National Medical Commission (NMC) Bill, 2019

Medical Council of India (MCI) is a statutory body for establishing uniform and high standards of medical education in India. It was first established in 1934 under the Indian Medical Council Act, 1933. As per recommendation given by NITI Aayog, the Government took measures to replace MCI with National Medical Commission (NMC) in 2019.

National Medical Commission

  • National Medical Commission (NMC) is an Indian regulatory body of 33 members which regulates medical education and medical professionals.
  • It replaced the Medical Council of India (MCI) on 25 September 2020.
  • The Commission grants recognition of medical qualifications, gives accreditation to medical schools, grants registration to medical practitioners, and monitors medical practice and assess the medical infrastructure in India.
  • The NMC will have four separate autonomous boards: under-graduate medical education, post-graduate medical education, medical assessment and rating and ethics and medical registration.

It’s legal backing

  • The NITI Aayog had recommended the replacement of MCI with NMC.
  • The decision was approved by most states and after its approval by the Prime Minister and NMC bill was passed by parliament and approved by President on 8 August 2019.
  • National Medical Commission ordinance was brought in to replace Medical Council of India in early 2019 through an ordinance issued in January 2019 by the President of India.
  • The Supreme Court had allowed the Central Government to replace the medical council and with the help of five specialized doctors monitor the medical education system in India, from July 2017.
  • The government dissolved the MCI in 2018 and Indian Medical Council Act, 1956 (102 of 1956) stands repealed.

National Medical Commission Bill:

  1. The bill provides for the constitution of four autonomous boards entrusted with conducting undergraduate and postgraduate education, assessment and accreditation of medical institutions and registration of practitioners under the National Medical Commission.
  2. Composition of National Medical Commission: It will have government nominated chairman and members, and the board members will be selected by a search committee under the Cabinet Secretary. There will be five elected and 12 ex-officio members in the commission.
  3. As per the Bill, the government, under the National Medical Commission (NMC), can dictate guidelines for fees up to 40% of seats in private medical colleges. The bill also has a provision for a common entrance exam and licentiate (exit) exam that medical graduates have to pass before practising or pursuing PG courses. For MBBS, students have to clear NEET, and before they step into practice, they must pass the exit exam.
  4. Recognized medical institutions don’t need the regulator’s permission to add more seats or start PG course. This mechanism is to reduce the discretionary powers of the regulator.
  5. Earlier, medical colleges required the MCI’s approval for establishment, recognition, renewal of the yearly permission or recognition of degrees, and even increase the number of students they admitted. Under the new bill, the powers of the regulator are reduced to establishment and recognition. This means less red tape, but also less scrutiny of medical colleges.

Background:

The Medical Council of India was first established in 1934 under the Indian Medical Council Act, 1933. This Act was repealed and replaced with a new Act in 1956. Under the 1956 Act, the objectives of MCI include:
  • Maintenance of standards in medical education through curriculum guidelines, inspections and permissions to start colleges, courses or increasing number of seats.
  • Recognition of medical qualifications.
  • Registration of doctors and maintenance of the All India Medical Register.
  • Regulation of the medical profession by prescribing a code of conduct and taking action against erring doctors.

Key features of the Bill include:

