SUBMISSION FOR DUE THOUGHTFUL CONSIDERATION
Subject:: National Medical Commission Bill
The provisions of the NMC Bill, as presented now, certainly contains noxious remedies to the ills and disabilities in the field of Medical Education and Health care in the Country.
The perceptions about corruption and ineptitude in the field of Medical Education and gross paucity of doctors to run rural healthcare necessitated the NMC Bill. Both these perceptions are valid, vital and needs to be addressed effectively and expeditiously.
The decay and degeneration in the field of medical Education in the Country , and the corruption and incompetence on the part of Medical Council of India as its Regulatory Body, is one major perception and premise on which NMC has been conceptualized as a remedial measure. The other one is the paucity of doctors in rural areas.The reluctance of MBBS doctors to do rural service, despite the best efforts by the Governments of different States also is a cause for concern. This, according to the Union Government, justifies a special cadre of doctors for rural service, drawn from Ayush doctors, equipped through a Bridge Course in Modern Medicine.
Both these perceptions and the need to evolve effective remedies to these two maladies in medical education and healthcare delivery respectively, are important and imperative, but the remedial measures conceived and formally incorporated in the NMC Bill 2017 are misdirected and can . even be highly detrimental to both the fields and people’s interest..Alternative effective remedies are possible in both the fields, as outlined below:.
1. Regulation of Medical Education
Admittedly, Medical Council of India, entrusted with the regulatory task in medical education has been' a Den of Corruption' ,as observed by the highest court, and is in dire need of revamping. However, replacing it with the NMC , with a composition, as given in the present draft bill ,is not likely to be effective to attain the objective of cleaning up and upgrading the regulatory system , in order to curtail the abysmal corruption and incompetence.
However, the assumption and argument of the Indian Medical Association that Medical Council of India has been a competent, representative and upright body, elected democratically by doctors in this country is far from true. Elections to MCI have almost always been fake and fraudulent . The ‘ eminent medical stalwarts' getting repeatedly elected from different States and Universities, through the blessings of political and bureaucratic godfathers , had made and maintained the corruption mafia that absolutely controlled the MCI, and caused the decay and degeneration of Medical Education through systematic loot, over the last three decades..
That situation needed a total change; but it is not achievable through the proposed NMC with twenty nominated non-medical members and just five elected medical teachers.. The Regulatory Body for setting and maintaining standards in Medical Education should have its majority members drawn from experienced medical teachers, elected from medical professionals through a fair, free and transparent election.. Administrators, representatives of students and eminent and thoughtful social leaders are certainly to be included in the body, possibly by thoughtful nomination.
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The decline of the MCI as a corrupt and incompetent body, has also been the result of the long continous term of office( often several decades) of the very same members,acheieved through repeated fake elections. The greedy and manipulative ones among them established, safeguarded and navigated through the channels of corruption, with impunity and continuity.. Therefore, one of the essential steps required is to limit the duration of membership of any individual to one term of three years, irrespective of his eminence and patronage.by political and bureucratic godfathers. This should apply to the elected and nominated members,
2. Rural Healthcare- Modern Medicine
The proposal to design and offer a bridge course in Modern Medicine, to enable Ayush doctors to serve ( and also practice in) Modern Medicine in rural areas can be detrimental and likely to be widely misused. Empowering practitioners of Modern Medicine through such a condensed course ,will in all probability, establish a substandard clinical service in Modern Medicine, praying on the gullible village people. In due course it will extend to, the marginalized urban segments also..( The experience of introduction of a cadre of Nurse Practitioners in USA to serve unreached remote areas in sixties and seventies offer a valid lesson in this regard. Many of them got comfortable employment in Corporate Hospitals, as it was cheaper for for the managements to employ them with lower wages, while the shortage of healthcare facilities in remote rural areas in USA continues.). A similar situation is likely to occur in our country also. It is possible that corporate hospitals in our metros and cities will be gald to employ the Ayush doctors, trained through the proposed Bridge Course, available at lower remuneration, to run their basic clinical services. for reasons of economy.(, as happened with cadre of Nurse Practitioners in USA )
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It is also unethical and hazardous to run clinical services in Modern Medicine for villagers, with sub-trained, therefore sub-standard doctors, as proposed in the NMC Bill.
It is necessary to evolve a safe and ethical scheme to find doctors for service in rural areas. Medical manpower for rural healthcare services can be acheived through more imaginative and bold steps in the field of Undergraduate Medical Education.. Forty percent of MBBS seats in open merit and the various reservation categories should be earmarked for students hailing from rural areas and who have completed their studies up to Plus 2 from rural schools. This reservation should be given, with a mandatory obligation to work in the rural areas for three years. This has to be implemented judiciously and effectively.( Of course, such a step needs genuine concern and commitment to the cause of healthcare of rural people and political will) This provision, along with a reasonable weight-age( not reservation/quota) for Post Graduate admissions ,would enable the Government(s) to harness fully trained MBBS doctors to steer rural primary healthcare services. Certainly, the perks and facilities for doctors, serving at rural areas need to be enhanced realistically..
Submitting these modifications in the proposed NMC Bill for due thoughtful consideration, in the best interest of medical education and safe quality healthcare for rural people in our country, before being brought back for legislative assent..
Prof(Dr) K.A.Kumar. M.D
Former Director of Medical Education, Kerala
T.C.13/598, Near Ulloor Bridge
Thiruvananthapuram-695004
Phone: 09447035533
