NMC Bill

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The NDA-government appears to be in a mood to have full control over the National Medical Council (NMC) which is being granted the status of statutory body that will replace the existing Medical Council of India (MCI) through an act of legislation in the Parliament. The new provisions added to the NMC Bill will be heavily controlled by the central government for regulation of medical colleges and allied institutions in the country. Previously the MCI has members from the premier institutions that have achieved excellence in their respective fields and make way for building excellent institutions across the length and breadth of the country in the field of medicines. Its members are to be picked by a search committee headed by the Cabinet Secretary, while the central government is to be the appellate body for those aggrieved by the NMC’s decisions. Only last week, the union cabinet approved six out of the dozens of changes to the contentious National Medical Commission (NMC) Bill that were suggested by a Parliamentary Standing Committee last month. These changes address some of the loudest criticisms of the Bill. Among them, the final year MBBS exam is now merged with an exit exam for doctors, and a contentious bridge course for AYUSH (Ayurveda, Yoga and Naturopathy, Unani, Siddha, Homeopathy) practitioners has been axed. Health-care experts had recommended other modifications, which the cabinet ignored. The parliamentary committee had batted for an independent appellate body. The amendments cleared by the Cabinet also increase State representation in the NMC from three part-time members to six, in what seems like a gesture to please the States. Contrast this with the parliamentary committee’s recommendation to include 10 state representatives, given India’s vastness. Another amendment that doesn’t go far enough is the decision to raise the proportion of private college seats for which fees will be regulated from 40 percent to 50 percent. This step is likely to bring in more money for the seats to the management of the private colleges and as per their sweet will. The fees for unregulated seats could then skyrocket, pushing poorer medical aspirants out of the system. Not only this, the corporate houses diversifying their businesses in this field will only add to the exploitation of the poor masses in this sphere. With all these deficiencies, if the Bill is passed by Parliament, the legislation will mark a new era for medical education in India. The next step will be to design rules and regulations that capture the intent of this law. This itself will be a massive challenge. How, for one, will the logistical difficulty of conducting a common final year MBBS examination across the country be overcome? Multiple-choice questions are easy to administer, but testing the range of theoretical knowledge and practical skills expected of medical graduates is more difficult. The same goes for the students, who will pass through the process without proper training and skill development will only add to the problems of the common masses. Throw in the enormous inter-state variations in medical education across India, and the challenge is obvious. The Parliamentarians will have to tackle this gigantic task in a slow and phased manner for implementation of the training programme. Another concern is that under the new amendments states now have the freedom to implement an AYUSH bridge course, even if no longer mandatory. How will the central government ensure the quality of such courses to prevent a new set of poorly trained doctors from emerging? The coming days may see many more protests against the NMC Bill, perhaps delaying its passage and prompting further discussion. For a Bill that marks the first major reform in medical education since 1956, such an extended debate is not a bad thing. But the central government will have to take into consideration how the issues can resolved and made transparent and understandable to the common masses for improvement in this sector. Some of the amendments in the Bill may have to be amended to suit the aspirations of the people. Besides this, how the central government creates new mechanism for the welfare of the people is to be seen in the coming days.