New Delhi: Touted as one of the biggest reforms in medical education in India, the National Medical Commission (NMC) Bill, 2019, is facing major resistance from medical fraternity even after getting passed in Lok Sabha.

What is NMC Bill 2019?

The NMC Bill proposes to repeal the Indian Medical Council Act, 1956 and replace the Medical Council of India (MCI), which was dissolved in 2010 following corruption charges against its president Ketan Desai by the Central Bureau of Investigation (CBI). As per the Bill, a national medical commission will be set up in place of MCI that will have responsibilities such as approving and assessing medical colleges, conducting common MBBS entrance and exit examinations and regulating medical course fees. The Bill aims to provide for a medical education system that improves access to quality and affordable medical education, ensures availability of adequate and high quality medical professionals in all parts of the country.

Why is medical fraternity against NMC Bill?

There are several provisions of the Bill that are raising eyebrows of the medical students and doctors across the country.

Community Health Provider

The Indian Medical Association (IMA) has raised concerned over Section 32 of the NMC Bill that provides for licensing of 3.5 lakhs non medical persons or Community Health Providers to practise modern medicine. According to the Bill, the Commission may grant limited licence to practice medicine at mid-level as Community Health Provider to such person connected with modern scientific medical profession who qualifies such criteria as may be specified by the regulations.

Earlier there was a proposal of a bridge course clearing which alternative medicine doctors could practise modern medicine. The provision was majorly opposed by doctors when the Bill was proposed. The government made changes in the bill for the provision but proposed similar idea of Community Health Providers to help tackle the disease burden in rural areas.

According to the Bill, the Community Health Provider may prescribe specified medicine independently, only in primary and preventive healthcare, but in cases other than primary and preventive healthcare, he may prescribe medicine only under the supervision of medical practitioners registered under sub-section (1) of section 32.

“The term Community Health Provider has been vaguely defined to allow anyone connected with modern medicine to get registered in NMC and be licensed to practise modern medicine," said IMA in an official statement.

“This means persons without medical background are becoming eligible to practise modern medicine and prescribe independently. This law legalises quackery. This provision and the other controversial provisions can never be accepted by the medical fraternity of the country," it said.

National Exit Test (NEXT)

Section 15 (1) of the bill proposes a common final-year MBBS exam, the National Exit Test (NEXT), before an individual starts practising medicine and for seeking admission to post-graduate medical courses and for enrolment in the State Register or the National Register. It will also be a screening test for foreign medical graduates.

Medical student fraternity has completely rejected NEXT in its present format.

“Merit should be the determining factor in securing a PG seat and the current NEET-PG should not be scrapped," said the All India Institutes of Medical Sciences (AIIMS) Resident Doctors Association (RDA) the Federation of Resident Doctors Association (FORDA) and the United-RDA in a joint statement opposing the NMC Bill in its current form.

"A gross breach of medical ethics and utter disregard for the noble profession in the form of the NMC Bill. The provisions of the said bill are nothing short of draconian and promote gross incompetence and mockery of the professionals currently working day and night," the joint statement said.

Private colleges Fee regulation

NMC would also regulate fees and all other charges for 50% of the seats in private medical colleges and deemed universities. “The MNC will frame guidelines for determination of fees and all other charges in respect of 50% of seats in private medical institutions and deemed to be universities which are governed under the provisions of this Act," the Bill states.

“There should be capping on the fee charged by the unaided medical in¬stitutions. Thus, in current system of fee regulation by Fee Regulating Authority should prevail and the said provision in the bill is to be amended accordingly. (section 10(1) (i))," said joint statement.

As per the Bill, of 25 members proposed for the NMC, only five would be elected which means the non-elected members would be either government officials or those nominated by the government.

“The system of allopathic health care by qualified MBBS graduates should be governed only by qualified MBBS graduates. And their representation should be more from democratically elected members than nominated. {section 4(4)}. The NMC should retain its autonomy over its decisions and should be an independent Autonomous body of regulators of highest standarss of professional integrity, and the Central Govermnent can definitely advice NMC on matters of National interest but it should not be of directive in nature," the joint statement said.

Protests against the Bill resume

When the NMC Bill was proposed, in 2017, doctors and medical associations raised voices against various provisions of the Bill. However, the current Bill in its transition has adopted many changes compared to the original draft but the protests have never stopped. As the contentious NMC Bill is to be taken for consideration and passage in Rajya Sabha on Thursday, country’s apex medical body the Indian Medical Association (IMA) has again resumed its protest, calling for a nationwide stir.

IMA on Wednesday warned the Government that the protest against the NMC Bill 2019 will be intensified. Santanu Sen, National President, Indian Medical Association also said that IMA’s call for withdrawal of non-essential services was implemented successfully by the entire medical fraternity of India across the country.

"If it is tabled in its current form in the Rajya Sabha without any amendments, the medical fraternity across the country will be forced to resort to extreme measures, which may hamper the healthcare services nationwide. We will withdraw from essential and non-essential services from the hospitals for an indefinite period," he said.

In last two days, medical students, across the country continued their agitation with hunger strike, boycotting of classes and marches to Raj Bhawans. “They will continue agitation tomorrow as well and the stir will be intensified, if grievances of the medical fraternity are not attended to," said R V. Asokan, Secretary General, IMA.

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