complaining that the Bill is very vague in defining the term “community health provider”.
The main apprehension has been that people, who have little knowledge of medicine, may also start practising. It will help quacks in strengthening their business and legalise their existence. And medical institutions so far have been making people aware of the consequences of consulting “ jhola-chhap” doctors, as they are called in local parlance. One can easily imagine if such people are given permission to practise, then what would be the situation of the health sector.
The second issue has been the introduction of a national exit test (NEXT). At present, those who aspire to take admissions to postgraduate medical courses are required to appear for the national eligibility-cum-entrance test for postgraduate (NEET-PG). However, after the new Bill comes into force, the students will have to appear for NEXT only.
This test shall determine the status of a medical student for both admission to PG courses and for obtaining license as well. This will be a common final-year undergraduate exam. Currently, the doctors need to register with the state medical councils for obtaining a license. There is no pre-requisite for getting a license except for registration with the medical council.
The doctors claim that suddenly a single exam would become a decisive factor for their career. And it may have adverse impact on medical aspirants. If those who have completed their education are not in a position to clear the exam, they may not get license for practise.
Three, the Bill empowers the commission “to frame guidelines for determination of fee and other charges in respect of 50 per cent of seats in private medical institutions and deemed to be universities.
At present, the state governments decide the fee for around 85 per cent of the seats. This move will give freedom to the private medical colleges to impose fees of their choice. Poor students who aspire to become doctors may face more problems in fulfilling their dreams. Also, the doctors want a capping on the fee charged by the private unaided medical colleges.
The government, of late, has been arguing that the new Bill will help in reducing corruption as the members of the NMC would be required to declare their assets, unlike the MCI. Not only this, they will have to give a declaration regarding their conflict of interest. The members would also be required to serve a two-year cooling period. However, this can be waived by the Central government.
While these provisions may ensure transparency in the overall functioning of the commission to some extent, the Bill has given undue power to the Centre, as only a few representatives would be elected members. The commission would have no autonomy to function as well. In other words, small level of transparency would be overshadowed by the kind of interference by the Central government.
The government has been pleading that there is a huge shortage of doctors in India, if the WHO’s thumb rule of one doctor against 1000 patients is to be followed. However, allowing the so-called “community health providers” to practise would only add fuel to fire. This may add on to the number of so-called doctors but will put the quality of services at huge risk.
In other words, the health conditions in the country may deteriorate further. Also, asking a person, who has completed his MBBS (undergraduate medical course) to appear for another exam for being eligible to practise or work, will undo the entire purpose. The community health providers, with hardly 30 per cent knowledge of a MBBS doctor, would get work. What kind of ethics is this?
Our elected representatives seem to have hastily approved the Bill, without thinking of the consequences, in the garb of reforms. It is high time, the government takes action by adding enabling provisions in the rules to the Bill. Otherwise, we all are set to head towards a medical crisis in the country.(Published on 12th August 2019, Volume XXXI, Issue 33)