12 Jan 2018 05:34am IST
If ever one needed an example of a cure being worse than the disease, one need not look beyond the government’s recent attempts to replace the MCI Act with the NMC. The MCI was established to oversee medical education, licensing, registration and ethics. It was derailed with the then president’s arrest and incarceration for accepting bribes for favorable inspection reports. MCI colleagues and IMA national leaders campaigned for his installation as President of the World Medical Association by certifying that he had been cleared of all charges. This reeked of chicanery because at that time, three cases were still pending. The hypocrisy extended this year to a newly instituted annual IMA oration by the outgoing national president entitled “Dr Ketan Desai Medical Statesman of the Highest Order Oration” taking duplicity to new heights without a word of protest from the fraternity.
A backlash was inevitable. The MCI was dissolved in 2010, and a governing board appointed. Meanwhile an expert committee led by the late Professor Ranjit Roy Chaudhury tabled its report in February 2015, followed by a Parliamentary Standing Committee (PSC) report in March 2016.
Both stated that the MCI had “failed on all its mandates over decades”; “was outdated” and “could not be remedied”. Its replacement, the “National Medical Commission (NMC) Bill” was drafted and presented for public comment in 2016. Prior PSC meetings spread over two years did not have any representation from the medical community; the NITI Aayog, which is neither a constitutional or statutory body but an executive one, was the sole arbitrator. Unfortunately when public comment was eventually invited, there was a muted response from the fraternity. At my instigation, the Goa Medical Council drafted and submitted its objections and circulated them hoping for a surge of opinion against the proposals. Only two doctors responded.
The Commission has an Advisory Council and four Boards; 1) An Undergraduate Medical Education Board. 2) A post-graduate Medical Education Board. 3) A Medical Assessment and Rating Board (MAR) and 4) A Board for Medical Registration to oversee professional conduct and ethics. It is to be packed with bureaucrats appointed by government appointed search-cum-selection committees. It is unbelievable that the NITI Aayog was unable to find any honorable people from a community of 9.5 lakh medical professionals in this country. The opinion of 80 MPs across party lines, with vested interests in private medical colleges carried more weight and was largely responsible for the second thoughts by a government concerned about upsetting MPs from its own party as well as allies. The sudden realisation that 3 MAR members could decide to impose a minimum penalty of half the fees collected for an entire batch in the event of any deficiencies, must have rattled the “investors”. For an average batch this can range from Rs 7.5 cr to 10 times that sum, hardly compensating for fees from 60% of students controlled by the colleges.
The background statement declares that “nowhere in the world is there an educational process oversight done by an elected body”. I could add that neither is there any such body which does not have any representation from the medical community, elected or nominated, to make decisions that intimately involve the profession. The General Medical Council, UK for example has a 50% representation from the medical fraternity. The main argument forwarded is that the MCI is corrupt. The corruption will merely be transferred to the non-medical appointees chasing the same goose laying those golden eggs.
The fraternity has not exactly covered itself in glory. The IMA quite rightly expressed grave concern at the possibility of a six month bridge course that would enable practitioners of the Indian systems of medicine to practice as allopaths. The allopaths themselves created the concept by employing Ayurveds in key positions even in ICUs in their hospitals (including major corporate hospitals). What’s good for the goose is also good for the gander.
The justification for this proposal is the neglect of PHCs by the allopaths, going against the government’s own stated agenda to develop the Indian systems of medicine as an alternative to modern medicine. The National President of the Indian Institute of Homeopathic Physicians has expressed grave misgivings over this provision stating it would be equally disastrous for Allopathy as well as Homeopathy. The move obviously serves the governments interests to paper over its neglect of primary healthcare for the last 70 years and foist a legion of half-baked professionals on an unsuspecting public endangering their lives even further. Bear in mind that currently, only 58% “doctors” in urban areas and 18% in rural areas have any medical degree. 31.4% of “allopaths” are educated only up to secondary school level. Six months training cannot possibly replace the 5 ½ years it takes to produce an M.B.B.S doctor and legalising this rot is not an option.
Undoubtedly there are problems that need rectification. The entrance examination was introduced with the best of intentions. Yet private colleges abuse the system by blocking seats supposedly for candidates with high scores and at the last moment declaring them vacant and available to the highest bidder. A common exit examination has been proposed; yet foreign medical graduates are free to enter the country and practise at will. These are often graduates from dubious colleges from Eastern Europe and elsewhere. The NMC solution: do away with inspections totally! Likewise the number of seats including PG seats are up to the discretion of the colleges without supervision or regulation. We owe it to our future generations to remove such deficiencies and restore sanity.
(The writer is a founder member of the Voluntary Health Association of Goa)