‘I can say with utmost conviction and firm belief that debating and passing the National Medical Commission Bill by Parliament today, will go down in history as one of the biggest reforms of the Narendra Modi Government’; these were the words spoken by the Union Health Minister, Dr.HarshaVardhan in a Lok Sabha session, claiming it to be one of the biggest reforms the health sector has seen in India. The bill, however, was subject to a host of protests from the medical community who objected to several proposed changes such as the proposed bridge-course which would allow those educated in Homeopathy and Ayurveda the status of a licensed medical practitioner. Since then, the bill has been modified and parts of it such as the bridge course have been scrapped to assuage medical students and practitioners; yet it remains largely unchanged. Earlier this year, it was cleared by both houses of the Parliament and received the assent of the President, becoming an Act that repeals the Indian Medical Council Act, 1956. The Act, without a doubt, will have a significant impact on the state of regulation of medical practice and education.
The Abandonment of Federalism
Prior to the passing of the Act, the Medical Council of India comprised of several members selected either by the Central Government in consultation with the State Government, or through the process of internal elections within the boards that these members belonged to. The Act has now replaced the MCI with the 25 member National Medical Commission (“the Commission”) in which all permanent members are chosen by the Central Government. The State Government is given limited representation in the form of one elected part-time member in each of the five autonomous bodies formed under the Commission and an elected member in the Advisory Council, a body which plays a merely an advisory role to the Commission.
There is a marked decrease in the role State Governments now play in the apex regulatory and governance body in the medical education field. Given that the subject of medical education is a concurrent subject under List III of the 7th Schedule of the Constitution, the Act has the questionable intent and effect of significantly diminishing the States’ capacity to influence regulation in a field that they are legitimately entitled to regulate. his move by the Government seems most certainly ‘an abandonment of federalism’ as termed by T Sundararaman, the erstwhile dean of the School of Health Systems at Tata Institute of Social Sciences.
The Shift in Control
The Act also affects the self regulatory nature of the medical profession. While key positions filled by nomination also require the candidate to have extensive experience in the field of medicine, it displaces the system of direct elections that afforded legitimacy to regulation and prevented a government controlled top-down approach to governance. According to IMA President Dr. KK Agarwal,“Dissolving a democratically elected body of 150 medical professionals and replacing it with a body of 25 members of which 20 will be nominated by the government is undemocratic. It’s a clear indication that government is hell-bent to take control over the medical profession.”
The NEXT Step
TheAct provides for a mandatory common final year undergraduate examination called the National Exit Test or the “NEXT” to grant licenses to practise medicine and also as the basis of admission to post-graduate courses in medical colleges. While the NEXT is proposed to be effected in the coming three years, by which time the related rules will bring clarity regarding the exact impact of this test; the discussions about NEXT in Parliament provide some indication.
NEXT is proposed to establish a uniform examination for all final year students across the country replacing the current system where different universities adopt different tests and curricula for their final year students. The intent behind such a move was to ensure that every practicing medical practitioner has a minimum basic standard of training.This would also prevent prospective PG students from the hassle of appearing for multiple exams, including the NEET PG for admission to PG courses and for their MBBS degree.
However, under the current setup, several medical colleges require students to pass practical examinations as well as theoretical ones to pass their final year. NEXT will do away with this crucial aspect of practical knowledge and may result in several licensed professionals having little or no practical experience or knowledge. It may have instead adopted an examination which was uniform throughout the nation and mandated all students regardless of university affiliations to pass a practical examination as well, thereby boosting the on-field capability of the doctors produced in the nation. While it may be argued that these students would still have to go through practical exams in the initial years in some of these universities, the above suggested change would have helped create a system where even those universities which don’t cover practical education presently, would now have to.
Though not confirmed yet, the NEXT is expected to be predominantly, if not completely multiple-choice-question (MCQ) based. This is a worrying development as most researchers agree that multiple-choice items are poor tools for measuring the ability to synthesize and evaluate information or apply knowledge to complex problems, skills that are essential to be an effective medical practitioner.
