Explainer: What is the National Medical Commission Bill & Why are Doctors protesting?
Sai Krishna Muthyanolla
August 5, 2019
Among other legislations, the Parliament passed the National Medical
Commission bill during the current session. What are the main features of this
bill and why are doctors across the country protesting against this
legislation? Here is an explainer.
On Monday, 29 July 2019, the Lok Sabha passed the National Medical Commission Bill. Even though it was initially tabled in the Lok Sabha in December 2017,it faced stiff opposition and was then sent for scrutiny to the parliamentary standing committee of Health andFamily Welfare.  The standing committeesubmitted its report in March 2018. The Bill finally lapsed with the culminationof the first term of the NDA Government (2014 to 2019). The Bill was againtabled by the Union Health Minister, Dr. Harsh Vardhan, in the current LokSabha following the resounding victory of NDA and was later passed. The Bill wasthen approved in the Rajya Sabha on 01 August 2019. The passing of the billsparked widespread protests by the medical fraternity. But why is the medicalfraternity protesting? We try to explore the pros and cons of the bill in thisstory.
This bill annuls the Indian Medical Council Act of 1956 and was introduced with an objective to make quality medical educationmore accessible and affordable. It also aims to attain universal healthcoverage by making healthcare equitable. Further, adoption of latest technologyfor medical research and conducting periodic and transparent assessment ofmedical institutions are also a part of the objectives.
25 Member National Medical Commission will replace the
Medical Council of India
As per the bill, a 25 member National Medical Commission (NMC) will besuperseding the Medical Council of India (MCI) to regulate the medicaleducation in India and the profession. MCI was tainted with scams and there were charges of corruption pressed against its members. The MCI had also been accused of not beingtransparent. It was later dismissed and replaced by a Board of Governorsappointed by the Union Government. The members of NMC will be appointed by theUnion Government on the basis of the criterion listed in the bill. The membersof the NMC should also declare their list of assets and liabilities at the timeof taking charge and at the time of leaving the office. A Medical AdvisoryCouncil will also be set up as a part of this bill which will then function asthe primary platform for representation of States and Union Territories andalso make recommendations to the NMC.
NEET and NEXT are two important examinations proposed
in the Bill
The Bill also proposes two important exams-National Eligibility cum Entrance Test (NEET) and National Exit Test (NEXT).NEET shall serve as the common entrance test for admission to the undergraduate medical education in India. NEXT on the other hand is a common final year undergraduatemedical examination that will serve as the primary means for granting licenceto practice as medical practitioners and for enrolment in the State Register orthe National Register irrespective of the country from which the student hascleared their graduation. In other words, any person with a foreign medicalqualification also has to qualify NEXT for the purpose of obtaining licence topractice medicine instead of the Foreign Medical
Graduates Examination (FMGE).
NEXT will also be considered as thequalifying exam for postgraduate broad- speciality education while NEET will beconsidered for admission to post graduate super-speciality education. Further,it has also been mentioned in the bill that the NMC will frame guidelines forthe determination of fees for half of the seats in private medical colleges.
Autonomous boards to recognize & monitor Medical Education
In order to monitor medical education and practice, the Bill proposesthe recognition of four autonomous boards:
Taking into consideration the recommendations made by theparliamentary standing committee, amendments were made to the bill that wasintroduced in 2017. One major amendment was the removal ofbridge course between AYUSH and Allopathy. Instead, the bill leaves it to the State Governments to take necessarymeasures for addressing and promoting primary health care in rural areas and toenhance the capacity of the healthcare professionals.
Limited license given to Community Health Providers
In order to make healthcare more accessible and  to increase the number of medicalpractitioners, the bill has introduces ‘Community Health Providers’ (CHPs) whowill be given limited license to practice medicine. Regulations on the criteriafor selection of CHPs will be framed under this act. The number of CHPs shouldnot exceed one third of the total number of licensed medical practitioners inthe country. To tackle the shortfall of qualified doctors, countries like USA & Canada, allow nursepractitioners and healthcare providers to practice primary healthcare fordelivering better and improved access. Individuals have to typically complete aMasters course in these countries to be a nurse practitioner. It remains to beseen if the criteria for recognition of a CHP would also include such arequirement.
