In defence of the Medical Council Bill: An AIIMS undergraduate's perspective
The National Medical Council Bill (NMC), 2017, has been in the eye of the storm ever since it was introduced and most in the profession have voiced their dissent with notable exceptions like Dr Devi Shetty.
As a doctor to be, I myself had reservations about the bill, but what forced me to rethink was a comprehensive list of FAQs (frequently asked questions) released by the ministry of health and family welfare (MoHFW) on its website and this article is a humble appeal to the citizens of India in general and the medical fraternity in particular to think about the new facts that have emerged with an open mind and recalibrate their views if they are convinced.
The first concern of the fraternity is about ceding control of the profession from an elected Medical Council of India to an NMC, which is largely appointed. Let us not for once pretend that the so-called elected MCI was an epitome of ethical and transparent conduct; grave allegations have been made against it and one of its ex-president's (who was interestingly "elected" unopposed more than once for the top post). So a fair system of checks, balances and regulations is more than welcome when it comes to regulation of the "noble profession". If one pays close attention to the composition of the NMC, it has 5 elected members and 16 to 21 senior representatives of the medical profession out of a total of 25.
So the medical professionals are adequately represented (which would avoid a situation akin to that faced by defence forces where the decision making power rests with the bureaucracy which is largely unaware of the nitty gritties of the profession) and the inclusion of experts from the planning side, most notably the CEO of NITI Aayog shall enable a seamless integration of the budgetary and executive decisions.
The second most contentious issue has been the proposed bridge course to allow practitioners of alternate forms of medicine like AYUSH to prescribe allopathic medications. I personally had an issue with the ambiguity about this proposal, but with enough clarifications being provided in the FAQ document, I am convinced it is a step in the right direction. It is clearly stated that the bridge course is intended only for prescription of basic allopathic medications at the sub-centre or primary health centre levels. One needs to understand that the urban to rural ratio of doctors in India is highly skewed with cities having nearly four times as many doctors according to a World Health Organisation study.
Another study has shown that of the MBBS graduates less than 20 per cent have willingness to serve in the rural areas in the long term (would be interesting to know how many of those vehemently opposing this proposal are ready to spend time in the rural areas). The length and breadth of the hinterland including the far-flung and tribal areas is and would remain underserved. It is in light of this harsh reality that the bridge course makes a new attempt to try and fill the short gap. At present the inhabitants of the rural and far-flung areas are at the mercy of quacks, health workers and pharmacists, none of whom are more qualified than the practitioners of alternative medicine (who in fact study the modern science right from anatomy-physiology-biochemistry to pharmacology side by side with the more specialised field specific subjects). So if this step is well implemented, it could indeed be a boon for the rural and neglected masses.
The third bone of contention is the licence exam at the end of MBBS which would double up as the PG entrance exam to replace NEET-PG. I again feel it is a welcome step to have a quality control before giving someone the licence to fiddle with life and death. But some more clarifications are welcome from the government's side regarding the format and criteria of the examination and whether it would be better if students from AIIMS, JIPMER etc are also brought under the purview of this exam (I am a firm proponent of a clinical skill based exit exam for all, but it seems difficult to conduct logistically in a country like ours).
Lastly, there has been concern about why fees of only 40 per cent seats of private colleges are being regulated. Let us be clear that at present, fee regulation is largely non-existent in the private college set-up and training a doctor is a costly affair (the government reportedly spent nearly Rs 1.5 crore training an AIIMS MBBS student vs annual fees of less than Rs 1,000).
So this partial regulation is welcome and if the government delivers on its promise of opening a medical college per three Lok Sabha constituencies, private colleges shall largely become redundant. Opening colleges is a time consuming process and by the time we have the capacity to train adequate doctors in the government set-up, such stop gap arrangements like bridge courses and partial fee regulation are indeed to be welcomed as pragmatic ways of dealing with the healthcare of a country as vast and diverse as ours. In a nutshell, while it may not be ideal, the NMC is certainly one of the most feasible ways forward.