The recent, token, 12-hour strike called by the Indian Medical Association (IMA) on 2ndJanuary 2018, brought to the fore a confrontation which had been slowly building up for some time now. The medical fraternity, beleaguered as it already is with several anti-doctor media campaigns running presently, finds itself pitted against the central government which, the IMA feels, seeks to single handedly bring sweeping changes in the Indian Medical Council Act of 1956. This open confrontation is an indicator of the desperation that the medical fraternity feels regarding the current problem. While most of the doctors would probably agree that the intention of the government in trying to bring changes is right, a majority of them also feel that only good intentions will not deliver the goods. The Medical Council of India (MCI), which the current Bill seeks to abolish, was widely seen, even in medical circles, as an archaic structure that served more as a font of corruption rather than the professional guiding mechanism that it was supposed to be. The government has rightly identified several problem areas within the medical education and healthcare delivery in India; the current problem has less to do with the government’s diagnosis than the medication it seeks to force down the throats of the medical profession. It is true that the medical profession in India today suffers from several maladies like corruption, lack of standardization, lack of healthcare delivery to the villages etc. All these diseases together, have made the medical fraternity very sick and in dire need of an overhaul. However, curing the disease by killing the patient can hardly be lauded as a brilliant plan, which is what the current bill seeks to do.
The bill seeks to replace the Medical Council of India with the National Medical Commission to oversee medical education and healthcare delivery in India; nothing wrong so far. However, the bill seeks to replace a body, which was largely ‘elected’ by a body that is purely ‘selected’. This is just the beginning of the list of grouses that the medical fraternity has with the bill.
The bill proposes to have four vertical, parallel bodies working under this NMC umbrella to look after different functions of the erstwhile MCI. These four bodies are the Undergraduate Medical Education Board (UGMEB), Post Graduate Medical Education Board (PGMEB), Medical Assessment and Rating Board (MARB) and the Ethics and Medical Registration Board (EMRB). This is also fine. The problem arises with what these boards propose to do. For example the MARB will give permissions for medical colleges and inspect them to ensure compliance with the standards set by the UGMEB and PGMEB and award penalty if the colleges are found wanting. The IMA feels that the provision of the awarding of penalties is arbitrary and will again lead to the same corruption that we have seen in the MCI and are trying to avoid. Also the MARB seeks to regulate the fee of only up to 40% of seats in private medical colleges, whereas currently the MCI is trying to regulate the fee of all the seats in private medical colleges. The IMA feels that this capping of regulation of the fee to 40% will hurt the interests of students from weaker sections and also that this has been done at the behest of the private medical colleges most of which are run by politicians or politically connected business houses.
Another issue of conflict is the licentiate exam which all the students who pass out from MBBS course will have to take before they can be registered in the National Medical Register which the EMRB will maintain. This dual examination system seeks to burden the MBBS students with one more exam on the pretext of bringing uniformity in the standards of the medical graduates. Also the EMRB seeks to maintain a separate register for the AYUSH practitioners who have taken the ill thought out ‘Bridge course’ and have been found to be fit to practice modern medicine. This dual registration has medico-legal loopholes, feels the IMA. Also the ‘Bridge course’ and registration of AYUSH practitioners as modern medicine doctors will provide a back channel for these practitioners to enter the field of modern medicine without going through the rigorous training that it entails.
The government feels that empowering the AYUSH practitioners is vital to increase the reach of healthcare delivery to the last possible person even in the far off villages of India. However, the medical fraternity feels that the malady lies elsewhere, and the government has got it all wrong.
Allowing AYUSH practitioners to practice modern medicine will dilute standards and expose the patients to ill prepared doctors, with grave consequences to the medical fraternity in the short term and the general public in the long term.
All these issues need to be addressed before the bill is made a reality as these will have far reaching effects on the healthcare delivery and standards of medical education in India for posterity. The government has rightly referred the bill to the Standing Committee for deliberation. It is the suggestion of the medical fraternity that the bill be discussed threadbare in state and national offices of IMA and suggestions sought from the medical fraternity before moving any further in this direction. The move of the government may be well intentioned, the diagnosis may be correct but the wrong surgery will kill the medical profession in India instead of improving it.
– Divya Narain Upadhyaya