The National Medical Commission Act 2019

The National Medical Commission (NMC) Act 2019 has been passed by both Houses of Parliament. The bill leads to the establishment of the National Medical Commission will replace the Medical Council of India (MCI), which faced many allegations and controversies recently. This new body expects to overhaul the system, which faces many issues like favouritism, corruption and other ethical issues.

Key provision of the Bill include:

  • On July 22, 2019 the National Medical Commission Bill, 2019 was introduced by the Ministry of Health and Family Welfare in Lok Sabha. The Bill intent to revoke the Indian Medical Council Act, 1956 and provide for a medical education system which ensures:
    • frequent assessment of medical institutions
    • adoption of the state of the art medical research by medical professionals
    • an effective grievance redressal system.
    • availability of high quality medical experts

  • Constitution of the National Medical Commission (NMC):
    The Bill establishes the National Medical Commission (NMC). Within 3 years of the passage of the Bill, state governments will constitute State Medical Councils at the state level. The NMC will include total 25 members, appointed by the union government. A Search Committee shall suggest names to the union government for the post of Chairperson, and the part time members. The Committee will include 7 members like the Cabinet Secretary and five experts designated by the union government.

  • Members of the National Medical Commission (NMC) :
    • The Director General, Indian Council of Medical Research (ICMR)
    • 5 part-time members to be selected by the registered medical practitioners from amongst themselves from union territories and states for a period of 2 years.
    • Presidents of the Under-Graduate and Post-Graduate Medical Education Boards
    • The Chairperson (must be a medical practitioner)
    • The Director General of Health Services

  • Functions of the National Medical Commission (NMC):
    • formulate policies for regulating medical professionals and medical institutions,
    • assessing the need of healthcare related infrastructures and human resources
    • ensuring compliance by the State Medical Councils (SMCs) of the regulations listed under the Bill,
    • framing instructions or guidelines for determination of fees for up to 50% of the seats in deemed universities and private medical institutions which are regulated under the Bill.

  • Medical Advisory Council (MAC):
    As per the bill, the union government will institute a Medical Advisory Council (MAC). The Council will be the main platform through which the union territories or states can reveal their concerns and views before the NMC. The Council will also guide the NMC on measures to maintain minimum standards of medical education.

  • Autonomous boards:
    The Bill establish autonomous boards under the supervision of the NMC. Each autonomous board will consist of a President and 4 members, nominated by the union government.
    These boards are:
    The Under-Graduate Medical Education Board (UGMEB) and the Post-Graduate Medical Education Board (PGMEB) These Boards will be accountable for creating guidelines, standards, curriculum, and granting recognition to medical qualifications at the undergraduate and post graduate levels respectively.
    The Medical Assessment and Rating Board (MARB) The Medical Assessment and Rating Board (MARB) will be authorized to levy monetary penalties on medical institutions which fail to keep the minimum standards as laid down by the UGMEB and PGMEB. The MARB will also permit to build a new medical college, starting any postgraduate course, or increasing the number of seats.
    The Ethics and Medical Registration Board This Board will keep a National Register of all licensed medical practitioners, and regulate professional conduct. Only those included in the Register will be permitted to practice medicine. The Board will also keep a separate National Register for community health providers.

  • Community health providers:
    Under the Bill, the National Medical Commission (NMC) may grant a limited license to some mid-level practitioners associated with the modern medical profession to practice medicine. These mid-level practitioners may prescribe certain medicines in preventive and primary healthcare. In any other cases, these practitioners may only prescribe medicines under the direction of a registered medical practitioner.

  • Entrance examinations:
    There will be a uniform National Eligibility-cum-Entrance Test (NEET) for admission to under-graduate (UG) and post-graduate (PG) super-specialty medical education in all medical colleges/institutions regulated under the Bill. The NMC will specify the method of conducting counseling for admission in all such medical institutions.

