NMC Bill puts spotlight on medical education, shortage of doctors

It is disconcerting when doctors need to protest to draw attention to issues affecting their community. But as the National Medical Commission (NMC) Bill gets discussed in Parliament, the silver lining is that concern over medical education and doctor shortages are getting catapulted onto centre-stage.

On Tuesday, the NMC Bill was referred to a Parliamentary standing committee, even as doctors across the country protested against the Bill.

The Bill is “non-democratic” as it seeks to replace an elected body (Medical Council of India, MCI) with one where representatives are “nominated”, says the Indian Medical Association (IMA). It also proposes to allow practitioners of traditional medicine to prescribe allopathic drugs, it added.

The changes are being proposed in a “non-transparent” manner, Dr KK Aggarwal, IMA’s immediate Past President, told BusinessLine . “We had our first stakeholder meeting with the Health Ministry just yesterday,” he said, of a Bill that has been in the works for over a year.

Though the MCI has seen its share of controversy in the past, the IMA may not be entirely off the mark in calling for the NMC to be more democratic and representative of needs from across the country.

Public health workers feel that the cost of medical education may increase if the government has limited control on the fees that colleges can charge medical students, among other things. While these may be valid concerns, the protest against the “back door” entry of traditional medicine practitioners into allopathy has triggered shrill arguments. There is a need for a reasoned and scientific discussion on the Bill, say experts, cautioning against turf wars.

In 2014, when Maharashtra took a similar approach to allow traditional practitioners to prescribe allopathic medicines, a chemist operating in rural areas of the State explained the rationale to BusinessLine . Allopathic doctors are not available in remote areas, he said. And if the chemist did not honour a simple, non-critical prescription from a homeopath or an ayurved, the shop ran the risk of being attacked by restive families of patients.

However, last month, the Bombay High Court stayed the Maharashtra government’s circular allowing homeopaths to practice allopathy. But the ground reality of shortage of allopathic doctors, nurses and para-medical staff remains. And it needs redressal at the medical education stage. Aggarwal suggests that district hospitals be converted into teaching ones to address the shortage of doctors in rural areas.

On the other side, trained homeopaths and traditional practitioners also are unhappy with the Bill that proposes a “bridge course” for their community to practice allopathy. This is like “lighting a fire in our own homes”, said a homeopath unwilling to be named. Instead of popularising traditional medicines, this move encourages traditional practitioners to gravitate towards allopathy, he said.

A regulatory expert and seasoned hand in traditional medicine Dr DB Anantha Narayana says the NMC Bill is the right step towards integrated medicine, though it needs fine-tuning. As more countries look to traditional practices, India, with its natural advantage, should frame rules to ensure that benefits of both sides of medicine are not lost or misused.

Clear guidelines are required indicating the circumstances and diseases where traditional practitioners can prescribe allopathic medicines, he says. In fact, they can even be told to clearly display signboards indicating that they are trained homeopaths with permission to dispense a limited range of allopathic medicines.

Dr Aggarwal though points out that integration should be evidence-based and done at the education level and not after doctors have completed their education and started practising. Clearly, many anomalies still need to be ironed out in the NMC Bill, and it needs to be done keeping in mind patients’ interests.

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