#FirstOnPlexusMD Government addresses common concerns and clarifies key provisions, strongly supports the reform
In a detailed FAQ released on MOHFW website last night, the Ministry answers commonly raised questions and concerns against the NMC Bill. Besides throwing more light on some of the common concerns, the tone and matter of the FAQs also indicate the Government’s firm determination to implement this reform. PlexusMD highlights some of the key points shared in the FAQ. Questions and answers are reproduced verbatim from the official Govt release.
On the constitution of the NMC
Q. NMC will be a bureaucratic body.
A. Not true. At least 16 members and upto 21 out of 25 members would be only senior medical doctors. The chairperson of NMC would have at least 20 years’ medical experience, out of which at least 10 years would be as HoD or Head of Institution. Similarly, Presidents of the 4 autonomous boards would have at least 15 years’ medial experience out of which 7 years would be in a leadership role.
Q. Medical practitioners will be able to elect only 5 members in their own body.
A. The DRPSC has recommended that ‘keeping in mind the disastrous experience with an elected regulated body, the Committee is convinced that …….. regulators of the highest standards of professional integrity and excellence will have to be sought by the Government through a rigorous selection process’ (Para 3.16). Although the Committee had recommended a purely selected body, the Government has provided for election of 5 (20%) members.
Q. There is nobody from outside the profession in the Bar Council of India and ISRO.
A. The DRPSC has observed that ‘a perspective has gained ground that self-regulation alone does not work because medical associations have fiercely protected their turf and any group consisting entirely of members from the same profession is unlikely to promote and protect public interest over and above their own self-interests and therefore check and balance mechanisms are required.’ (Para 3.20). They have recommended ‘opening Council membership to diverse stakeholders such as public health experts and social scientists, health economists, health NGOs with an established reputation, legal experts, quality assurance experts, patient advocacy groups, to name but a few’ (Para 3.21). Prof Ranjit Roy Committee Report also recommended introduction of non medical members in NMC for increasing transparency especially in terms of ensuring that the rights of patients are heard and protected. Similar councils in developed world such as GMC, UK the counterpart of MCI, also comprises equal number of medical and non- medical members(lay members). In NMC, given the request of medicos at the draft/ consultation stage, only three non-medical experts have been added and the NMC would still be a body largely constituted of medical experts.
Q. Power would be centralized in a few hands only.
A. It was felt by the Committee that a large 108 member General Body as in the existing MCI is too unwieldy and is not conducive to good regulatory organization structure[a1] . Moreover, Most regulators like AICTE, UGC, TRAI, CERC, PNGRB, AERA etc. are small in size. Small body will be able to make decisions at a faster pace.
Q. Full-time members will practically run NMC.
A. All full-time/part-time members will have the same voting rights in NMC. The only real full-time members would be the Chairperson, Presidents of the four boards and Member Secretary.
Q. There should be representation from AYUSH streams in NMC.
A. NMC is primarily meant to regulate education and practice of modern medicine.
Q. There is no representation of SC/ST/OBC in NMC.
A. There was no representation in MCI also. Other regulators such as AICTE, UGC CERC, TRAI, AERA etc. also do not have any such representation.
On consultations with various stakeholders
Q. There was no discussion with State Governments on NMC Bill.
A. Not True. The Committee under the chairmanship of VC, NITI solicited the views of the State Govts. on the reforms required in MCI in the 1st round in May, 2016. Thereafter, the draft NMC bill was circulated by NITI Aayog to all State Governments for their views in August 2016. States were also invited for another round of discussion and to express their views on the draft NMC Bill in September, 2016. The minutes of these meetings may be seen Here.
