Various Issues Around Medical Council of India

In first week of April 2016, a Parliamentary Standing Committee had come up with its 92nd report on “Functioning of the Medical Council of India”. In this backgrounder, we look into various issues of functioning of the MCI.

About Medical Council of India

MCI is a statutory body established in 1934 in British India via the Indian Medical Council Act, 1933 on the lines of General Medical Council (GMC) of UK with twin mandate to regulate medical practice and medical education in the country. To upkeep with the changed environment, this act was repealed in 1956 and was replaced with a new act. The new act also broadened the mandate of MCI and established it as an apex body with responsibility of establishing and maintaining high standards of medical education and recognition of medical qualifications in India. This act was further modified in 1964, 1993 and 2001. Thus, today, the various functions of MCI can be broadly kept in two categories viz. medical education and ethics. These are as follows:

• MCI maintains uniform standards of UG as well as PG medical Courses in India.
• It recognizes / derecognizes medical degrees of India / foreign countries for India; and maintains register of doctors in the country.
• Reciprocity with foreign countries in the matter of mutual recognition of medical qualifications.
• Upholding the ethics in medical education and profession in India.

What went wrong with MCI?

For last few decades, MCI has been subject to severe criticism. In 2010, its president Ketan Desai {who was also President Elect of World Medical Association then} was arrested on charges of accepting huge bribe for recognizing one of the private medical colleges. He was later released and reinstated. Apart from the corruption, the following are some of the major issues {also highlighted in the Parliamentary Committee Report} regarding functioning of the MCI.

• It has failed to create a curriculum that produces doctors suitable for Indian context, especially in rural / poor urban areas.
• It has failed to maintain uniform standards of medical education.
• There has been devaluation of merit in admission, particularly in the private medical colleges, due to prevalence of capitation fees in these colleges.
• There has been excessive focus on the infrastructure and human staff but without substantial evaluation of quality of teaching, training and imparting skills in medical institutions.
• MCI has failed to raise the abysmally low doctor-population ratio.
• It has failed to rationalize the setting up of Medical Colleges in the country as per regional needs and this has led to geographical misdistribution of the  medical education resulting in concentration of institutes in some states while absence in others.
• In words of parliamentary committee, MCI had failed to “produce a competent basic doctor.“
• MCI has put excessive focus on medical educationat the cost of another mandate of upholding the ethical practice. Thus, the commmittee recommended that MCI should be split in two parts – one dealing with education while other dealing with ethics.

Recommendations of the Parliamentary Standing Committee

The following are the important recommendations of the panel, if implemented are likely to have far reaching consequences for the health sector:

• It has suggested to replace the existing architecture of the MCI with four independent boards dealing with:
  • Curriculum development, teacher training, and standard setting for undergraduate and post-graduate education,
  • Accreditation and assessment processes of colleges and courses for ensuring uniformity in standards,
  • Registration of doctors and licensing, and
  • Overseeing adherence to ethical standards.
• It has favored a new architecture which is in tune with the current needs and aspirations of the country.
• It favors replacing the principle of election with nomination.

Expected outcomes of the proposed reforms

The proposed reforms are likely to plan the required human resources essential for primary care by promoting family medicine and general physicians along with specialists. It will also make medical education affordable by rationalizing the standards. It would pave way for the uniform national entry and exit examination. However, this recommendation was overruled by the Supreme Court and has been pending appeal.

Main shortcomings of the report

The report is silent on policy of corporatizing public assets in the name of establishing medical colleges to provide quality care. The Ministry of Health and Family Welfare has recently sanctioned funds to upgrade 58 district hospitals to medical colleges. The idea behind such upgradation of district hospitals to medical colleges was proposed to cut down on the costs of establishing a separate 300-bed hospital for a new college as well as utilizing the available specialists for teaching.  It is argued that it will pave way for the rural population to access the specialist services at an affordable cost. For instance, Bhuj district hospital was leased to the Adani Group for 99-years and in 2015 the 300-bed Chittoor district hospital in Andhra Pradesh was leased to Apollo Group for five years for establishing a medical college. In the past, the experience of handing over district hospitals to private entrepreneurs had invited controversies on the ground that poor will be denied access to free health care. Though the committee has strongly condemned commercialization of the health sector it has not come up with any clear directions on this subject.

It has not recommended a rigorous assessment of all the 400-plus existing medical colleges by a high level committee. Such measures are needed to usher in the credibility to the system and prohibit the production of poorly trained doctors. This type of exercise was carried out in the U.S. in 1910 which found that only 16 out of 155 medical schools were functioning as per the expected norms.

Lastly, the committee has given the power of deciding the fee structure to the Health Ministry. It would have been prudent if that power of evolving and regulating fee structure is awarded to the new system within its mandate.

Way forward

The parliamentary committee has fairly done its job by indicting the MCI. Now it is time for the government to take action on the report. The MCI may be set aside with immediate effect. Instead a team of eminent people needs to be appointed as a transition team to work out the new architecture. The help of the Law Commission may be sought to draft a new law to safeguard the interests of the new body and prevent it from becoming overly centralized.

Elitism should not be allowed to rule over the medical education. As in U.K. and many other European countries, medical education should fall under the purview of the government.

National Commission for Human Resources for Health

The National Commission for Human Resources for Health Bill, 2011 was introduced in the Rajya Sabha on December 22, 2011. The bill seeks to establish the following with a mandate to prescribe minimum standards for health education:

• National Commission for Human Resources for Health (NCHRH),
• National Board for Health Education (NBHE), and
• National Evaluation and Assessment Council (NEAC).

The Bill seeks to repeal the following acts:

• Indian Nursing Council Act, 1947.
• Pharmacy Act, 1948.
• Dentists Act, 1948.
• Indian Medical Council Act, 1956.

NCHRH is proposed to be established under the Ministry of Health & Family Welfare as an overarching regulatory body for medical education and allied health sciences. The main objective is to reform the current regulatory framework and enhance the supply of skilled manpower in the health sector. The proposed NCHRH would subsume:

• Medical Council of India,
• Dental Council of India,
• Nursing Council of India and
• Pharmacy Council of India.

The NCHRH shall have the following functions:

• Determine and maintain the minimum standard of human resources in health education by adopting the following measures:
  • Conducting studies to assess the needs of human resources in states,
  • Conducting elections in national councils
  • Providing necessary grants to the NBHE, NEAC and councils
  • Regulating the entry of foreign institutions in consultation with NBHE.

The NBHE is proposed to facilitate academic studies and research in emerging areas of health education and shall conduct a screening test for medical practitioners to enroll in a professional council.

The Bill proposes to constitute the National Commission for Human Resources for Health Fund to meet the expenses of the various bodies.

The Bill also proposes to impose penalties for various offences such as running institution without permission, practicing without enroling, and enroling without a screening test.