What is National Medical Commission Bill (NMC) 2019?

National Medical Commission Bill proposes to replace the Medical Council of India (MCI) with National Medical Commission which will be a central authority that will responsible for regulating medical education in the country.

What is National Medical Commission Bill, 2019?

The aim of the Bill is to address several concerns including medical education, provide strategies to address shortage of trained doctors and medical care givers and restructure the medical regulatory authority of the country that clearly defines jurisdiction and responsibilities. According to the bill, it will eliminate all corruption in medical regulatory bodies. But despite of all these, the bill has drawn protests from doctors across the nation. Let us tell you that NMC bill had been introduced in Lok Sabha in 2017.  

Do you know how medical education and practice regulated presently?

The Medical Council of India (MCI) currently is responsible for regulating medical education and practice. Since several years, various issues are there which are related to the functioning of the MCI like regulatory role, composition, allegations of corruption and lack of accountability. Let us tell you that MCI is an elected body. Its members are elected by medical practitioners themselves that is the regulator is elected by the regulated.

According to NMC bill, the new regulatory body will be set up under the chairmanship of a government nominated individually and the members will also be appointed by a committee which will be headed by the Cabinet Secretary. Doctors across the country and the Indian Medical Association (IMA) felt that this bill will make the regulatory body a government controlled instead of democratically elected one. And because of this the needs of the people across the nation will not be able to addressed or fulfilled.

What is NIA Amendment Bill 2019?

Let us tell you that to meet the objective, the bill repeals the Indian Medical Council Act, 1956 and dissolves the current MCI.

In fact the 2019 NMC Bill will set up the NMC as an umbrella regulatory body with certain bodies under it. The Bill also states that states will establish their respective State Medical Councils within three years. At the state level, these councils will have the same role to the NMC.

Functions of National Medical Council

- To lay down the policies for regulating medical institutions and medical professionals.

- To assess the requirements of human resources and infrastructure in healthcare.

- To ensure compliance by the State Medical Councils with the regulations made under the NMC bill.

- To frame guidelines for determination of fee up to 50% of the seats in the private medical institutions.

Structure of National Medical Council

As discussed above the Bill replaces the MCI with the NMC and the members of NMC will be nominated. NMC will consists of 25 members including (a) Director Generals of the Directorate General of Health Services and the Indian Council of Medical Research (b) Director of any of the AIIMS (c) five members (part-time) to be elected by the registered medical practitioners, and (d) six members appointed on rotational basis from amongst the nominees of the states in the Medical Advisory Council.

Also, out of these 25 members, at least 15 that is 60% will be medical practitioners. This all is recommended to reduce the monopoly of doctors and it should include diverse stakeholders like public health experts, social scientists and health economists. For example, in the United Kingdom, the General medical Council is responsible for regulating medical education and practice which consists of 12 medical practitioners and 12 are lay members including community health members, administrators from local government.

Regulatory bodies that will be set up under NMC are as follows:

- Under the supervision of NMC, the Bill will set up four autonomous boards. Each board will consists of President and four members of which two members will be part time and they are appointed by the central government on the recommendation of a search committee. These bodies are:

- The Under-Graduate Medical Education Board (UGMEB) and the Post-Graduate Medical Education Board (PGMEB).

- The Medical Assessment and Rating Board: This board will be responsible to levy monetary penalties on institutions which fail to maintain the minimum standards as laid down by the UGMEB and the PGMEB.

- The Ethics and Medical Registration Board.

• The Medical Assessment and Rating Board.

What is Unlawful Activities Prevention Act (UAPA)?

NEXT Exam

According to the bill, there will be a uniform National Eligibility-cum-Entrance Test for admission to under-graduate and post-graduate super speciality medical education in all medical institutions. Also for the students who are doing graduation from medical institutions and want license for practice have to give a common final year undergraduate examination known as the National Exit Test (NEXT). Under this bill, the test will serve the basis for admission into post-graduate courses at medical institutions. There will be a screening test for foreign medical graduates. Let us tell you that the Bill does not specify the validity period of this license to practice.

Arun Singhal, additional secretary, ministry of health and family welfare said that there will be single National Eligibility cum Entrance Test (NEET) to admit students to all medical colleges including AIIMS and JIPMER along with a common counselling. The final-year exam of the MBBS course will now be called as NEXT, it will also be treated as entrance exam for PG courses. We have included the skill-based training during the internship period and MBBS course has been made competency-based.

Limited License to practice at Mid-level as Community Health Provider

India has a doctor population ratio of 1.1456 as compared to WHO standards of 1:1000. There is a huge gap in the doctors working in urban and rural areas with the urban to rural doctor density ratio. Therefore, most of our rural and poor population is denied good quality care. It is necessary to note that at present 57.3% of personnel currently practicing allopathic medicine and does not have a medical qualification.

Fee Regulation

For regulation of fees there is no such provision according to IMC Act, 1956. In fact some states regulate fees of some seats in private colleges through MOUs signed with college managements. As a result, the Supreme Court has set up committees chaired by retired High Court Judges to fix fees in private colleges as an interim measure. Several Universities claim that they are not covered by these committees. It is said that nearly 50% of MBBS seats are there in India in government colleges having nominal fees and remaining 50% seats would be regulated by NMC. That is almost 75% of total seats in the country would be available at reasonable fees. Also, to  decide the fees for remaining seats in the private medical colleges on the basis of the individual MOU signed with colleges of mutual agreement, the State governments would still have the liberty.  States will also provide scholarships on the basis of merit cum means and will also continue to do to make medical education affordable to all the students.

According to the health addition secretary, NMC will bring transparency era in medical education. We can't ignore the fact that NMC will have some control over fee in private colleges with 50% seats and it will vary from state to state. At last, let us tell you that the bill is an outline. Finalisation of the rules, details of framework, standard operating procedures and modalities are yet to be developed by the government.

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