Why doctors are against NMC?

• The opposition to the Bill is centred around three major factors-
• Section 32 of the Bill empowers the commission to “grant limited licence to practise medicine at mid-level as Community Health Provider”.
• Critics argue that the term ‘Community Health Provider’ has been vaguely defined, and this will allow people without sufficient medical background to practise medicine.
• The second bone of contention is the National Exit Test (NEXT) proposed by the Bill. Currently, admissions to postgraduate medical courses are done through NEET-PG (National Eligibility cum Entrance Test for Postgraduate).
• However, NEXT has been conceptualised as a single test, which will act as a common final-year undergraduate medical exam and be used for granting medical licence as well as admission to postgraduate courses.
• Medical practitioners are currently required to register with a state medical council to practise, but they are not required to give any test to obtain a licence.
• It has also been argued that a single exam is being accorded too much weightage, and it can have an adverse impact on the career of medical aspirants.
• Thirdly, the Bill allows the commission to “frame guidelines for determination of fees and all other charges in respect of fifty per cent of seats in private medical institutions and deemed to be universities”.
• This increases the number of seats for which private institutes will have the discretion to determine fees. At present, in such institutes, state governments decide fees for 85 per cent of the seats.
• There have also been suggestions to put a cap on the fees charged by unaided medical institutes.

• NExT is likely to begin 2024 onwards. The National Exit Test is a proposed examination for granting license and registration for practising medicine in India, similar to the USMLE (United States Medical Licensing Examination) for those wishing to practice in the US.
• At present, students who complete their MBBS and pass the final exam of their university are eligible to get their license without any such licentiate test.
• The exam will act as a country-wide standardised test for passing MBBS, for granting of license, as well as a qualification test for post-graduation courses instead of the current NEET-PG that students have to sit for after they have completed their MBBS and one-year internship.
• Another feature of the exam is that it will not only be a theory paper, much like MBBS finals or NEET PG test. It will be held in two parts – one written and one practical exam where the students will be judged on their clinical acumen.
• Students will have to appear for the first NExT test after completion of MBBS and the second one after completion of the internship.
• Although NExT was to start from the current year, students who were to appear have already given their MBBS finals and completed their internships, and those who could appear for next year’s exam have also given their MBBS exam.

• Some of the provisions of the Bill, however, may prove to be helpful in fighting corruption, which had affected MCI.
• Unlike MCI, the members of NMC will have to declare their assets at the time of assuming office and when they leave. They will also have to submit a conflict of interest declaration.
• The members will have to serve a two-year cooling-off period after their tenure, which, however, could be waived by the government if required.
• Also, the World Health Organization prescribes a doctor to patient ratio of 1:1,000, but as reports indicate, India is far from achieving that target. Allowing ‘Community Health Providers’ to practise medicine is likely to plug this shortfall to some extent.

• The Bill aims to repeal the existing Indian Medical Council Act, 1956, and replace the Medical Council of India (MCI) with a new body — National Medical Commission.
• The Bill aims to set up a National Medical Commission with 25 members. These members will be appointed by the central government on the recommendation of a committee.
• The members will include a chairperson, who must be a senior medical practitioner and academic with at least 20 years of experience, 10 ex officio members and 14 part-time members.
• The ex officio members will include the presidents of the undergraduate and postgraduate medical education boards, the director general of Indian Council of Medical Research, and a director of one of the AIIMS, among others.
• Part-time members, on the other hand, will include experts from the field of management, law, medical ethics, etc. and nominees of states and union territories.
• Compared to the present 70 per cent figure of elected representatives in the Medical Council of India (MCI), only 20 per cent members of the NMC will be elected representatives.
• Unlike MCI, whose decisions were not binding on state medical councils, the NMC Bill allows the commission’s ethics board to exercise jurisdiction over state medical councils on compliance related to ethical issues.
• Also, while action can be taken against the MCI president only on the direction of a court, the NMC Bill enables the central government to remove the chairperson or any other member of the commission.

Who will provide unique ID to all students as per draft guidelines?

• At present, a national medical register of all doctors does exist, which is created by collating data from all states. However, the draft regulation seeks to create a dynamic and regularly updated register.
• As per the draft regulations, the NMC will issue a unique ID to all students who pass the NEET and get admission to recognised medical colleges.
• The portal will then be thrown open to colleges and institutes to update their student data and put up all verified degrees and certificates.
• The same ID will be updated when the student does a post-graduation, a super-speciality course, or any other recognised training programme.
• The draft guidelines also put an onus on the doctors to keep updating their registration with details of additional qualifications, change in employment, contact details, or place of work “as soon as the change occurs”. At present, the registration maintained by states is updated only when doctors re-register themselves every five years.
• Currently, all states maintain individual registers and follow different norms for deleting names.
• Take Delhi, for example, which is a hub for medical students. It does not delete the names of graduates who move to other states before the completion of the five-year duration; they simply give an NOC for registration in the other state. This essentially results in duplication of data.
• “Many students apply for registration after completing their MBBS in Delhi and then go on to do their internship in other states where they get registered.
• However, we just issue an NOC but d not delete their names from the Delhi register because many of these students come back to Delhi for higher studies or practice. The name is only deleted when they do not re-register themselves after five years,” said an official from Delhi Medical Council.
• The five year lag in updating the medical register also means that many doctors who have retired or died continue to be on the register for years. For this reason, when the government has to take stock of the number of doctors in the country, they assume only 80 per cent of those registered are active.
• With a consolidated national register and unique ID, there will be no duplication of data.
• The data is also likely to be updated more frequently, resulting in a comprehensive database of doctors in India, including details on all their education and training in one place.
• This database can then be shared with state governments or other health programmes, which are looking to hire doctors.

How will foreign medical graduates be registered?

• Foreign medical graduates, on the other hand, have to complete their MBBS-equivalent degree from a medical institute “recognised and listed by the NMC” in other countries, be registerable as a medical practitioner in the said country, complete a 12-month internship in India, and pass the same NExT exam.
• At present, the NMC does not have a list of recognised foreign medical institutes.
• It does, however, have a set of minimum requirements, such as a 54-month long course or medium of teaching being English, which if an institute follows, their degrees are recognised in India.
• Secondly, the students are supposed to complete a year-long internship in the country of their study and come back and do another year-long internship. The new guidelines do not specify this.
• Thirdly, unlike Indian Medical Graduates who get registration after they complete their MBBS, foreign medical graduates have to clear a screening test before they do.
• The draft also makes provisions for short duration registrations for doctors from other countries to study in India, do fellowships, do clinical research, and voluntary community work.
• They also have a provision for registering foreign medical experts for practicing medicine (such as live surgeries) at a workshop or seminar in India.
• The temporary registration can be for a maximum period of 12 months, with the registration expiring either at the end of the programme for which it was granted, or the date on which a valid visa expires.