Q. No experts were consulted during drafting of the Bill.
A. NITI Aayog held nine meetings during which consultations took place with 14 experts out of which 10 were eminent doctors. The Committee under the chairmanship of VC, NITI sought views and suggestions of various experts including eminent physicians and surgeons; former Secretaries to the Government of India, Department of Health and Family Welfare; public health experts; President/Vice-President and other Members of the MCI; representatives of the State Governments; and lawyers. The draft NMC Bill was also placed on NITI’s official website to seek views/opinion of General Public and experts. Also, a written request to experts was made to give their views on the draft bill. Around 14500 mails, were received from public, experts (including those who were invited by the Committee), private medical Universities, advocacy groups, MCI and State. In addition, written submissions were also received from experts. The minutes of these meetings may be seen Here.
On the National Licentiate examination (NLE)
Q. Can the licentiate exam be merged with common final year exam?
A. No format for the licentiate exam has been prescribed in the Act. As an expert body the NMC will take a call on the format and design of NLE and frame regulations after appropriate consultation. It is possible for NMC to take a decision to merge the licentiate exam with common final year exam.
Q. Will graduates of AIIMS, etc. be required to take the licentiate exam?
A. This would not be required since the Institutes of National Importance have their own Act of Parliament and do not fall within the purview of NMC. However, if they wish to take up post-graduation in any medical college within the purview of NMC, then they would have to take the licentiate exam as it will be utilized for post-graduate admissions also.
Q. Can the licentiate exam be repeated for rank improvement?
A. Yes the exam can be repeated to improve rank for PG admissions.
Q. Doctors who fail the licentiate exam will be allowed to practice under the proviso to Section 33.
A. The proviso to Section 33 is not meant to allow doctors failing the NLE to practice but is intended to allow medical professionals like nurse practitioners, dentists and possibly any shorter duration allopathy courses introduced by NMC in future.
On the State representation and role of State Medical Councils
Q. Will there be any change in the role of State Medical Councils?
A. Under the MCI Act, State Medical Councils look after registration of medical practitioners and enforcement of professional ethics. They will continue to perform these roles. NMC Bill does not poach upon the role of State Medical Councils. It rather promotes the States to constitute State Medical Councils within three years of the commencement of this Act. (Clause 30(1)).
Q. NMC has very little representation of States.
A. 3 members on rotational basis and 5 elected members would represent States. Thus 8 out of 25 members will be representing States.
Q. Having one representative of each State in the MAC is unfair to States having a large number of doctors.
A. Each State is represented in the MAC so that the benefit of the States’ experiences on policy matters can be obtained and also State specific issues can be raised. The Vice chancellor of the health university or university having maximum number of medical colleges would represent the State. The intention is not to have representation of doctors in proportion to their strength in their State.
On fixing up to 40% fees in Medical colleges
Q. Why have only 40% seats been regulated in terms of fees?
A. There was no provision of regulation of fees in the IMC Act. Regulation of 40% seats is a step forward. The proportion of regulated seats has a direct impact on the feesof remaining seats and a reasonable balance has to be struck so that the fees of unregulated seats do not become unviable.
Q. Why can’t a cap be proposed on the fees for all seats?
A. The cost of setting up medical colleges varies from State to State and according to the quality of infrastructure created. Moreover in the case of PG seats, the fees varies widely between pre-and para-clinical subjects and highly sought after subjects on the other hand. Hence a uniform cap on the fees that can be charged would be difficult.
Q. What is the proportion of seats for which fees is fixed by State Governments under the present dispensation?
A. This varies from State to State according to the MoUs signed by private medical colleges. Generally 33-50% of seats in private medical colleges are designated as State quota seats. In most States fees of seats in deemed universities is not regulated by State Governments.
On the proposed bridge course for AYUSH practitioners
Q. Why has a provision for bridge course for AYUSH been added in Section 49(4)?
A. India has a doctor-population ratio of 1:1655 as compared with the WHO standards of 1:1000. In addition, city doctors are not willing to work in rural areas as can be seen in the Urban Rural ratio of doctor density (3.8:1) . There are 7,71,468 AYUSH practitioners in India who can be leveraged to improve the health access situation of the country. There is already a policy for co-locating AYUSH and allopathy to ensure better utilization of resources. Further, with the government’s ambitious target to revamp 1,50,000 Sub Health Centres into Health and Wellness Centres, there is a need of large human resource to meet this challenge.
