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Will this booster shot for medical education work?

Karan Thakur | Updated on March 10, 2018

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Newly proposed NMC seeks to clean up processes so as to bring out a good doctor

The proposed National Medical Commission (NMC) Bill 2016 intends to create a new overarching body to oversee and regulate medical teaching institutions, medical education and doctors. And in doing so, the much-derided Medical Council of India (MCI) will be disbanded, as the new body comes into place with four distinct functions.

The conduct and reputation of the MCI has been a sordid saga befitting a Greek tragedy, with allegations of corruption, nepotism, court cases and failed attempts to regulate medical education. Few will be sad to see it go.

The NMC, in contrast, comes with good credentials that combine recommendations from the late Prof Roy Chaudhury expert committee and a Parliamentary Standing Committee report on health, besides the Health Ministry’s own experts. So a wide consultative approach has been taken before the much-needed overhaul of medical education in India.

The effort has been to make the otherwise monolithic Commission more focused and nimble by dividing its responsibilities through four standalone bodies. And through them the NMC would oversee undergraduate and postgraduate medical education, certification and accreditation of medical colleges; registration of all medical professionals and professional ethics and conduct of doctors.

The overall architecture, if implemented well, will have adequate checks and balances to prevent the previous near monopoly enjoyed by the MCI’s governing council. Again, the previously elected President will be replaced by a nominated one, taking away the allegation of the “regulated deciding the regulator”. Naysayers argue that the move will usher in Government “stooges” in place of elected representatives. But the reasonably good experience with nominated regulators like TRAI (Telecom Regulatory Authority of India) and the IRDA (Insurance Regulatory and Development Authority), for example, should allay such fears.

The Bill also permits private companies registered under the Companies Act 2013 to be allowed to set up medical colleges. Public health experts have criticized this, with one expert even calling it “disastrous”. The criticism stems from the fear of commercialization of medical education and the need for Government to take a bigger role in medical education. This criticism, while not entirely unfounded, seems to miss the wood for the trees. According to the Union Health Ministry data, India has 493 medical colleges, 212 of which are publically run while 227 operate privately. The country produces 59,883 MBBS graduates and 26,390 postgraduates – a majority of them from the private sector. The vast majority of the 4474 DNB postgraduates produced annually are from the private run institutions. Therefore, the addition of private companies will not alter an already existing reality on ground.

The earlier effort to avoid commercialization of medical education meant that only registered societies or trusts could set up colleges. And yet, today we face a predicament of corruption, shortages and so on. The benefit in private companies getting involved is that the Companies Act will usher in more transparency into their running of colleges. With multiple stakeholders, and mandatory declarations, the opaque and arbitrary manner by which Trusts have operated will be reduced. And with a tuition fee cap on about 40 percent of all seats in any private medical college, the Government will be able to control cartelization or arbitrary fees.

The Government will also control entry into a medical college through the National Entrance and Evaluation Test (NEET). And with exit licensing tests and mandatory ratings of all medical colleges, college administrations will be forced to ensure quality of teaching and infrastructure.

The Government has put in adequate safeguards to encourage and regulate private medical colleges. But to put India’s medical education system in the top league and bring out a good doctor, it will have to ensure the implementation of its reforms.

(The writer is a doctor and healthcare administrator with the private sector, with a special interest in policy and reforms. Views expressed are personal.)

Published on September 02, 2016

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