Over centralisation: The over centralisation of the NMC and the near control over it by the central government, ranging from appointing all the 77 members for the various bodies; being the appellate for a variety of routine technical matters rejected by the autonomous bodies and the whole NMC such as, granting permission to set up colleges; granting exemptions to criteria; approving courses; setting aside any punishment against a doctor found negligent; allowing doctors trained abroad to do surgery and practice without having to go through any screening or taking the licentiate examination; recognising degrees and qualifications; and finally having powers to issue directions to state governments and the NMC to comply with any orders it seeks to issue, not to speak of setting the Commission itself aside.

Such wide-ranging powers that will be exercised by the central ministry robs not just the federal nature of the law and reduce the NMC to an advisory role. In fact, the whole nine-year battle for revamping the MCI was mainly centred around the growing politicisation of medical education with the powers introduced in the Act in 1992 that made it mandatory for MCI to take prior approval for starting a college, a course and student strength. This is one grouse that those opposing the Bill have.

Cross pathy: In view of the shortage of qualified doctors, the urgency to address the primary health needs of the communities and public health that are now largely being provided by unqualified quacks, the government has, since 2010, been requesting the MCI to institute new cadres of public health personnel along the lines of the LMP’s (Licentiate in Medical Practice) during the British days that worked very well.

Instead of mandating the board related to undergraduate education and the NMC to consider such options, keeping in view the current realities prevailing in the country, the Act has introduced a system under which the Commission and the heads of the councils of Ayush can, by a simple voice vote of those present, design bridge courses legalising Ayush practitioners to prescribe allopathy medicines. At all levels – primary level to post graduate. Such cross pathy then endangers the credibility of all the systems of medicine and has been severely opposed.

NEET: One bold reform pertains to the National Eligibility Entrance Test (NEET), about which much has already been said, and the National Licentiate Examination that all students have to take for getting the license to practice and also pursue postgraduate education. This is a laudable idea as it will enable standardising the competence levels of the “Indian Doctor”. Currently, the variance between the training and competencies in different colleges and regions is astoundingly wide. So such a reform was sorely required. Yet, there is apprehension that in the absence of standardisation of the quality of instruction in the country, it may widen disparities and become inequitable.

With a sizeable number of medical colleges with fake faculty or hopeless infrastructure, the quality of teaching is highly varied resulting in hurting students from backward states, poorer families and rural areas. But of greater importance is the fate of the students who study in accredited colleges, pass approved courses and examination systems and are found fit to practice by the university, but fail in the multiple choice question (MCQ) examination. What happens to them if they cannot afford private tuition to prepare for the licentiate examination?

Fees: Assuming that an investment of Rs 400 crores is required to set up a medical college and with a view to attract investment, the Bill permits 60% of seats to be open for managements with unfettered freedom to charge any quantum of fees in order to recoup the investment. This logic is highly debatable. It is apprehended that this will increase rent seeking, corruption and reserve medical education only for the rich and well off.