AYUSH has an effective role in integrating the preventive and promotive aspect of healthcare. In addition, with growing incidence of non-communicable diseases (NCD), there is a need to provide holistic prevention and treatment of diseases. In many places around the world doctors are not taking care of the preventive and wellness aspect of healthcare. Countries such as Thailand, Mozambique, China, and New York have regularized community health workers/non-allopathic health providers into mainstream health services, with improved health outcomes. We also need to take such kind of steps when we have acute shortage of doctors and specialists.
The NMC bill seeks to fill in the gaps of availability of health care personnel by facilitating trained AYUSH practitioners to expand their skillsets through a Bridge Course and provide preventive and promotive allopathic care. The bridge course may help address this demand and better utilization of resources, and make the health sector a bigger provider of employment.The NMC Bill also promotes this through raising exposure of such NCD patients to non-allopathic practitioners in addition to allopathic doctors. Thus, in order to homogenize and regulate the entry of AYUSH professionals towards practicing modern medicine through a strict regime, this bill has provided for the clause.
Various States such as Maharashtra, Assam, UK, Haryana, Karnataka and Uttar Pradesh etc. have already amended their Acts and permitted AYUSH professionals to practice modern systems and prescribe all modern medicines. Any bridge course will be introduced only by a unanimous vote as provided in Section 49(4) and hence each one of the allopathic doctors in the NMC will have a veto power. Even if the bridge course is introduced, it will only be for prescribing specified medicines at specified levels. The provision is intended for prescribing a small number of medicines including OTC drugs at the Sub-Centre/PHC level.
Q. Instead of a bridge course for AYUSH, the focus should have been on nurse practitioners and dentists.
A. Nurse practitioners and dentists can be allowed under the proviso to Section 33, which is applicable to ‘medical professionals’. It needs to be clarified that all professionals associated with modern medicine systems fall in this category and not only MBBS doctors.
Q. Bridge course would be unscientific and dangerous.
A. NMC will be dominated by allopathic doctors. If all of them unanimously approve a bridge course after due consideration, then there is no reason to assume that it will be unscientific and dangerous. The course would be designed in such a manner that it would enable the participants to prescribe a limited set of medicines in a responsible manner.
Q. Would AYUSH doctors doing the bridge course be under dual control?
A. Yes, control over their professional conduct would be exercised by the respective Councils /Commission depending on the medicine prescribed by them.
Q. Retrenchment of existing MCI staff will cause hardship.
A. Adequate compensation will be paid to all such employees as specified in Proviso 2, Section 58(3) of the Act. In view of the past legacy of MCI, it will not be advisable to take these employees into the NMC secretariat.
Q. Why has a parallel PG degree in the form of DNB been retained?
A. On account of its design, the DNB course allows post-graduate education in comparatively smaller towns which may not have medical colleges. This would help in improving the geographical location of PG seats. Moreover, there is a severe shortage of faculty for medical colleges. To meet the expanded demand for faculty, we need to recognize DNB as equivalent to specialist.
Q. Fine upto 10 times the annual fees will give a handle for extortion by inspectors.
A. At present penalties are not graded. It is binary; either recognition or de-recognition. This gives huge leeway to the assessors/inspectors of MCI to extract rent. A graded system of monetary penalties with de-recognition after 3 instances of continued violation and increasing fines are exhausted will actually be more corrective and less extractive than the current provisions of MCI Act . It is further specified in Section 26(1)(f) that the imposition of monetary penalty would be accordance with the regulations made for this purpose.
The above points were taken verbatim from the original FAQ document published on the Ministry website on 30th January, 2018 that can be accessed here: https://bit.ly/NMCFAQ. If you are not able to access this link you may download the FAQ here: https://bit.ly/2nnS9yV.
Dr. Nikita Shah
Editorial team at PlexusMD