THIRUVANANTHAPURAM: Powerful resistance is building up in the state against Central Government's proposed National Medical Commission (NMC) Bill which seeks to replace the Medical Council of India with a nominated body. The doctors are at loss to understand Centre's logic behind the proposal to abolish MCI. While all other councils have been left out, the MCI is being singled out raising serious doubts about the government's intentions, they say. The proposed Commission will comprise a chairperson, a member secretary and eight ex-officio members including bureaucrats from various ministries. Of the 10 part-time members there will be those appointed by central government from diverse backgrounds economics, law, health research and patient rights.
There will be just five part-time members from amongst the nominees of the States and Union Territories in the Medical Advisory Council, who shall be appointed on a rotational basis for two-year terms by the Central Government. Doctors say the 70 to 80 per cent of members in the existing MCI are elected representatives. They represent various sections including colleges, universities and registered medical practitioners. Elections to MCI take place in multiple tiers.
Planning Board member Dr B. Ekbal has described the proposed bill "anti democratic."
It is not at all democratic. It looks like a bureaucratic centralised control system which is very hierarchical. The presence of professionals is very much limited. While the present MCI system has its own problems, instead of looking at current problems and rectifying them, they are coming out with such anti democratic proposals," he said. Dr Ekbal who heads the expert panel on state health policy, said Centre should hold wider discussions with all stake holders before taking a decision. "Replacing a 150 member strong elected body with a nominated 15 member panel is unacceptable in a democratic set up. Nearly 40 per cent of members proposed in new commission will be persons who have nothing to do with medical profession," said IMA outgoing national president Dr A Marthanda Pillai.
The reasons being pointed out by the Centre for replacing MCI with commission is that the council has failed in all fronts. But the fact is that powers of MCI had been reduced over the years. Another allegation is that MCI was not updating syllabus and curriculum as per the changing health situation in the country. "MCI amended the curriculum six years ago and submitted before the government. But that proposal is yet to be approved," said Pillai. The doctors reject the allegations that MCI enjoyed absolute powers and the allotment of medical colleges was skewed. They say even for granting NOCs, the approval of union health ministry is mandatory. MCI only inspects the institution and submits report. It is up to the government to accept or reject it.
There are enough provisions under the existing Act to intervene and act against administrative and financial irregularities. "We are with the government for fighting against corruption. But corruption is not limited to MCI," said a doctor. Another concern being raised by the medical fraternity is the proposed increase in management quota. From the existing 15 per cent it could go up to 60 per cent. The boards under the Commission will be prescribing norms for determination of fees for a proportion of seats, not exceeding 40%, in the Private Medical Educational Institutions.
The medicos are up in arms against the Commission because of the anti student proposals. After completing MBBS by taking 20 to 25 exams in 5.5 years, a person becomes a medical graduate. But the NMC proposal says it's not enough. The doctor will have to take another examination. The IMA feels Licentiate examination is not required and is unnecessary. It casts aspersions on university who are conducing MBBS examinations. Besides it would reduce available manpower because a student who has passed MBBS but fails in Licentiate exams will not be able to practice. It is mindless copying of American system.
"Quality of medical education will be badly hit, cost of medical education and health care might go up considerably if these proposals are accepted," said Dr A Jayakrishnan state president of IMA . The doctors' organisations allege that the ulterior motive of the bill is to bring in indigenous medicine in an inappropriate way by diluting and controlling modern medicine. Ayurvedics, Homoeopaths and others will get registration in modern medicine through Schedule IV of NMC, they allege. "Health minister has called us for another round of discussions. We will press for the scrapping of these proposals," said Dr Pillai.
NMC will bring in professionalism
Those in favour of the proposed National Medical Commission say the replacement of the Medical Council of India was the need of the hour and important for injecting professionalism. The MCI members are elected from the same medical fraternity that they have to control. So there was a clear conflict of interest and the MCI had also become an exclusive organisation by the doctors, for the doctors and of the doctors. In many other countries both medical professionals and non-medical professionals regulate the profession making it more transparent and accountable.
The current style of functioning of MCI lacks transparency and professionalism which has had its adverse impact on the medical sector as a whole. One of the reasons for mooting the NMC Bill is the scathing attack on the MCI by parliamentary standing committee on health. The parliamentary panel had even called for scrapping the MCI for its all round failure. On the allegations that the proposed Bill gave enough scope for private managements to take away 60 per cent of fee is also rejected by those who have mooted the proposals.
The Bill's main aim on keeping attractive fees is to lure more private capital investment. But at the same time there was also a need for keeping the fee economical enough for ensuring opportunities to the meritorious students. It is in this context that the Bill proposes a 40:60 ratio of subsidised seats. The independent boards that have been proposed under the NMC would also function independently thus reducing the monopoly. The proposed commission also had enough provisions to check corruption by avoiding conflict of interests.
The non medical professionals and a functional secretariat would act as watch dog. According to Neeti Aayog, the proposed Bill had received wide response from the public, professionals, representatives of various organisations and medical experts. Nearly 20,000 suggestions had come up before the team which was now in the process of vetting these ideas. These recommendations and suggestions would be taken into consideration while giving final touches to the draft. On the question raised by IMA as to why MCI was being singled out, the experts say there were more problems in the MCI compared to others. Moreover, the parliamentary standing committee had also severely indicted the medical panel.
