FAQs on National Medical Commission (NMC) Bill 2019

  1. Clause 32: Limited License to practice at Mid-level as Community Health Provider:
India
has a doctor-population ratio of 1:1456 as compared with the WHO
standards of 1:1000. In addition, there is a huge skew in the
distribution of doctors working in the Urban and Rural areas with the
urban to rural doctor density ratio being 3.8:1.
Consequently, most of our rural and poor population is denied good
quality care leaving them in the clutches of quacks. It is worth noting
that at present 57.3% of personnel currently practicing allopathic medicine does not have a medical qualification.
       

The
ambitious Ayushman Bharat initiative announced by GoI in this year’s
Budget Speech needs 1,50,000mid-level providers within the next 3-5
years to provide comprehensive primary and preventive care.It will take
7-8 years to ramp up the supply of doctors, therefore, in the interim we
have no option but to rely upon a cadre of specially trained mid-level
providers who can lead the Health and Wellness Centres.
There
are international examples of Health Systems permitting such Community
Health workers. Countries such as Thailand, United Kingdom, China, and
even New York have permitted Community Health Workers/Nurse
Practitioners into mainstream health services, with improved health
outcomes. Since we haveshortage of doctors and specialists, the task
shifting to Mid- level Provider will relieve the overburdened
specialists.
This is merely an enabling provision to grant limited licence only in primary and preventive healthcare to practice medicine at mid-level
to such persons, who qualify such criteria as may be specified by
regulations which will have an overwhelming representation of Doctors.
Chhattisgarh and Assam have experimented with the Community Health
Workers. As per independent evaluations (carried out by Harvard School
of Public Health), they have performed very well and there is no ground
of concern if the quality of personnel is regulated tightly.
  1. Clause 15: NEXT Exam
Medical
Education (ME) is a specialized area with high focus on technical skill
sets. A common final year undergraduate examination (NEXT) withcommon
standards of knowledge and skills for Doctors on a Nation-wide basis.
An
enabling provision has been made to ensure common standards.
Regulations for operationalizing the NEXT would be made in due course
keeping in mind importance of both theoretical as well as clinical skill
setsrequired at the level of UG. Composition of NMC includes 75%
doctors representing Central and States Institutions/Councils and health
universities. Such a composition of NMC will ensure that due weightage
to theoretical as well as clinical skill sets is adhered to. There is a 3
year window before NEXT becomes operational, leaving ample scope for
detailed negotiations on the contours of the exam.
  1. Clause 10(1) (i): Fee regulation
IMC
Act, 1956 has no provision for regulation of fees. As a result, some
states regulate the fees of some seats in private colleges through MoUs
signed with college managements. In addition, the Supreme Court has set
up committees chaired by retired High Court Judges to fix fees in
private colleges as an interim measure. Deemed to be Universities claim
that they are not covered by these committees.
Nearly
50% of the total MBBS seats in the country are in government colleges,
which have nominal fees. Of the remaining seats, 50% would be regulated
by NMC. This means that almost 75% of total seats in the country would be available at reasonable fees.
 In the spirit of federalism, the State governments would still have
the liberty to decide fees for remaining seats in private medical
colleges on the basis of individual MOUs signed with colleges on the
basis of mutual agreement.
States
also have been providing scholarships on the basis of merit cum means
and would normally continue to do so in order to make medical education
affordable to all students. We need to balance the interests of the poor
but meritorious students and the promoters of the private medical
colleges in order to expand the number of seats on offer. It is not
correct to assume that colleges would be free to arbitrarily raise the
fees for unregulated seats. The transparency provided by NEXT results
would lead to regulation of fees through market forces. Colleges would
have to provide quality of education commensurate to the fees charged by
them, otherwise there would be no takers for their management quota
seats.
Rating
would be provided by MARB for medical institutions based on the
standard of education/training.  This will serve to regulate fee through
market forces.
Any
affirmative action has to meet the test of reasonability. India has a
large middle class population. The government of the day is duty bound
to create infrastructure for all segments of society.
While
we solicit private investment in the medical education sector and want
private medical colleges to be financially viable, this government has
not shied away from its responsibility to create more seats in the
government sector. We have invested more than Rs 10,000 crores in
creating government seats in the past five years, and are also setting
up 21 new AIIMS at a cost of over Rs 30,000 crores to boost the medical
education sector. This trend of creating government seats will continue
in future.
There
is no question of NMC Bill making medical education a preserve of the
rich. On the contrary, it is common knowledge that before the reforms of
NEET and common counseling were introduced by our government, rich
students who could afford to pay huge and unrecorded capitation fees
were able to secure admission to private medical colleges. Our reforms
have eliminated the role of black money in medical education and the NMC
Bill will provide statutory force to the reforms which have been
carried out.
Another
bogey which is being raised is that merit will be given a go by in the
proposed dispensation. Nothing could be further from the truth. The
earlier provision was that any student who obtains 50% marks at class 12
level could gain admission to MBBS courses. Colleges negotiated with
students and conducted their own admission tests in a totally
non-transparent manner. As a result, many undeserving students got
admission. Now only NEET qualified students can get admission, which
ensures that merit prevails in admissions.