In a move that is expected to usher in major reforms in medical education and practice in the country, the Government of India recently repealed the 64 year old Medical Council of India and replaced it with the newly constituted National Medical Commission. The new regulatory body has been entrusted with ensuring better transparency, accountability and governance of medical education and practice in the country.
The National Medical Commission (NMC) was constituted by an act of Parliament known as the National Medical Commission Act, 2019. The Act provides for setting up of the National Medical Commission in place of the Medical Council of India which has repeatedly come under scrutiny for allegations of malpractices and mismanagement. As per an official notification of the Ministry of Health and Family Welfare dated September 25, 2020, the Medical Council of India Act, 1956 was repealed and was replaced by the NMC Act. With this, the Board of Governors that superseded the Medical Council of India on September 26, 2018 to perform its functions was dissolved and the Indian Medical Council Act stood abolished.
The National Medical Commission will be responsible for the development and regulation of all aspects of medical education and the profession. The objectives of the National Medical Commission are laid out as below:
- Improve access to quality and affordable medical education,
- Ensure availability of adequate and high quality medical professionals in all parts of the country
- Promote equitable and universal healthcare that encourages community health perspective and makes services of medical professionals accessible to all the citizens
- Encourages medical professionals to adopt latest medical research in their work and to contribute to research
- Objectively assess medical institutions periodically in a transparent manner
- Maintain a medical register for India
- Enforce high ethical standards in all aspects of medical services
- Have an effective grievance redressal mechanism.
The NMC Act proposes the setting up of four autonomous boards that will function independently under the supervision of the NMC. These are the Under-Graduate Medical Education Board, Post-Graduate Medical Education Board, Medical Assessment and Ratings Board, and the Ethics and Medical Registration Board.
Each board will consist of a President and four members appointed by the central government on the recommendation of a search committee. The four boards have one single task each and each board will have the independence to take decisions in a holistic, transparent, and focussed manner. In the erstwhile MCI, all the above areas were under the president of MCI which lead to instances of concentration of authority, corruption and lack of transparency.
Unlike MCI whose members were elected, members of the NMC will be nominated. The Commission comprises a chairperson, ten ex-officio members and 22 part-time members. The ex-officio members include presidents of the four autonomous boards. Dr Suresh Chandra Sharma , the former head of the ENT department at the All India Institute of Medical Sciences, Delhi has been appointed chairperson for a period of three years. Rakesh Kumar Vats, the Secretary-General in the Board of Governors of the MCI, would be the secretary of the commission.
Why a new regulator?
The Medical Council of India, was till now, responsible for regulating medical education and practice in the country. Over time, several issues were observed with its functioning in terms of its regulatory role, composition, allegations of corruption, and inadequate accountability. MCI was an elected body and its members were elected by medical practitioners themselves. The fact that the regulator was elected by the regulated was seen as a problem. Nomination based constitution of the MCI was recommended instead of election. Another recommendation was separating the regulation of medical education and medical practice.
In 2016, the 92nd Parliamentary Standing Committee report on health was submitted. It highlighted stern observations against the functioning of the Medical Council of India. The committee went on to say that the MCI is ridden with corruption and the systems are beyond repair. A new legislation was therefore recommended.
In 2016, the first draft of the National Medical Commission Bill was prepared by the NITI Aayog. On August 8, 2019, the President gave his assent to the NMC Bill and it became an Act. After multiple stakeholder consultations the Union Cabinet of ministers gave their approval. The new regulator was set up with the focus of unshackling the sector.
How will the NMC change things?
It is expected that the NMC will unshackle and overhaul medical education and practice in the county to ultimately fill the gap in the availability of trained and competent human resources for health. There are many ways in which the NMC is expected to achieve this.
The Commission has changed the eligibility guidelines for doctors to practice medicine. This has been done with a view to have clinicians in adequate numbers and of a certain quality and competence. The NMC proposes a competency based curriculum that reduces the burden on the students and ultimately improves the quality of education. It has tried to create a single benchmark for graduating doctors going into practice through a national exit exam for all graduating doctors, to judge their competencies.
