Why killing the NMC bill is not a good idea

The overhauling of the Medical Council of India (MCI) is underway in earnest. The Union Cabinet has approved the successor body, the National Medical Commission (NMC), which now stands scrutiny of the Rajya Sabha Standing Committee on Health & Family Welfare. This came after protracted debate, agitation and bitter contentions on the Bill from the entire spectrum of stakeholders.

The most strident voice against the NMC has been the Indian Medical Association, the largest conglomerate body of doctors of India. Their objections include a loss of autonomy for running the profession, the ill-thought bridge course proposal for alternate medicine practitioners to get licenses for allopathic practice, Governmental intrusion and opacity in decision making that will embody the NMC as a result thereof. While many of the objections carry merit in their contentions, equally so, many are also fears that are being propounded prematurely. 

The advent of the NMC has to be taken into historic context. The Medical Council of India, established in 1933, was the statutory body responsible for regulating medical education and professional licensing for doctors in India. The body was envisaged to be a self-regulating entity that was run by doctors for the interest of doctors and medical education in India.

The sordid unfolding of scandal, scams, corruption and the stark fall in standards of medical education has left a legacy that needed urgent and widespread reforms. While many may disagree on the nature of the successive body, there is unanimity on the need to dissolve the MCI in its current avatar. 

Initial piece meal steps at reform were attempted by successive Governments but to little avail. The need for radical reform was deemed to be the only suitable way forward. The late Prof. Ranjit Roy Chaudhury Committee Report became the basis of the NMC - a larger umbrella body with an expanded mandate.

The mandate now includes licensing of doctors, regulating undergraduate and post graduate medical education through separate bodies, entrance and exit examinations, assessment of medical colleges, monitoring professional conduct and exerting appellate authority powers over state medical education boards.

This onerous mandate was rightfully divided over multiple bodies, which ensured that the NMC was more nimble and its decision making not left to any monolithic power centre or cabal. 

The NMC is contoured to create a widely representative and consensus driven organisation. The NMC will have a secretariat and Medical Advisory Board (constituted by States & UT’s and comprising of doctors). Each of the 4 boards - Undergraduate & Postgraduate Medical Education, Medical Assessment & Rating Board and the Board for Medical Registration - will find representation in the NMC. Nominees (of rank no less than Joint Secretary) from the Health Ministry, Human Resource Development Ministry and the Directorate General of Health Services, five members nominated by the Union Government and five rotating members from the Advisory Council.

Qualification criteria for the NMC Chairman and Board heads are stringent and nominees can only be doctors. Clearly in intent, NMC is envisioned as an inclusive body made up of a mix of members from the widest possible institutions. However, the NMC architecture in the Bill and its actual implementation and functioning is one that only time can tell.  

The NMC Bill will mark a radical move as it moves from an elected body to a primarily nominated body. The ‘elected body model’ came under criticism, where the sanctity of the regulator being made up of the regulated was constantly under scrutiny. The new nominated model will take away some autonomy but equally also arbitrariness that monolithic power centres in the erstwhile MCI came to embody.

Issues like bridge courses and Governmental oversight remain contentious. But amongst three broad reform options - piece meal corrections, complete Government take over and a mixed model, the latter seems to be most acceptable and is seemingly the essence of the NMC. 

How this new body operates only time can tell. The Government has taken a consultative view of the final makeup of the body by asking for stakeholder representations on the Bill. One must use this avenue to get a better bill, but not protest to stop the NMC in toto. This will not serve the interests of medical education and the fraternity, but only ingratiate vested interests that have brought medical education to its nadir in the first place.