The National Medical Commission (NMC) Bill, 2019, was approved by President Ram Nath Kovind and is a significant milestone in the reform of medical education and practice in India. Replacing the Medical Council of India (MCI), which was criticized for inefficiency and corruption, the NMC Bill seeks to create a more transparent and efficient regulatory framework. This bill promises to simplify procedures, increase the number of medical professionals, and improve access to quality healthcare.
Key Issues with Medical Regulation Before NMC
For many years, the functioning of the Medical Council of India (MCI) was under scrutiny. Various experts pointed out several deficiencies in the regulation of medical education and practice. The following issues were raised:
(a) Separation of Regulatory Powers The MCI was responsible for both regulating medical education and overseeing the medical practice, which led to centralization and inefficiency. This overlap often resulted in slow decision-making processes and hindered the growth of medical education. Experts recommended that the regulation of medical practice be separated from medical education to ensure more specialized oversight. The National Medical Commission (NMC) was suggested as an independent body focused on medical practice, while academic functions should be managed by a proposed National Commission for Higher Education and Research.
(b) Recommendations by Expert Committees A significant development came in 2015 when an expert committee chaired by Professor Ranjit Roy Chaudhury recommended a complete restructuring of MCI. It suggested the formation of a National Medical Commission with four key verticals: undergraduate medical education, postgraduate medical education, accreditation of medical institutions, and doctor registration. This structure was aimed at ensuring a more focused and transparent approach to regulating medical education and practice.
(c) Issues with the Composition of MCI One major concern with the MCI was that most of its members were elected by their peers, creating a conflict of interest. This "regulated electing regulators" system often resulted in the selection of less skilled professionals, further undermining the quality of governance. The NITI Aayog, in a 2016 report, recommended the establishment of an independent selection process for appointing regulators, which the NMC Bill addresses.
(d) Fee Regulation in Private Colleges The NITI Aayog also criticized MCI's involvement in fee regulation for private medical colleges, arguing that it encouraged corruption and capitation fees (unregulated, excessive fees). The Aayog suggested that regulatory authorities should not interfere in fee regulation, as it could stifle the expansion of private medical education. The NMC Bill addresses this concern by allowing regulation of fees for 50% of seats in private institutions but avoiding excessive control.
(e) Lack of Professional Conduct Monitoring The Standing Committee on Health (2016) raised concerns that MCI focused primarily on licensing medical colleges, with little attention to enforcing medical ethics or addressing corruption within the organization. There was a need to strengthen professional conduct regulations, and it was suggested that medical education and practice enforcement be separated to maintain stricter oversight at each stage.
Key Features of the National Medical Commission Act, 2019
The NMC Act introduces sweeping changes to the way medical education and regulation are managed in India. The legislation is seen as progressive and addresses many long-standing concerns:
1. Replacing the MCI with the NMC The NMC will replace the MCI, bringing in a more streamlined and efficient structure. The NMC will consist of 25 members, with a mix of selected and elected representatives. The NMC will oversee medical education, including approvals for new colleges, admissions, and fee regulation. This new regulatory framework aims to improve the quality and accessibility of medical education.
2. Fee Regulation in Private Colleges One of the unique aspects of the NMC Act is its provision to regulate fees for 50% of seats in private colleges and deemed universities. This is expected to make medical education more affordable while allowing institutions some autonomy over the remaining seats.
3. Medical Advisory Council The NMC will have a Medical Advisory Council that will allow states and Union Territories to voice their concerns and offer suggestions. This platform will ensure that regional issues in medical education are addressed, promoting a more inclusive approach to governance.
4. Autonomous Boards The NMC will have four autonomous boards to manage specific aspects of medical education:
- Undergraduate Medical Education Board
- Postgraduate Medical Education Board
- Medical Assessment and Rating Board
- Ethics and Medical Registration Board
These boards will ensure that education and professional practice are regulated independently and transparently.
5. Common Entrance and Exit Examinations The NMC Act introduces a uniform National Eligibility-cum-Entrance Test (NEET) for both undergraduate and postgraduate medical admissions. Additionally, it introduces the National Exit Test (NEXT), a common final-year MBBS examination, which will act as a licensing test for medical practice and a criterion for postgraduate admissions.
6. Temporary Registration for Foreign Medical Practitioners Under the NMC Act, foreign medical professionals can be granted temporary registration to practice in India. This is expected to address the shortage of medical professionals, especially in specialized fields, by allowing experts from abroad to practice in the country.
7. Licensing for Mid-Level Practitioners To bridge the gap in healthcare availability, particularly in rural areas, the NMC will grant limited licenses to mid-level practitioners, known as Community Health Providers. These professionals will be authorized to provide primary and preventive healthcare services, under the supervision of registered medical practitioners.
Concerns and Opposition to the NMC Bill
Despite its progressive stance, the NMC Bill has faced opposition, particularly from the Indian Medical Association (IMA). The two main concerns are:
1. Licensing of Community Health Providers Section 32 of the Bill allows the licensing of non-medical professionals or Community Health Providers to practice modern medicine. The IMA has expressed concern that this provision could dilute the quality of healthcare, as individuals without a formal medical background may be authorized to practice. There is a fear that this could lead to unqualified individuals practicing medicine, especially in rural areas where oversight may be limited.
2. National Exit Test (NEXT) The introduction of the NEXT examination has been met with resistance from the medical student community. Many students believe that the existing system of NEET-PG should continue and that the NEXT, in its current format, may not be the best method for determining eligibility for postgraduate education. They argue that merit-based admissions should continue without an additional exit exam.
Conclusion
The National Medical Commission Bill, 2019, marks a significant shift in the regulation of medical education and practice in India. By replacing the MCI with the NMC, the government has introduced a more transparent and efficient framework that aims to improve the quality of medical education and healthcare delivery. Although the Bill has been met with some opposition, particularly concerning the licensing of mid-level practitioners and the NEXT exam, it is expected to bring much-needed reforms to the medical sector.
By simplifying procedures, reducing the burden on students, regulating fees, and ensuring quality education, the NMC Act lays the foundation for a more robust healthcare system. Over time, the success of the NMC will depend on how well these reforms are implemented and how effectively they address the concerns of stakeholders. The Bill represents a major step forward in ensuring that India's medical education system is better equipped to meet the healthcare needs of its growing population.
