A recent report by the Parliamentary Standing Committee (PSC) on Health and Family Planning has pulled no punches on the functioning of the Medical Council of India (MCI).

Strongly censuring the organisation, the PSC report tabled last month in Parliament advocates far-reaching changes in healthcare and medical education. And by doing so, it endorsed what health experts and activists have been prescribing for over two decades.

Time for a revamp Central to the PSC’s report is the need to revamp, reconfigure and reform the MCI which is mandated with the task of regulating medical education and practice so that it addresses the healthcare needs of the country.

It is the MCI’s responsibility to “ensure adherence to quality standards by medical colleges, produce competent doctors possessing requisite skills and values as required by our health system and regulate medical practice in accordance with the professional code of ethics,” the report says, indicating that the MCI has failed to deliver on each of these counts.

“Quality of medical education is at its lowest ebb; the current model of medical education is not producing the right type of health professionals because medical education and curricula are not integrated with the needs of our health system; many of the products coming out of medical colleges are ill-prepared to serve in poor resource settings like Primary Health Centres...instances of unethical practice continue to grow due to which respect for the profession has dwindled. But the MCI has not been able to spearhead any serious reforms in medical education to address these gaps.”

So, what ails medical education? A few pointers from the report:

Despite having 381 medical colleges and 9.29 lakh doctors enrolled on the Indian Medical Register, there is a shortage of doctors.

Corruption and vested interests in MCI have ensured uneven distribution of medical colleges in the country. Six states, representing 31 per cent of the national population, have 58 per cent of MBBS seats while eight states, with 46 per cent of population, have 21 per cent seats. Admissions in private medical colleges are not streamlined and capitation fees rule, making setting up of medical institutions a lucrative business.

Registration and approvals of colleges and courses by the MCI is ridden with corruption and graft. There is poor regulation of graduate and post-graduate education.

There is a shortage of quality teachers.

The current system has failed to produce doctors, including specialists who can serve the needs of the country. Most doctors gravitate to the cities and private hospitals. The PSC has recommended some remedies too, the most important being: reform MCI. That it lacks accountability, is widely considered to be corrupt and has failed to discharge its mandated responsibilities is no secret.

Remedy for MCI Since money power plays an important role in its elections, it should not be an elected body dominated by vested interest but should represent all stakeholders. Says the report: “The MCI, as presently elected, neither represents professional excellence nor its ethos. The current composition of the Council reflects that more than half of the members are either from 21 corporate hospitals or in private practice.”

The MBBS syllabus has remained unchanged for 14 years, but requires to be revised every four to five years to be in step with developments in the medical profession. Methods of teaching too need urgent revamp.

Doctor salaries need revision, especially if they serve in public healthcare and the rural sector. As for the proliferation of private hospitals, they need to be monitored to check unethical practices. Observes the report: “The oversight of professional conduct is the most important function of the MCI. However, the MCI has been completely passive on the ethics dimension which is evident from the fact that between 1963-2009, just 109 doctors have been blacklisted by the Ethics Committee of the MCI.”

Coming back to MCI’s need for reform, the PSC report notes: “Game changer reforms of a transformational nature” are needed. “There is total system failure due to which the medical education system is fast sliding downwards and quality has been hugely sidelined in the context of increasing commercialization of medical education and practice.

The situation has gone far beyond the point where incremental tweaking of the existing system or piecemeal approach can give the contemplated dividends,” the report notes.

Is the government listening?