Why Are Doctors Opposing the National Medical Commission Bill?

The bill is bound to create a significant impact on the working of medical professionals in India.

(Photo: Arnica Kala/The Quint)

On 2 January 2018, nearly three lakh doctors hit the streets, calling for a 12-hour long countrywide shutdown of out-patient department (OPD) services at all private hospitals.

The doctors called the day a “Black Day” in the history of medical profession.

But what led to this mass agitation?

Doctors in the county are concerned about provisions in the National Medical Commission (NMC) Bill, which was tabled in the Lok Sabha by Union Health Minister JP Nadda on 29 December 2017.

According to the doctors, the bill is “anti-people and anti-poor” and it would “cripple” the medical profession. The bill has now been referred to a standing committee for review.

But what does it say and why was it drafted? Why were the doctors so strongly against it? And what has the government done so far?

Why Was the NMC Bill Drafted?

The contentious NMC Bill was the brainchild of a high-level committee headed by former NITI Aayog Chairperson Arvind Panagariya, following reports of corruption in the functioning of the Medical Council of India (MCI).

The bill proposes to replace the MCI as the top medical education regulator of the country with another body called the National Medical Commission.

If passed, it will also repeal the Indian Medical Council Act, 1956, which holds the provision for the functioning of MCI.

MCI has been surrounded by controversy since 2010, when the then president of the body was accused of corruption and bribery while granting permits for medical colleges. To solve the menace of corruption, the bill replaces one body with another.

The difference between the two bodies lies in the fact that the new constituted body will have its members nominated and appointed by the government, while the MCI has elected members from the medical fraternity.

Salient Features of the Bill

The draft bill that was tabled in Parliament had the following provisions:

1. The Indian Medical Council Act, 1956, which governs the Medical Council of India, will be repealed. The Council will be replaced by the National Medical Commission as the top regulator of medical education in India.

2. Within three years of the passage of the bill, state governments will establish State Medical Councils. The NMC will consist of 25 members, appointed by the central government.

3. NMC will be responsible for framing policies for regulating medical institutions and medical professionals, assessing the requirements of healthcare, and ensuring compliance by the State Medical Councils.

4. The NMC will also frame guidelines for determination of fees for up to 40% of the seats in private medical institutions. This has been incorporated to ensure relief to students from exorbitant fees.

5. The bill proposes to have a common entrance and licentiate* (exit) exam for medical graduates before they start practicing or enroll for post-graduate courses. The latter is to obtain license for practice.

6. The Ethics and Medical Registration Board will maintain a separate National Register, containing details, including all recognised qualifications, of a licensed AYUSH** practitioner. The AYUSH practitioners can take up a “bridge course” of six months which will allow them to practice modern medicine.

*In a new draft, the government has decided to do away with this feature.
**AYUSH practitioners include: Ayurveda, Yoga, Unani, Siddha, and Homeopathy.

So, Why Are the Doctors Opposing NMC?

The Indian Medical Association has been a vocal opponent of the bill. Let’s try and analyse their problems one-by-one:

"Bridge Course" for AYUSH Doctors

Section 49 of the bill, in a nutshell, allows for setting up of a ‘bridge course’ that homeopaths, Ayurveda practitioners, yogis and others who fall under the Indian system of medicine can take. Post this course they can prescribe modern medicine.

The major concern of the Indian Medical Association (IMA) and other doctors is that a bridge course will promote quackery.

Speaking to The Qunit, Dr Ashwini Setya explained:

Largely homeopathic and Ayurvedic medicines don’t have side-effects. However, allopathic medicines do, and if you don’t prescribe the right thing for what the problem actually is, a lot could go wrong. There are many differences that a bridge course, be it six months or two years, cannot compensate.

“There can be medico-legal aspects for this. The law is very strict for who can treat what and where. But this bridge course will leave a huge gap. Who will be liable if some untoward incident happens when these AYUSH doctors treat?” he added.

According to the World Health Organisation, a healthy doctor-patient ratio is 1:1,000. In India, the ratio is 1:1,674

The government proposes to fix the demand-supply dynamic in the medical field through the bridge course, but Dr Setya dismisses the idea by saying:

The only answer to lack of doctors cannot be this. Instead, give incentives to already qualified people to work in rural and semi-urban areas.

Some still argue that instead of totally junking the idea, can we not take inspiration from China’s “barefoot doctors”, and tweak the proposal a bit to make it work for places where there are no doctors?

Dissolving the Medical Council of India

Another proposal of the bill that hasn’t gone down well with many within the professional community is to replace the existing Medical Council of India with the National Medical Commission.

Dr KK Agarwal, former president of IMA, had earlier said that the move will “cripple” the functioning of the medical profession by making it completely answerable to the bureaucracy and non-medical administrators.  It will also give greater control to the government in running the commission.

But the government claims that the new body will have experts from related fields, which will put Indian standard of education at par with the global standards.

National Licentiate Examination

There is strict criticism against the National Licentiate Examination or the exit test. The bill states that after completion of MBBS, students will have to appear for an exit test to get the license in order to practice medicine.

According to a report in NDTV, Dr Agarwal calls the move “highly insensitive” towards the plight of the doctors/students who have otherwise been through a rigorous academic year.

Nationwide Protests Against the Bill

There have been nationwide protests against the bill. On 25 March, a mahapanchayat of doctors was organised by the IMA at the Indira Gandhi Stadium, New Delhi.

IMA’s President Dr Ravi Wankhedkar criticised the bill at the event, calling it anti-poor, pro-rich, anti-student and undemocratic, reported News18.

Lakhs of doctors and students took part in the protest demanding scrapping of the bill and amending the existing Medical Act.

The doctors allege that the government’s argument in support of a bridge course is a farce.

Speaking to News18, Dr Vinay Aggarwal, chairman of the organising committee of the mahapanchayat, said that there is no shortage of doctors and the existing potential needs to be utilised.

Dr Aggarwal told The Quint that the doctors want a dialogue with the government and there should be a consensus between the government and the doctors on this bill.

What Has the Govt Done so Far?

On Wednesday, 28 March, the cabinet led by Prime Minister Narendra Modi approved amendments pertaining to the National Medical Bill. The amendments include the contentious “bridge course”, action against quackery and doing away with the licentiate exam for MBBS students.

• The government has decided to approve the MBBS exam as an exit test instead of the National Exit Test to practice medicine. Thus, the students will not be required to appear for a separate test.
• The bridge course for AYUSH practitioners has been removed but to a limited extent. Since this 6-month course aims to improve primary healthcare, it has been left upon the state governments to decide how they will address and promote healthcare in rural areas. Some states have already implemented this bridge course.
• Addressing the problem of quackery, the government has included a provision for imprisonment up to a year along with a fine up to Rs 5 lakhs against quacks.
• They have further responded to the demands of the states and increased their representation in NMC. The NMC will comprise of 25 members of which at least 21 will be doctors.

The government has accommodated the recommendations made by the Parliamentary committee on some of the loudest criticisms against the bill. However, the bill still has issues that need to be addressed, like the “bridge course”, which the government has simply pushed under a rug.

Doctors have decided to go on a nationwide strike on 2 April. The Quint spoke to former IMA President Dr KK Agarwal who said, “The junior doctors have certain concerns and they will protest. But the future course of action will be decided after meeting the health minister on Monday, 2 April.”