Under the Act, the Commission shall also have the power to frame guidelines for determination of fees and all other charges with respect to 50% of all seats in private institutions.The State Governments were free to decide these parameters on the rest of the seats. The Indian Medical Council Act, 1956 had no provision for the regulation of fee and the Supreme Court then had to pass orders instituting fee committees in each state which had the power to regulate fees and no control over the additional charges levied on the students. However, this Act provides for regulation all other charges levied by medical institutions as well. Thus, in addition to government institutions providing subsidized education, such regulation will also help aspiring practitioners access medical education at reasonable costs.
This however, may lead to a number of problems. As stated by noted academician T N Sundararaman, “It is like putting a ball in the court of the states. Moreover, it is unlikely that the states will take the cudgels to decide for the rest of the seats. Even if they do, it might not stand legal scrutiny. It may lead to a no-holds barred situation for private medical colleges and that’s grave.” It is also likely to meet with much lobbying and dissent from private institutions.
The recently enacted National Medical Commission Act seeks to address the issues that plagued the earlier Medical Council of India. It has had its fair share of detractors and it would be wrong to say that it rectifies all that is wrong with medical education in the country. Along with the several new changes it aims to bring about in a bid to improve the state of medical education in the country, it comes its own set of issues and predicaments. Only time will tell if the Act will lead India into a new paradigm of medical security or whether, just like its ill-fated predecessor, the National Medical Council, it is doomed to be faced with the issues of corruption and inefficiency.
Lok Sabha Debates, The National Medical Commission Bill, 2019, July 29, 2019 available at http://loksabhadocs.nic.in/debatestextmk/17/I/29.7.2019f.pdf.
Medical Students Protest Against NMC Bill, The Hindu, August 3, 2019, available at https://www.thehindu.com/news/cities/chennai/medical-students-protest-against-nmc-bill/article28802394.ece.
Milan Sharma, National Medical Commission may create 3.5 Lakh Registered Legal Quacks in India, say Doctors, India Today, July 25, 2019, available at https://www.indiatoday.in/india/story/national-medical-commission-bill-2019-may-create-3-5-lakh-registered-legal-quacks-in-india-says-doctors-1573249-2019-07-25.
 The Indian Medical Council Act, 1956, § 3.
 The National Medical Commission Act, § 4.
 The National Medical Commission Act, § 17(5).
 The National Medical Commission Act, § 11(e).
Constitution of India, 1950, Schedule VII, List III, Item 25.
Banjot Kaur, National Medical Commission will encourage corruption, centralize power, Down to Earth, August 1, 2019, available at https://www.downtoearth.org.in/news/health/-national-medical-commission-bill-will-encourage-corruption-centralise-power–65942.
 The National Medical Commission Act, 2019, § 5
 The Medical Commission of India, 1956, § 3.
Siddhart Tiwari, The National Medical Council Bill aims to improve healthcare for you, Then why the worry?,Youth Ki Awaaz, available at https://www.youthkiawaaz.com/2018/08/the-national-medical-council-bill-aims-to-improve-healthcare-for-you-then-why-the-worry/.
The National Medical Commission Act, 2019, § 15(1).
The National Medical Commission Act, 2019, § 15(6).
The National Medical Commission Act, 2019, § 15(3).
The National Medical Commission Act, 2019, § 15(2).
Medical final year exit exam in 3 years, August 7, 2019, available at https://www.telegraphindia.com/india/medical-final-year-exit-exam-in-3-years/cid/1696064.
Available at https://www.ruseducation.in/the-next-promises-exit-exam-facts-for-mbbs-medical-students.html.
Multiple-Choice Tests, Fairtest, August 17, 2007, available at https://www.fairtest.org/multiple-choice-tests.
The National Medical Commission Act, 2019, § 10(i).
Press Release, Press Information Bureau, August 8, 2019, available at https://pib.gov.in/newsite/PrintRelease.aspx?relid=192533.
ibid (n 9).
ABOUT THE AUTHOR
Aditya Pattanayak is a second year law student at Dr. Ram Manohar Lohiya National Law University, Lucknow.
In Content Picture Credit: Live Law