According to the Act, the Medical Assessment and Rating Board will assess medical colleges and develop a ranking system. The NMC will rank medical colleges based on how many students pass the NEXT from that college. This would enable students to choose their institutes in an informed manner. That will also lead to competition among colleges as against the current donation based system and in turn raise the quality of education. These measures are expected to ensure a transparent admission process and also bring down admission fee.
The MCI’s focus in assessing the performance of colleges was more input based, mostly focused on infrastructure requirements. The focus of NMC will be on assessing the quality of outgoing students. Experts also believe that the NMC will be able to regulate fees in private and deemed universities in consultation with the State governments.
As per the Act, states will establish their respective State Medical Councils within three years. These Councils will have a role similar to the NMC, at the state level. In cases relating to professional or ethical misconduct against a registered medical practitioner, the State Medical Councils will receive complaints. If the medical practitioner is aggrieved of a decision of the State Medical Council, he may appeal to the Ethics and Medical Registration Board under the NMC. If the medical practitioner is aggrieved of the decision of the Board, he can approach the NMC to appeal against the decision.
According to the Act, a common final year undergraduate medical examination, to be known as the National Exit Test (NEXT), will be held for granting the licence to practice medicine and for enrolment in the State Register or the National Register. At present, every medical college has its own final MBBS exam.
In addition to being the licentiate examination to practice medicine, the NEXT will enable the setting of criteria for admission to postgraduate medical courses, and also for screening of foreign medical graduates.The NEXT will also be applicable to institutes of national importance such as all the All India Institutes of Medical Sciences (AIIMS) in a bid to ensure a common standard in the medical education sector in the country.
Any person with a foreign medical qualification will have to qualify the NEXT for the purpose of obtaining licence to practice medicine as medical practitioner and for enrolment in the State Register or the National Register.
Community Health Providers: A New Cadre
As of January 2018, the doctor to population ratio in India was 1:1655 compared to the World Health Organisation standard of 1:1000. To fill in the gaps of availability of medical professionals, the Bill provides for the NMC to grant limited license to certain mid-level practitioners called community health providers, connected with the modern medical profession to practice medicine. These mid-level medical practitioners may prescribe specified medicines in primary and preventive healthcare. However, in any other cases, these practitioners may only prescribe medicine under the supervision of a registered medical practitioner.
The NMC is being seen as a mega policy reform in the health sector. With the power to laying down policies for regulating medical institutions and medical professionals, the responsibility of assessing the requirements of human resources and infrastructure in healthcare, ensuring compliance to the regulations under the Act, and by framing guidelines for private medical institutions, the NMC is expected to usher in welcome changes in the way medical education and practice are conducted in the country.
BOX: The National Education Policy and its Impact on Medical Education
Another policy initiative of the Government of India that is expected to bring significant reforms in medical education is the National Education Policy. The NEP is expected to pave the way for reforms in school and higher education systems in the country.
The NEP states that healthcare education needs to be “re-envisioned” with the objective to match the duration, structure, and design of the educational programmestothe role requirements that graduates will play. However, assessments based on competence and a focus on creating professionals who can work in primary and secondary healthcare settings will require redesigning current healthcare education models that often focus on tertiary healthcare settings.The policy states that students will be assessed at regular intervals on well-defined parameters primarily required for working in primary care and in secondary hospitals. There shall also be a much greater emphasis on preventive healthcare and community medicine in all forms of healthcare education.
Apart from this, the policyproposes to integrate modern medicine with the traditional system of Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homeopathy (AYUSH). “Given that people exercise pluralistic choices in healthcare, our healthcare education system must be integrative, meaning thereby that all students of allopathic medical education must have a basic understanding of AYUSH and vice versa”, the NEP states. The has elicited mixed reactions from experts. Many from the modern medical community have raised their concerns over the move.