Medical Education Reform: Cure & Its Cost

Medical professionals rang in the New Year debating the implications of the National Medical Commission Bill tabled in the Lok Sabha. That it has now been sent to the standing committee should hopefully put some concerns to rest considering the bill. Despite some of its good provisions, the bill was far from ideal and needed revision. Debate on medical medical education reform is not new. "This is a debate with a history," says a former health ministry official referring to nearly the decade spent on the issue by successive governments.

Many within the industry would remember around 2009, in her address to the Parliament, Pratibha Patil, the then President of India, talked of the need for a National Commission For Human Resources In Health (NCHRH). But then, not much happened thereafter. Sometime in May 2010, the government promulgated the Indian Medical Council (Amendment) Ordinance, 2010. This ordinance superseded the IMC Act, 1956 for one year with a newly constituted Board of Governors taking over the functions of the Medical Council of India (MCI). It was a six member board chaired by Dr Shiv Kumar Sarin. The IMC (Amendment) Act, 2010 replaced the ordinance in September 2010. The Amendment Act required, however, that MCI be reconstituted within three years from the date of supersession, by May 2013. By amending the Act in 2011 and 2012, the government twice extended the terms of the board of governors by one year at a time.

The ministry then apparently revived the announcement by the government and the whole exercise, as is being done currently, was followed, right upto the making of a bill. Called the NCHRH bill, it was moved in the parliament in 2011 and later sent to a standing committee, which returned it with some strong observations and seeking a fresh attempt.

The MCI was thereafter reconstituted by a notification in 2013. Again, in 2016, the government constituted a committee on the Indian Medical Council (IMC) Act 1956 under the chairmanship of the Vice Chairman, NITI Aayog. The Committee was charged with examining all aspects of the IMC Act, 1956 and suggest reforms leading to improved outcomes in medical education in India. It included as members: P.K. Mishra, Additional Principal Secretary to Prime Minister,  Amitabh Kant, CEO, NITI Aayog andi B. P. Sharma, Secretary, Department of Health. Subsequently, a National Medical Commission was proposed and meant to replace the current MCI with the new body having a different structure and governance system.
 
So, where do we go from here? What needs to be watched now is how progress is made on two or three main issues: Primarily, the whole process of nomination of the board members. It is no brainer that unless, it is seen as one that is rigorous, objective and not susceptible to pressure from the government, the new arrangement may not take off. Second, is the hotly debated aspect that mixes up homeopathy and ayurveda with allopathy. A former senior official of the health ministry, who has looked at this subject in detail, said, without undermining the AYUSH system, you cannot use the Act to make an AYUSH doctor into an allopath.  Provision that the commission can frame appropriate bridge courses and maintain a register of AYUSH doctors who have cleared the bridge course and thereafter eligible to practice as allopath, is not done.

Equally debatable will be the provision around fees. This refers to the section 10 (i) of the bill that says: the commission can "frame guidelines for determination of fees in respect of such proportion of seats, not exceeding forty per cent., in the private medical institutions and deemed Universities which are governed by the provisions of this Act". This could keep the door open to raise the fees to exorbitantly for the rest and since it is not exceeding 40 per cent, it could theoretically be as low as fees fixation for just 1 per cent of the seats.

One positive provision is the common exit exam that all would-be doctors will need to clear before getting the clearance to practice. This will address concerns around need to ensure uniform quality across the country.

The other bright spot in the bill is the  move to constitute four autonomous boards for under-graduate medical education,  Post-graduate medical education, Medical assessment and rating; and Ethics and medical registration.

One only hopes the bill sees the light of day for reforming medical education and not meet the fate of the NCHRH bill, which was also moved in the parliament and underwent a similar process.