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

drkakumar@gmail.com

Phone: 09447035533