The National Medical Commission (NMC) Bill, 2019, which was scheduled in the Lok Sabha on Monday by health minister Harsh Vardhan, is been receiving criticism from several quarters of the medical fraternity.

Resident doctors had voiced strong criticism of the bill on Tuesday, while doctors associated with the Indian Medical Association (IMA) said that they would sensitize MPs about their apprehensions.

The NMC Bill, which will cancel the Indian Medical Council Act, 1956, was first tabled in December 2017 in the Lok Sabha, but was referred to the Standing Committee on Health and Family Welfare as many doctors, and few MPs, opposed its provisions. At the end of the 16th Lok Sabha’s term, the bill lapsed.

The MCI was dissolved in 2010 after a series of corruption charges against its then president Ketan Desai and other members. From then, the Union government has been appointing body of governors each year through ordinances to perform the functions of the council. After nearly a decade of instability, the current NMC Bill, if passed, will be the primary act regulating medical education and human resources in health in India.

The annual inspections of medical colleges might end under the new bill. Instead, the regulatory body can appoint a third party for evaluating if the medical college has the necessary resources to run. Under the existing system, the medical schools are annually inspected and they need permission from the MCI to increase the seats. Then, the MCI sends a team to inspect these colleges. This area of inspection was where the alleged corruption sneaked up in MCI. The inspection teams allegedly used to take commissions to give positive reports.

Dr Sumedh Sandanshiv, president of FORDA, an association of resident doctors, says that giving a free hand to hospitals will have a disturbing effect. He also explained how private medical colleges, under the current firmer rules, are stopping courses mid-term as they have no faculty after three years of admitting students. With slack rules, the medical colleges will be more irresponsible. He also says that even in Delhi, medical colleges do not have enough faculty and situation is worse in smaller cities. As there will be no checking, the quality of medical education will deteriorate.

Under the IMC Act, two-thirds of MCI’s members are elected and the NMC has a heavy control by the Union government. The Centre, through a search committee, will select the head and the members of national and state medical councils, which will be formed under the NMC.

India at present has 506 medical colleges, out of which, 279 are run privately, offering 53% of all MBBS seats in the country. The NMC proposes that the government can regulate fee in only up to 50% undergraduate seats in medical colleges. Thus, the government will have no control on the fee structure on more than 18,000 seats.

The biggest spiking point under the new Bill is the license to mid-level practitioners to practice modern medicine in primary and preventive care. Both the IMA and the FORDA have in the past opposed this move by the government which has also been proposed several times previously.

In 2010, a PIL was filed in the Supreme Court suggesting to introduce the bridge courses to train health practitioners, such as AYUSH doctors and Auxilary Nurse Midwives who live and serve in the rural areas, in primary care medicine. The PIL said that with basic training, these community health workers can prevent and cure illnesses in areas where qualified MBBS doctors are not present. Hence, making up for the acute shortage of doctors.

The SC instructed the health ministry and the then MCI to implement the course, but the programme could never take off. The NMC proposes a similar idea by providing licenses to community level workers, but the doctors are against it.

Also, to reorganize the system of examination, the NMC recommends one exam -- the final MBBS exam -- which can serve multiple purposes of an exit exam to give licenses to a doctor to practice medicine, an entrance exam for admission in post-graduate courses and a screening test for foreign medical graduates. The doctors allege that this rearrangement is as good as diluting the current inflexible checks and balances that a medical student goes through to practice.

In the existing exit exams, a student has a theory paper, after that has a practical exam where he examines patients and four examiners evaluate him or her and then has a viva. After clearing all of these exams the doctor gets a license to practice.

Under NMC, there is no clearness on what would be the nature of common exam, since the purpose of all exams which are clubbed are completely different. Furthermore, if the student does not clear the exam, what is the procedure for him to reappear, ask the doctors. Whereas the disapproval over the clauses in the NMC Bill 2019 continues, the Bill is expected to be scheduled in the Rajya Sabha.