Why is the Medical fraternity Protesting?
The medical fraternity seems to be protestingfor multiple reasons. Below are some of the important ones.
Objection 1:  More
power has been given to the Union Government
The bill has been claimed to be ‘poorly drafted’ and ‘draconian’ bydoctors across the country. They also claim that the bill gives more power tothe Union Government. They further claim that the Central Government has thepower to override the decisions made by the NMC. The Indian Medical Association(IMA) has stated that NMC will not onlybe a bureaucratic body but will also function like a department of thegovernment. Unlike in the MCI where doctors (registered medical practitioners)could elect and make up almost 75% of the members, in the NMC, only 20% of themembers can be elected by them. The representation from states and unionterritories is also less than before. States get a chance only every two yearsto be represented in the NMC.
Government’s Response: In defence of thegovernment, former Union Minister & Rajya Sabha member Suresh Prabhu duringthe discussion in the Rajya Sabha stated that  interference of the Union government in healthcare is because there are many villages in the country where that do not havewell-trained medical doctors and that the people haven’t received proper healthcare. He also said that the central government doesn’t wish to ‘wash off itshands’ by not making it a priority and just by stating health is a part of thestate list. He also stated that at the time of emergency, what matters is notwhether the hospital is private or public but the availability of healthcare.
Further, the government stated that the clause giving powers to theCentral Government to give directions on policy matters to NMC and autonomousboards is part of many other acts (even IMC Act).
Objection 2: Community Health Providers not clearly
defined
Another criticism raised by those opposing the bill is the granting oflimited license to CHPs, who are expected to make up for the shortfall ofdoctors in the country .The CHPs have not been defined clearly in the bill. Ithas only been mentioned that he/she should be someone connected with modernscientific medical profession and is permitted to prescribe certain medicinesin primary and preventive healthcare and in other cases, under the supervisionof medical practitioners. This has raised concerns among many since there ispossibility of quacks legally entering medical profession. Congress’s JairamRamesh raised this in the Rajya Sabha and asked the government if this is about‘Institutionalising quackery’.
Government’s Response: The NDA government justifiedthis by stating that under the new institution, unless and until someone’s nameis mentioned in the State or National Registry, he/she is not allowed topractice and this move will in fact help in eliminating quackery. The Ministerwent onto state that there is aprovision for imprisonment if such rules are violated. He added that CHPs arenecessary so that the ideal doctor- population ratio can be reached and to makeprimary healthcare available even in the remotest parts of the country. Hementioned a list of countries where such a system exists and that definition ofa health worker is also given in Lancet etc. He assured the house that the NMCwill decide on the regulations and qualifications for CHP after studyingeverything and that there should be no misgiving about it.
Fees of only 50% seats in private and deemed
universities will be regulated
Privatisation of medical education is another important issue raised bythe opposition, the IMA as well as the protesting medical practitioners, sinceguidelines for fee determination and other charges in private and deemeduniversities has been made only for 50% of the seats. Nothing has beenmentioned with regard to the regulation/criterion for increasing intake inprivate colleges. The unregulated fees might exclude those who cannot afford itand make medical education affordable to only the rich. Another issue raised isabout NEET and NEXT exams which require rigorous coaching in coaching classesthat charge an exorbitant fee.
Government’s Response: Though the governmentdid not specifically address all these issues, it stated that since therequirement of doctors is large, private medical colleges along with governmentcolleges need to be encouraged.
Details of NEXT examination not given
A major concern for medical students in the uncertainty regarding theNEXT exam.  The requirement to qualifythis examination itself contradicts the bill’s objective to make more medicalpractitioners available all over the country to improve healthcare. In case,the candidate does not clear this examination, he/she will not be eligible topractice medicine in India. Five years of efforts and hard work will gounrecognised.
Government’s Response: Regarding NEET andNEXT, the government stated that these exams are student-friendly and will helpstudents appear for one instead of different exams for different universities.NEXT covers final year exam, PG entrance and is a licentiate exam as well.
Although the bill seems to have been introduced with a good intention ofimproving the medical education, there are a few loose ends as explained above whichneed to be looked into carefully while implementing it.
Featured Image: National Medical Commission Bill