Healthcare experts and doctors The Sunday Guardian spoke to have, in general, welcomed the National Medical Commission (NMC) bill which seeks to overhaul medical education and disband the Medical Council of India (MCI). However, they have expressed reservations about the bill’s provision to allow AYUSH and homoeopathic doctors to practice modern medicine after qualifying a “bridge course”. Allowing private medical colleges to increase the undergraduate and postgraduate seats is another provision which is being contested by these experts.
The draft bill, which has now been referred to a Parliamentary Standing Committee, had caused a nationwide strike called by the Indian Medical Association (IMA) earlier this week. However, many healthcare experts maintain that the bill is futuristic, and is a sincere attempt to do away with corruption and shortage of doctors in the medical sector.
MCI needs to go
The review of MCI by the Standing Committee on Health and Family Welfare on 23 September 2015 established that the body had failed to maintain transparency in medical colleges’ inspections, create a curriculum that produces doctors to suit Indian context, and no substantial evaluation of teaching skills, among many others. Consequently, the idea to replace MCI with NMC was floated.
Dr Kush Lochawala, Medical Officer, Nirmal Hospital, Gujarat, alleged: “MCI is a body of no regulation. It is rooted in corruption—right from granting permission for new colleges, to conducting inspection in private medical colleges. If you assess the situation through numbers, the degree of corruption in the MCI runs in crores. The new bill will introduce greater transparency.”
While the Indian Medical Association (IMA) has dismissed the bill as undemocratic and anti-poor, doctors, health experts, and medical representatives told this newspaper the MCI needs to be scrapped, not just reformed.
Dinesh C. Sharma, Delhi-based journalist and Managing Editor at India Science Wire, told The Sunday Guardian: “MCI is kind of a trade union of allopathic doctors and mostly functions as a lobby group. The MCI certainly needs to be replaced and the proposed NMC Bill seems to be promising. Maybe, 10-20 years later, we might explore other alternatives, but for now, we must give NMC a chance.”
Sharma further noted that the presence of non-medical professionals on the board would bring multiple perspectives on the table.
“We have tried with self-regulation for decades where an elected body of doctors decided upon the standards of the medical ecosystem, but that has fully failed. There’s nothing wrong with the proposed mechanism. It’s a misnomer on doctors’ part to contest that only doctors can be on the regulatory boards. Countries like US and UK have a considerable amount of non-medical professionals on the board. In fact, doctors are fewer in number. Health is not a domain of the doctors alone,” Sharma asserted.
Reiterating Sharma’s observations, Prof Akshay Anand, editor-in-chief at Annals of Neurosciences and Integrative Medicine International, said: “Calling the bill undemocratic and anti-poor is misleading. The body will have proper representation of doctors, health economists, and non-medical professionals. This means it is totally democratic. Also, with the presence of health economists, there will be a cost audit of every patient and cross-checking of every referral. Moreover, increased competition in rural and under-served areas will regulate the amount people spend to avail medical help. So, contrary to their arguments, the bill is rather pro-poor.”
A Jaipur-based medical representative, who requested anonymity, told these correspondents that doctors are worried that the NMC Bill will eliminate the monopoly of allopathic doctors and will affect their nexus with big pharmaceutical companies.
“MCI is basically a body of corrupt doctors, for corrupt doctors and by corrupt doctors. Many of their members are owners of big private medical colleges. All they do is lobby to get away with sub-standard infrastructure, despite running on huge capitation fees. Also, presently these doctors enjoy a favourable nexus with big pharma companies and in exchange of favours—holiday package, cut-commissions, etc—they defy their obligation to serve the people in the best and cost-effective manner. NMC will change all this and this is what is irking them,” the medical representative alleged.
Last year in May, The Sunday Guardian’s report investigated the nexus between doctors and big drug companies, which helps them to rake in huge cash mutually. (‘Rational drug policy needed to curb doctor-pharma nexus’, 28 May, 2017)
Bone of contention
One of the proposed provisions of the bill is that it would allow ayurvedic and homoeopathic doctors to practice allopathy after they clear a six-month bridge course. While the clause has seen a greater part of the medical fraternity up in arms against the bill, healthcare experts have maintained that the bridge course could help mainstream informal health service providers (AYUSH doctors), and expand health force in the under-served areas of the country.
Prof Akshay Anand said: “A few doctors are spreading misinformation that anyone could practise medicine by doing a bridge course and put patients at risk. The RMPs (Registered Medical Practitioners) and AYUSH doctors will only be gearing up to serve the poor in areas where health services are abysmal and there is a severe shortage of doctors. When the situation calls for some immediate measures, we have to look for available resources and ways to use them to bridge the gap.”
Dr Kush Lochawala said that AYUSH doctors are already providing their services in all cities and villages, but they are doing it without any legal backing from the medical sector or the government.
“BHMS (Bachelor of Homeopathy and Surgery) and MBBS courses have almost similar syllabi, then why can’t they (AYUSH doctors) practise modern medicine after doing the required course in it? India has a severe shortage of allopathic doctors, particularly in rural areas. The course will help in bridging the shortage. Some institutions in Maharashtra and Rajasthan are already providing this type of a bridge course. The whole point is that AYUSH doctors are equally serving the people of the country, and they too need to have the rights and dignity they deserve,” Kochawala said.
Dr Samiran Nundy, former head of the Department of Gastrointestinal surgery at AIIMS, reiterated the sentiment and said over 60% of the people go to “untrained” doctors simply because they are accessible, friendly and cheap. He told this newspaper of a double blind study conducted in Kolkata, wherein training was given to the “untrained” doctors in two districts. At the end of the training, it was found that the “untrained” doctors who had completed the course were as competent as the other “trained doctors”.
“AYUSH doctors, contrary to popular perception, are not the worst doctors. They can be brought to mainstream modern medicine to meet the growing demand,” Nundy added.
Talking about ways to address the shortage of doctors in under-served areas of the country, experts also laid emphasis on the WHO-approved phenomenon of Task Shifting, whereby tasks are moved to less specialised health workers in order to enable the public health community and national governments to strengthen and expand the health workforce.
Experts have, however, stressed that the move should be treated with caution. A senior homoeopathic doctor told this newspaper that the provision will work as long as the government lays clear guidelines indicating the kind of treatment that a trained homeopathy doctor can provide.
“Trained AYUSH doctors should be asked to put up signboards to specify what field of medicine they are trained in. Without proper guidelines and precaution, this provision will remain flawed. Simply bringing unqualified practitioners into the mainstream without laying suitable guidelines would not be ethical,” the doctor added.
Fine-tuning needed
The doctors expressed their concern against allowing private medical colleges to increase undergraduate and postgraduate seats. Experts said that while India needs to increase the number of medical colleges, there needs to be a proper check mechanism to decide whether or not a college is qualified to run medical courses.
Dr Jayesh Sheth, founder and chairman at Foundation for Research in Genetics and Endocrinology, Institute of Human Genetics, said: “The NMC Bill is good and has my support, but I do not agree with the clause where it states that no permission would be required to add new seats. It is not justified to let any college increase their seats without proper assessment of their infrastructure, quality of the teachers and many other qualitative indicators that are essential to impart a high-value medical education.”
A senior homoeopathic doctor said: “The NMC Bill would help create a better system of checks and balances, with the four autonomous boards under the supervision of the NMC. That the government will get to determine the fee for up to 40% of the seats in private medical colleges will ensure that medical seats are not for the rich to take advantage of. But the bill does need some fine-tuning.”