  1. Constitution of the National Medical Commission:  The Bill sets up the National Medical Commission (NMC).  Within three years of the passage of the Bill, state governments will establish State Medical Councils at the state level.  The NMC will consist of 25 members, appointed by the central government.  A Search Committee will recommend names to the central government for the post of Chairperson, and the part time members.  The Search Committee will consist of seven members including the Cabinet Secretary and five experts nominated by the central government (of which three will have experience in the medical field).
  2.  Members of the NMC will include: (i) the Chairperson (must be a medical practitioner), (ii) Presidents of the Under-Graduate and Post-Graduate Medical Education Boards, (iii) the Director General of Health Services, Directorate General of Health Services, (iv) the Director General, Indian Council of Medical Research, and (v) five members (part-time) to be elected by the registered medical practitioners from amongst themselves from states and union territories for a period of two years.
  3. Functions of the National Medical Commission:  Functions of the NMC include: (i) framing policies for regulating medical institutions and medical professionals, (ii) assessing the requirements of healthcare related human resources and infrastructure, (iii) ensuring compliance by the State Medical Councils of the regulations made under the Bill, (iv) framing guidelines for determination of fees for up to 50% of the seats in private medical institutions and deemed universities which are regulated under the Bill.
  4. Medical Advisory Council:  Under the Bill, the central government will constitute a Medical Advisory Council.  The Council will be the primary platform through which the states/union territories can put forth their views and concerns before the NMC.  Further, the Council will advise the NMC on measures to determine and maintain minimum standards of medical education.
  5. Autonomous boards:  The Bill sets up autonomous boards under the supervision of the NMC.  Each autonomous board will consist of a President and four members, appointed by the central government.  These boards are: (i) the Under-Graduate Medical Education Board (UGMEB) and the Post-Graduate Medical Education Board (PGMEB):  These Boards will be responsible for formulating standards, curriculum, guidelines, and granting recognition to medical qualifications at the undergraduate and post graduate levels respectively. (ii) The Medical Assessment and Rating Board (MARB):  MARB will have the power to levy monetary penalties on medical institutions which fail to maintain the minimum standards as laid down by the UGMEB and PGMEB.  The MARB will also grant permission for establishing a new medical college, starting any postgraduate course, or increasing the number of seats.  (iii) The Ethics and Medical Registration Board:  This Board will maintain a National Register of all licensed medical practitioners, and regulate professional conduct.  Only those included in the Register will be allowed to practice medicine.  The Board will also maintain a separate National Register for community health providers.
  6. Community health providers:  Under the Bill, the NMC may grant a limited license to certain mid-level practitioners connected with the modern medical profession to practice medicine.  These mid-level practitioners may prescribe specified medicines in primary and preventive healthcare.  In any other cases, these practitioners may only prescribe medicines under the supervision of a registered medical practitioner.
  7. Entrance examinations:  There will be a uniform National Eligibility-cum-Entrance Test for admission to under-graduate and post-graduate super-specialty medical education in all medical institutions regulated under the Bill.  The NMC will specify the manner of conducting common counselling for admission in all such medical institutions.
The Bill proposes a common final year undergraduate examination called the National Exit Test for the students graduating from medical institutions to obtain the license for practice.  This test will also serve as the basis for admission into post-graduate courses at medical institutions under this Bill.
National Medical Commission (NMC) Bill, 2019
National Medical Commission (NMC) Bill, 2019
National Medical Commission (NMC) Bill, 2019
NMC Bill, 2019

Significance and the need:

  • The Bill seeks to regulate medical education and practice in India.
  • The Bill attempts to tackle two main things on quality and quantity: Corruption in medical education and shortage of medical professionals.
  • The Bill aims to overhaul the corrupt and inefficient Medical Council of India, which regulates medical education and practice and replace with National medical commission.

Why is Medical Council of India being replaced?

  1. The Medical Council of India has repeatedly been found short of fulfilling its mandated responsibilities.
  2. Quality of medical education is at its lowest ebb; the current model of medical education is not producing the right type of health professionals that meet the basic health needs of the country because medical education and curricula are not integrated with the needs of our health system.
  3. Medical graduates lack competence in performing basic health care tasks like conducting normal deliveries; instances of unethical practice continue to grow due to which respect for the profession has dwindled.
  4. Compromised individuals have been able to make it to the MCI, but the Ministry is not empowered to remove or sanction a Member of the Council even if he has been proved corrupt.

Concerns:

  1. A bridge course allowing alternative-medicine practitioners to prescribe modern drugs is mentioned in the bill. Unscientific mixing of systems and empowering of other practitioners through bridge courses will only pave the way for substandard doctors and substandard medical practice. This will seriously impact patient care and patient safety
  2. Indian Medical Association (IMA) opposed the bill that it will cripple the functioning of medical professionals by making them completely answerable to the bureaucracy and non-medical administrators. NMC will become subservient to the health ministry, given that the representation of the medical profession in the new regulatory framework is minimal.
  3. The bill takes away the voting right of every doctor in India to elect their medical council.
  4. The bill allows private medical colleges to charge at will, nullifying whatever solace the NEET brought. The proposed NMC Bill discreetly intends to equate the post-graduate degrees given by MCI or proposed NMC and the National Board of Examination (NBE), which is unjustified too.
  5. Standards have been laid down for MCI courses, but not for NBE courses which are often run in private hospitals and nursing homes.
  6. It would replace an elected body (Medical Council of India, MCI) with one where representatives are “nominated.

Conclusion:

  • The Bill seeks to regulate medical education and practice in India.
  • The Bill attempts to tackle two main things on quality and quantity: Corruption in medical education and shortage of medical professionals
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