NMC: When politics turn medical profession a child's play

This Saturday, the NDA government introduced National Medical Commission Bill-2017 in the Lok Sabha and very soon, it would be passed and formally get notified in Gazette.

I was wondering as to how come no efforts were made by the government to tame the legal profession by way of a similar Bill to replace Bar Council of India, which is more or less a replica of Medical Council of India with regard to its functions and responsibilities performed for their members.

I could list out two important reasons: 

(If you are looking for tips to wriggle out of this mess, I would recommend either you change your profession or better read one of these books on positive thinking)

The first is the docile nature of the doctors: quiet, submissive, affable and showing no aggression when required. Too much of academic education does no good in facing worldly realities of politics.

I have rarely seen a doctor lose his/her cool at government authorities as 'Chalta Hai' attitude is rampant in this profession. Sometimes, it's better to look over your medical books and lose your cool. 

The second reason is the absence of a troubleshooting leader in the Indian Medical Association. Someone, whose call to action can bring everything to a halt. Sadly, the professional body of doctors is no better at overcoming their gross ineffectiveness in getting a fair deal from the government.

If you ask a child to come out with solutions for the controversial provisions of the NMC Bill, his/her answer would be to call Doraemon - the robotic cat from space - for help. 

Controversial provisions

a)    The NMC Bill allows a maximum of 25 members, but out of which only 5 members will be elected, according section 4 of the Bill. It translates into only 10% elected members in the commission and the rest will be government nominated. 

This is in contrast to present Medical council of India, which has 75% elected members and 25% nominated members.

b)   Similarly, Medical advisory council shall consist of about 60 members and all of them will have nominated members, according section 11 of the Bill. This translates into 100% nominated posts.

c)    The composition of 4 autonomous boards to be known as the UGME Board, PGME Board, MAR(Medical Assessment and Rating) Board and EMR(Ethics and Medical Registration) Board too will have all nominated members. Each board consists of 3 members only and all these members will be nominated by Central Government, according to section 16 of the Bill. Again zero representation to elected representatives.

d) For determination of fee in respect of such proportion of seats not exceeding 40% in the private medical institutions, the nominated commission will have rights. This means the rest of 60% seats in private medical colleges would be open to private managements to have their own fee structure, as per section 10(1)(i) of the Bill.

In Telangana and Andhra Pradesh states, fee structures for both management and NRI seats too are regulated. This will be done away with now?

e) Many state politicians start medical colleges by proxy and to ensure they benefit from NMC Bill, it is ensured that as per section 26(1)(b) of the Bill, all permissions to start medical college/PG/superspeciality courses or increase in seats in MBBS/PG/superspecility courses will be granted by the nominated MAR board members directly.

f) It seems prescribing tests for their patients too often will turn full circle as doctors too would get a taste of their own medicine. 

Without qualifying licenciate examination no person will be enrolled in the National register and would be entitled to practise and do further post graduate courses. Under section 15, provision is made for introduction of licenciate examination mandatory after acquiring MBBS qualification. 

It is being argued by National IMA leaders that the licenciate exam will adversely affect medicos from SC/ST/BC communities. By default, they would be in their middle age by the time they settle down in life.

g) The EMR Board will maintain a separate National Register including the names of licensed AYUSH Practitioners - ie those who qualify the bridge course to enable them to practice allopathy. 

In short, the EMR Board will allow crosspathy, albeit legally according to section 55 (2) of the Bill.

h) Under 44(1)(2) of the Bill, Central Govt. would be entitled to give directions to the commission and all the NMC's autonomous boards on the questions of policy which would be binding for them to follow. This clearly means there is no autonomy at all.

Similarly, as per section 10(1)(f) of the Bill, State Medical Councils also have to comply all such directions/policy of the National Medical Commission.