Why some vested interests have created a fog around National Medical Commission Bill

by Arvind Panagariya

The Economic Times, February 5, 2018

As the Parliamentary Standing Committee deliberates the National Medical Commission (NMC) Bill, 2017, fog around it must be cleared. Vested interests have deliberately created some of this fog.

Corruption, low quality and slow expansion have been the hallmarks of medical education under the current Medical Council of India (MCI) regime. With a small self-interested and self-perpetuating clique of doctors controlling the MCI for decades, the top scholars and practitioners of medicine have simply quit playing any role whatsoever in shaping medical education.

Therefore, the NMC Bill makes a conscious effort to bring the best in the profession to the centre stage of regulation. The Bill proposes that a committee of unimpeachable integrity headed by the Cabinet Secretary select the members of the National Medical Commission and its four boards. One hopes that the guiding lights of the disciplines are ready to step up to the plate.

The Bill proposes to place quality in medical education at the centre of the regulatory process. Under the MCI, regulation has focused solely on enforcing strict infrastructure and personnel norms, which has resulted in widespread allegations of corruption and steady deterioration of education quality. The proposed Bill replaces this regulation by a system of accreditation and exit examination. Accreditation will serve as a signal of quality of education and research in respective institutions. Results from a common exit examination will amplify this signal by providing information on the relative performance of students educated at different institutions.

Some have opposed the exit examination arguing that it constitutes hardship for students. Frankly, the objective of the examination being to identify unqualified candidates in a profession that deals with human life, such opposition is unconscionable. In the US, doctors must renew their licences every two or three years, and one of the requirements of the renewal is the evidence of continuing medical education.

The Bill also addresses the acute shortages of medical personnel we currently face. This is done through three avenues. First, by replacing continuous inspections of infrastructure and personnel by accreditation, it eliminates the perpetual threat of closure of colleges on flimsy grounds. It also eases entry of new colleges and allows automatic expansion of seats up to 250 in the existing colleges as long as they maintain acceptable quality standards of education.

Right School of Thought 
Second, the Bill established full parity between the Diplomate of National Board (DNB) conferred upon postgraduate and postdoctoral candidates by the National Board of Examination (NBE) and the postgraduate and postdoctoral degrees under the National Medical Commission. This feature preserves the independence of the NBE while also opening the door to DNB holders to serve as faculty members in medical colleges.

The Bill also gives freedom to collegesto start postgraduate courses without seeking approval of NMC. These measures will greatly alleviate the current faculty shortage. Competitionfor entering students between NBE and NMC-blessed postgraduate programmes will also bring pressure to improve quality standards in postgraduate education on the two entities.

Finally, the Bill proposes to offer bridge courses that would equip ayurveda, yoga and naturopathy, unani, siddha and homeopathy (AYUSH) graduates to provide basic allopathic treatment to patients. Currently, due to shortage of qualified medical doctors, India has far too many unqualified practitioners in both rural and urban areas. These practitioners have no formal training in medicine.

The vast majority of them picked up their treatment skills working as assistants to doctors for short periods and then launched their own practices. Because they now refer the cases beyond their capability to the doctors from whom they got their training on a commission basis, a symbiotic relationship between the two has developed.

Consequently, doctors vehemently oppose the bridge course provision. The only effective way to break this nexus and protect the patients' interests is to replace the unqualified practitioners by imparting proper knowledge to AYUSH doctors.

Finally, many have argued that the provision allowing private medical colleges to set the fees on 60% of the seats would make medical education inaccessible to India's poor. This argument is based on incorrect analysis and is contrary to evidence. Fees on 100% of the seats in government colleges and on 40% seats in private medical colleges will remain subject to regulation. Moreover, relaxed entry of new private colleges and the expansion of seats in the existing colleges will improve access in two ways.

First, with the seats in private colleges substantially expanding, the absolute number of seats falling under fee regulation will be large. And, second, competition from new entrant colleges would limit the ability of private colleges to arbitrarily raise their fees. Removal of licence-permit raj-era price controls on cement, steel, scooters and cars did not translate in arbitrarily high prices of these products. Competition matters.

Beneficial Surgery 
A comparison of medical education with engineering and management education in recent decades lends further support to this conclusion. Strict controls on seats and fees in medical education have created huge shortages of doctors. Moreover, with corruption and capitation fees proliferating, potential poor students have hardly been served well. In contrast, rapid expansion of engineering and management colleges has translated in much greater access and reasonable fees in these areas.

If India had followed the MCI model in engineering and management, its economic growth would have surely been stifled by scarcity of engineers and managers.

The writer is former vice-chairman, NITI Aayog