NMC Bill progressive, but has some troubling provisions
Abolishing the Medical Council of India (MCI) and setting up a new regulator, the National Medical Commission (NMC), is welcome. MCI has been labelled a “den of corruption” and “corruption-ridden” by the Delhi High Court and a parliamentary committee in a 2016 report on its functioning, respectively. No wonder then, that while Ketan Desai was removed as MCI president after being charged for corruption in 2010, he—along with 16 others similarly charged—was able to pull off renomination to the Council in 2013. Mismanagement and graft at MCI has led to a situation where there were grounds for the parliamentary committee to point out 14 failures, including the failure to “maintain uniform standards” in medical education, to “create a transparent system of medical college inspections and grant of recognition”, to “guide setting up of medical colleges in the country as per need” and even to “instill respect for a professional code of ethics” in medical professionals and take disciplinary action for violation. The parliamentary committee report states that the committee “was also informed that the private medical colleges arrange ghost faculty and patients during inspections by MCI and no action is taken for the irregularity”.
The NMC structure promises many positives since it will replace MCI’s process-oriented regulation with an outcome-based monitoring approach. It will serve as a coordinating body for four proposed autonomous boards with appellate jurisdiction over the decisions of three of them. It does away with the system of medical institutions having to seek annual renewal of recognition and permission for expanding intake—though this will still be subject to the present cap of 250 seats. Under the NMC, colleges will be free to start PG courses without requiring any approval. The NMC vision also eschews penalties like cancelling licences of institutions—instead, it proposes to fine a college violating the norms sums ranging from half the cumulative fees it charges to 10 times the same. It also proposes a National Licentiate Examination for graduates from medical institutions for commencing practice. Importantly, it does away with the “regulation by medical professionals only” that characterised the MCI—and led to the formation of a cabal by corrupt doctors—and puts in place a regulator that will have on board both medical experts and experts from areas that have intersections with regulation of medical education and practice, including law, economics, management, and health research.
However, the proposed NMC regime has some unsound provisions as well. For instance, the Bill empowers NMC to set the fees for 40% of the seats in private colleges. This introduction of fee-regulation—absent under the MCI regime—will impact the quality of medical education since private colleges often rely on passing on costs of updating hospital infrastructure and addition of personnel, etc, to students. While it is important to get rid of the MCI structure that has failed so miserably, it must be kept in mind that the replacement doesn’t makes things worse. The government must thus ensure that the final NMC vision is free of such damaging provisions.