  • The Bill recommends a common final year undergraduate examination called the National Exit Test (NET) for the students graduating from medical institutions to get the license for practice. This test will also setup the basis for admission into post-graduate courses at medical institutions under this Bill.

Doctor Fraternity against this bill

  • Section 32 of the Bill empowers the government to permit non-medical degree holders to practice medicine as community health providers. This provision has been forcefully opposed by Indian Medical Association that says it will legalize quacks in the country.
  • NMC will have merely 20% elected representative than that of 70% elected representatives in MCI (medical council of India). So the government can appoint a person which may not belong to the medical line or profession. So this also becomes a controversial point because this promotes bureaucratic interference and favouritism.
  • National Exit Test (NEXT) has been contemplate as a single test, which will act as a common final-year undergraduate (UG) medical exam and be used for granting medical licence as well as admission to postgraduate (PG) courses. This provision has been opposed on the ground that a single exam will have too much weightage and its negative impact on the career of medical aspirants.
  • The new NMC bill permits the commission's ethics board to exercise jurisdiction over state medical council, while former Medical Council of India (MCI) has no control over state medical council and they were not binding by the MCI decision
  • Earlier the President of the Medical Council of India (MCI) can be removed only on Court's order, but in a new NMC bill, Indian Government has the authority to remove the chairman or any other members. So this gives power to an executive run institution on government will and jeopardize autonomy of the system.
  • The Bill allows the commission to “formulate guidelines for fixing of fees and all other charges in respect of 50% of seats in private medical institutions and deemed to be universities”. This enhance the number of seats for which private institutes will have the choice to determine fees. At present, in such institutes, the state government determines fees for 85 percent of the seats. So this will directly impact the people especially the poor because colleges/institutions will charge them heavily. So medical education becomes hostage to wealthy people and a competent and talented person will deprive to become a doctor.

Why government needs to replace Medical Council of India (MCI) with National Medical Commission (NMC)?

MCI had been facing many issues regarding its composition, allegations of corruption, lack of accountability and regulatory role. Seeing this, the government appointed the Yashpal Committee and the Committee gave its recommendation.
Recommendation are:
  • Seperation of the regulation of medical practice and medical education.
  • Domination of doctors in Medical Council of India (MCI) and less representation of other stakeholders like health economists, public health experts and social scientists
  • Allegation of corruption because as per Medical Council of India (MCI) guideline a college is required to be inspected twenty five (25) times to get final recognition. This establishes an Inspector Raj.
  • MCI was facing an allegation of conflict of interest because MCI is an elected body and its members are elected by medical practitioners themselves,

Advantages of National Medical Commission (NMC)-2019 Bill

  • The NMC is capable to link the disease burden and the specialties being produced. Till now MCI operating autonomously so this created vaccum which can be bridged by the establishment of NMC.
  • NEET and NEXT exam by NMC will bring regularity in the standard of skills and competence and this can mitigate the burden of taking multiple exams
  • NMC can encourage innovation and promote research by laying down rules that make research a essential in medical colleges.
  • NMC-bill will safe-guard the interest of the patients and checks the commercialisation of medical services because of grievance redressal body for any complaints relating to professional or moral misconduct against a registered medical practitioner

India has a doctor-population ratio of 1:1456 as compared to WHO standards of 1:1000. There is also a huge gap in the distribution of doctors working in the Rural and Urban areas with the rural to urban doctor density ratio being 1:3.8. India has suffered from the problem of inappropriately skilled and trained doctors of varying quality for a very long time. The Mudaliar Committee Report (1959) stated that doctors had neither the knowledge nor skills to tackle primary care and infectious diseases that were a high priority concern at the time. At present, the excessive reliance on a multiple diagnostic tests is reflection of weak knowledge and commercial considerations. While NMC can support in improving medical education and practice in India, the government must entirely focus on addressing much bigger issues like Antibiotic resistance, crunch in public expenditure in health, and so on.