Doctors and medical students alike have come out in force against the National Medical Council (NMC) Bill – with some students going so far as to create copies of the Bill to burn in the streets.
The NMC Bill seeks to supersede the Medical Council of India (MCI) for a period of two years, retroactively taking effect from September 26th, 2018, during which time a board of governors will run it. This board of governors will expand to a total number of twelve, increasing from the current seven members.
Union Health Minister Harsh Vardhan has commented that “a perception has set in in the last two decades that the MCI has been unsuccessful in discharging its duties and corrupt practices are prevalent in the regulatory body. The NMC Bill is the need of the hour,”
Doctors express concerns
The MCI in its current state democratically elects over two-thirds of its membership — roughly 160 individuals. These individuals are chosen and voted for by the medical fraternity. The NMC Bill replaces this body with a panel of 25 individuals, none of whom are elected. As such, to many in the medical community, the Bill represents a centralisation of power, with control seized from the medical community and transferred to the government.
Vagueness permeates the definition of “medical professional” in the new Bill
Dr R. V. Asokan, secretary-general of the Indian Medical Association (IMA), expresses some major concerns with the Bill. The first is a section guiding the creation of Community Health Providers (CHPs), a new class of medical staff given license to practice modern medicine to a “mid-level”, whose training must be “connected with modern scientific medical profession”.
Such vague terminology and propensity of the current administration towards ayurvedic doctors being allowed into allopathic fields is reminiscent of the complaints of doctors following the “bridge course” controversy. The bridge course allows for ayurvedic students to undertake a short course during their studies that would allow them to practice allopathic medicine to a limited degree. Doctors stated this would allow for an entire generation of quacks to be sanctioned.
The following quote is specified in section 32 of the NMC Bill: “The commission may grant limited license to practice medicine at mid-level as a community health provider to such person connected with modern scientific medical profession who qualify such criteria as specified by the regulations”.
Who qualifies as being “connected with modern scientific medical professions” is, as of yet, unspecified, though the Bill does specify one third of India’s health workers could fall under this category. This potentially hints at recruitment drives that may allow for individuals with dubious qualifications to begin practice as a mid-level health worker – similar to past proposals that would train unqualified ‘quack doctors’ to make up for India’s doctor shortage.
While India suffers from a severe shortage of medical staff, this potential for a vague allowance for anyone with experience only marginally connected to the medical field to practice medicine could be disastrous.
“Here the government is providing an opportunity for unqualified or partially qualified persons to practice while the qualified ones are available and frustrated because of unemployment”, observes Dr Asokan, adding that this is another attempt at lateral entry for the unqualified or partially qualified.
It is worth noting, however, that unqualified community health providers already staff India’s healthcare workforce in significant numbers: 25 percent of India’s medical personnel lack the appropriate medical qualifications. So-called ‘quack doctors’ typically staff rural areas, where shortages of doctors are most pronounced. This suggests that qualified doctors are concentrated in urban metros, leaving vacancies in swathes of the country where doctors are most needed. While certifying ‘quack doctors’ could be easily abused and dangerous, particularly if patients are unaware that their practitioner is unqualified, the Bill arguably changes little with regard to how India’s healthcare workforce currently operates.
Dr Asokan also expresses concerns at the changes to both examination structure — with new qualifications being added to allow for more individuals to practice medicine following graduation — and funding issues. In terms of funding, he claims there is a dilution of regulatory powers under the new bill, with seats in private medical institutions now under the control of an unelected panel. This, he claims, will drive up the cost of medical education.
Students join the protests
As of Wednesday, July 24th, students in Gujarat began hunger strikes in addition to burning copies of the Bill. Students and the IMA will hold meetings to plan the future of the protest movement from July 29th. It is likely that such protests will continue for the foreseeable future.
Previous protests by students and doctors alike have not stopped mention of the bridge course and other means of allowing non-allopathic fields to cross into medicine permeating new Bills. It is a recurring issue that has been a topic of debate in the last year. One that could threaten to severely impact the quality of healthcare in India. In a country where sub-par healthcare already kills over a million each year, this could translate into a medical catastrophe of staggering proportions.