Cleaning the medical stables

The proposed NMC is mostly old wine in a new bottle, but with two clauses that could hurt medical education

The Centre’s latest move to replace the Medical Council of India (MCI) with a National Medical Commission (NMC) has stirred a hornet’s nest among practicing doctors as well as medical students aspiring to become doctors.

The former has objected to the provision in the NMC Bill that enables community healthcare workers to practice medicine without possessing the necessary qualifications which, they feel, will encourage quackery. Medical students have objected to the rules relaxing entry into post-graduate courses in medical education as they fear it will hurt the prospects of truly merited undergraduate students.

Other than these two major amendments, the NMC Bill is nothing more than old wine in a new bottle. Like many other “reforms” which new governments like to introduce, this one, too, is an attempt to show a magical transformation in the health sector.

By scrapping the existing Medical Council of India (MCI), which had become notoriously corrupt and responsible for the proliferation of sub-standard medical colleges in the country, the Centre hopes that its successor body, the National Medical Commission, which will approve new medical colleges, conduct common entrance and exit examinations and regulate their fee structure, will set right the existing anomalies in the country’s health sector.

According to regulations, a proper medical school should be attached to a hospital where the number of teaching beds, outpatient attendance and other variables are on par. The ratio of three beds per student, along with a student-teacher ratio of 1:1 should be the norm in post-graduate studies to ensure proper training of doctors. The MCI flouted all accepted norms and allowed hundreds of money spinning “teaching shops” to mushroom in the country. It is hoped that the National Medical Commission will set right these irregularities.

One of the biggest anomalies that it will have to set right is the dearth of qualified doctors in the 15,650 primary healthcare centres of the country. Despite 30,000 to 35,000 medical graduates emerging from the 460 recognised medical colleges in India, a very small percentage is willing to serve in rural areas, where there is a dire need for proper medical
care.

Again, it is only a small percentage of medical undergraduates who are interested in general medicine. The majority craves to specialize in super specialty subjects like cardiology, neurology or orthopaedics. The glamour of these subjects, apart from their leading to lucrative careers, has reduced general medicine to the status of a poor relation in medical colleges. This is unfortunate in a country like India where the primary need is to have doctors treating poor patients for simple ailments.

Also, having enjoyed the benefits of an excellent medical education at an absurdly low cost, many of these graduates have their sights set on practicing medicine in countries outside India. It is a sad state of affairs that rich countries like America benefit from the services of the best doctors whose education was borne by poorer countries like India at great cost.

Perhaps, these anomalies can be set right by making rural service compulsory for 2-3 years after a degree course in medicine. Indeed, it’s what the Supreme court has ordered, too, recently, upholding the idea of compulsory rural service bonds that some states insist on and calling for a uniform policy on the duration of such service.

Affiliating universities should be given the right to withhold medical graduates’ degrees until they fulfil that requirement. If medical students are also made to undertake to pay back the costs of their education before going overseas after graduation, that would be a deterrent to fleeing to other countries after utilizing India’s resources.

These rules – especially the first -- can be imposed only if proper facilities are provided for doctors to serve in rural India. The lack of proper housing, tolerable working conditions and a safe environment for women is a great deterrent for medical graduates to work in primary healthcare centres. Will the National Medical Commission set right these discrepancies?

The proposed medical commission has one disturbing clause that needs to be revised. If it permits community health workers to practice modern medicine in rural areas, it will be unleashing lakhs of bogus doctors on unsuspecting patients belonging to the most deprived sections of society. The much-touted Ayushman Bharat National Health Protection Scheme, said to be the biggest health reform in the world, will then become a farce.

That, and the proposed National Exit Test, which will serve as a basis for entry into post-graduate courses as well as providing licence for medical graduates to practice medicine without further specialization, will make a mockery of medical education in this country. It is no wonder that established bodies like the Indian Medical Association (IMA) have protested vehemently against this travesty of healthcare.

These anomalies, however, can be corrected with more dialogue between the various stakeholders, whereas uncivilized methods of protest like hurting the interests of patients will defeat the very purpose of medical ethics.