Why Rajya Sabha passing National Medical Commission bill is a good thing | Opinion
Set to replace the Indian Medical Council Act that regulates medical education in India, the NMC bill has been called a visionary reform by supporters and an assault on the medical profession by critics, almost all of whom are doctors.
Sick patients were once again denied treatment by doctors on strike to protest the National Medical Commission (NMC) Bill 2019 that was passed in the Rajya Sabha on Thursday. Set to replace the Indian Medical Council Act that regulates medical education in India, the NMC bill has been called a visionary reform by supporters and an assault on the medical profession by critics, almost all of whom are doctors.
Doctors’ associations and students of medicine are opposing several provisions in the NMC, with the most contentious ones being the introduction of a common National Exit Test (NEXT) in the final year of medical studies.
The NMC attempts to standardise the quality of doctors by introducing a common National Exit Test in the final year of MBBS along the lines of the National Entrance -cum- Eligibility Test (NEET) for admission to undergraduate courses. NEXT results will be used to both select students for post-graduate courses and to provide graduates, including those who have studied medicine overseas, with a licence to practice in India.
The provision of training nursing and allied health professionals as community health providers will make preventive and primary healthcare less dependent on doctors, who will then freed up to provide secondary and advanced care. Around 3.5 lakh community health providers are being trained to work in Ayushman Bharat Health and Wellness Clinics being set up for every 5,000 population across states. More than half of India’s population still has no access to primary health services, which can provide 80%-90% of healthcare needs of any given population across a lifetime, according to the World Health Organisation (WHO).
Trained community health providers can help make up for the shortfall of doctors and nurses to improve outreach. There were 1,157,771 allopathic doctors registered with the state medical councils/Medical Council of India as on January 31, 2019, to treat a population of 1.3 billion. Assuming 80% availability, it is estimated that around 9.26 lakh doctors are in active service, which makes India’s doctor-population ratio 1:1,457, minister of state for health and family welfare, Ashwini Kumar Choubey, told the Lok Sabha in May. The World Health Organisation recommends a doctor-population ratio of 1:1,000.
The IMA and its 3,05,458 members have challenged the mostly-nominated structure of the NMC, which will have 25 members operating through four subsidiary boards regulating undergraduate education; postgraduate education; medical assessment and rating; and ethics and medical registration. Only five members will be elected, with the non-elected members being either government officials or those nominated by the government.
The IMA wants the nominated members be replaced by elected doctors, which is the model that has been tainted by the scam-riddled Medical Council of India, which, for decades, was controlled by a cartel of doctors. In contrast, the nominated boards of All India Institute of Medical Sciences and the National Board of Examinations, which is an autonomous body for postgraduate medical education and examination, have nominated, yet independent boards.
Past attempts to reform the MCI, both through the setting up of the National Commission for Human Resources in Health and amending the MCI Act, over the past decade have failed. It’s critical to reform and standardise medical education to provide quality healthcare with equity. Around 80% of India’s registered doctors work in cities, which is home to 31% of the country’s population. Private hospitals are heavily skewed in favour of Tier-1 and Tier-2 cities, which leaves the rural population heavily dependent on under-staffed public health centres and government hospitals.
Trained and licenced community health providers will strengthen preventive and primary care at the health sub-centres at the village level and substantially reduce out-of-pocket spending on treatment. Doctors are the pillars of public health delivery. It will be a disaster if they do not embrace change and work with government to provide strong primary health care rooted in community participation to respond to emerging and existing diseases, evolving health needs and environmental challenges to prevent disease and improve outcomes.