NMC Bill, 2019

Key highlights of the bill:

1. 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: 
   • Government nominated chairman and members,
   • 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. Government, under the National Medical Commission (NMC), can dictate guidelines for fees up to 40% of seats in private medical colleges.
4. Common entrance exam and licentiate exam: MBBS students have to clear NEET as medical entrance, and before they step into practice, they must pass the exit exam.
5. Less Discretionary powers of Regulator: Recognized medical institutions don’t need the regulator’s permission to add more seats or start PG course. 
6. Measure to reduce red tape: Powers of the regulator are reduced to establishment and recognition of medical college. 

Need:

• Huge shortage of specialists. Need for additional five lakh doctors.
• Regional Disparities:  For example, there are enough doctors in Kerala and Tamil Nadu, whereas in Bihar and the northern States, there is an acute shortage.
• Rural – Urban Divide: Many doctors tend to settle in urban areas

Significance:

1. Amidst growing institutional inefficiencies, NMC bill regulates medical education and practice in India.
2. The Bill attempts to tackle two main things on quality and quantity
   • Corruption in medical education,
   • Shortage of medical professionals.
3. Overhaul of the corrupt and inefficient Medical Council of India, which regulates medical education and practice and replace with National medical commission.
   • Medical Council of India has been marred by several issues regarding its
     • regulatory role,
     • composition,
     • allegations of corruption, and
     • lack of accountability.
4. In 2009, the Yashpal Committee and the National Knowledge Commission recommended separating the regulation of medical education and medical practice.

Potentials of the bill:

• According to the Bill, the Commission may grant limited license to practice medicine at mid-level as Community Health Provider to such person connected with modern scientific medical profession who qualifies such criteria as may be specified by the regulations.
• Potential to link the disease burden and the specialties being produced. In the UK, for example, it is the government that lays down how many specialists of which discipline need to be produced, which the British Medical Council then adheres to.
• By introducing qualifying exams like NEET and NEXT, NMC can instil uniformity in the standard of competence and skills.
• It can reduce the burden of taking multiple exams, ensure a minimum level of knowledge in science, and reduce corruption by restricting student admission to those qualifying these exams.
• The State Medical Council will act as a grievance redressal body for any complaints relating to professional or ethical misconduct against a registered medical practitioner.
• This checks the corrosive impact of the process of commercialisation of medical services.
• The differential pricing of medical education can benefit the economically weaker sections of society.
• NMC can incentivize innovation and promote research by laying down rules that make research a prerequisite in medical colleges.

Cause of Concern:

1. Section 32:
   • This permits non-medical degree holders to practice medicine as community health providers.
   • This is opposed by IMA because it will legalize quacks in the country.
   • For example, rampant Hysterectomies(as prescribed by local RMPs) in Beed District in Maharashtra left behind severe health and economic distress to the sugar cane cutting women.
2. Less Democratic:
   • Compared to the present 70 per cent figure of elected representatives in the MCI, only 20 per cent members of the NMC will be elected representatives.
3. Centralization of Authority:
   • Unlike MCI, whose decisions were not binding on state medical councils, the NMC Bill allows the commission’s ethics board to exercise jurisdiction over state medical councils on compliance related to ethical issues.
4. Arbitrary Powers:
   • While action can be taken against the MCI president only on the direction of a court, the NMC Bill enables the central government to remove the chairperson or any other member of the commission.
5. National Exit Test (NEXT) has been conceptualized as a single test, which will act as a common final-year undergraduate medical exam and be used for granting medical license as well as admission to postgraduate courses. It has been argued that a single exam is being accorded too much weightage, and it can have an adverse impact on the career of medical aspirants.
6. Commercialization:
   • The Bill allows the commission to “frame guidelines for determination of fees and all other charges in respect of fifty per cent of seats in private medical institutions and deemed to be universities”.
   • This increases the number of seats for which private institutes will have the discretion to determine fees. 
   • At present, in such institutes, state governments decide fees for 85 per cent of the seats.

Conclusion:

Decades back, the Mudaliar Committee Report (1959) pointed out that doctors had neither the skills nor the knowledge to handle primary care and infectious diseases that were a high priority concern at the time. In recent times, the excessive reliance on a battery of diagnostic tests is reflective of commercial considerations and weak knowledge.