The first day of the new year saw the medical profession in the country debate the National Medical Commission bill, 2017 before the Indian parliament. When passed by both houses and enacted, it will replace the current regulator of medical education in the country - The Medical Council of India. The Indian Medical Association, the voluntary organisation of doctors , has expressed strong reservations against some of the provisions of the bill and called for a one day protest on Tuesday.
So, what does the bill seek to achieve? In its very preamble, it describes itself as a bill "to provide for a medical education system that ensures availability of adequate and high quality medical professionals; that encourages medical professionals to adopt latest medical research in their work and to contribute to research; that has an objective periodic assessment of medical institutions and facilitates maintenance of a medical register for India and enforces high ethical standards in all aspects of medical services; that is flexible to adapt to changing needs and has an effective grievance redressal mechanism and for matters connected therewith or incidental thereto." What it also implies is that the current system has not worked, or is not matching up to needs, necessitating the need for such a bill.
Looking at the protests by the body of doctors, one could argue that a medical regulator need not be dominated by doctors and may need representatives of the civil society, government and others, which is what the bill seeks. The new entity, will have a government -nominated council, which may not go down well with some doctors. It is also no brainer that medical education needs reform and we are woefully short in terms of availability of specialists. This despite some politicians either owning or linked to medical colleges. In some key areas, we have just one fourth of the actual need. We clearly need to strengthen medical education, set standards, and most important, align medical education to the needs of the health system.
But instead of a dialogue, the emphasis seems to be more on protest. Here are some of the pain points: First around removing curbs for starting a medical college. The argument being that a proliferation without adequate checks will result in poor quality. There could be a counter to this argument that there is going to be a national exit exam for doctors before they are allowed to practice medicine. This will be through a licentiate exam. But the question is around the extent which it be standardised. In which case, colleges will have to pull up their standards if their graduates are to pass the examination. Getting a nationally standardised exit examination, passing which would be mandatory for them for practice, will be better than the current system where many today see loopholes and an element of variable standards.
There is also debate on why only five states should be represented on the National Medical Commission but since this is by rotation, it should not be a major issue. Then, concerns are being raised on providing for only bridge courses in modern medicine for AYUSH practitioners. This will be for those who are into homoeopathy or other forms of Indian medicine.
As it appears, there are areas where discussion is still needed and the bill in its present form may not be the ideal solution. "The National Medical Commission is a very essential reform in order to strengthen medical education in this country , to set standards and to align medical education much more to the needs of the health system. However, there are several provisions in this bill which need to be carefully examined and revised . Therefore, the bill in its present form may not be the ideal solution," says Professor K Srinath Reddy, President of the Public Health Foundation of India. A doctor himself trained in cardiology and epidemiology and the former head of the department of cardiology at the All India Institute of Medical Sciences. Ask him on the specifics of the bill that need correction and he points to two areas where focus is not being given. This is in relation to section 10 of the bill. This section of the bill also refers to regulation of medical research, which Reddy feels may not be the best thing as the commission is meant to regulate medical education. Research is under entities such as the ICMR (Indian Council of Medical Research), department of biotechnology, department of science and technology. What is also debatable is that, as per section 10 of the bill, the commission is to assess the requirements in healthcare infrastructure and develop a road map for meeting such requirements. These are under central and state governments and how will the commissions decide these?
Apparently, some of the provisions of the bill in the current form need to be discussed and thought through for some may need revision, and in some cases changes, especially where it is over ambitious and going beyond the remit of the commission.