The introduction of the National Medical Commission Bill in Parliament in just concluded session led to widespread protests by the medical professionals all over the country. As a result Government had to refer the Bill to Standing Committee of the Parliament for wider consultation.
The extent of protests shows that Medical Profession is deeply aggrieved. Doctors have a feeling that this Bill will make them subservient to bureaucrats and politicians. Like any other profession, medical profession has also been self-regulated so far. With this Bill Government proposes to bring external regulation of medical profession for the first time.
Historically self regulation is a hallmark of all professions. In the ancient times professions were organised into guilds, which had a code of ethics. They also had highly evolved mechanisms to regulate the professional behaviour of their members and could award punishment to erring professionals.
As opposed to this business, trade and industry has always been regulated by the State. Professions require prolonged training in complicated technical subjects which are not well understood by the lay public. Most professions also need high levels of skills in addition to knowledge and therefore there is generally a need to work as apprentice under a more experienced and qualified senior to achieve success in professions.
In addition professions by their very nature are considered noble and altruistic. The lay public and the State therefore realize that professions are best regulated from the inside. Professions have also generally responded by adhering to self evolved code of professional conduct which has a very high level of integrity.
Like other professions, medical profession also prides itself for its self-regulations. Obviously doctors are unhappy with the proposed bill because it is bringing external regulation of medical profession for the first time. The specific points raised by doctors against the bill include: -
1. The members of regulator in the proposed bill will be nominated by the Government and not elected by members of the profession.
2. The bill proposes to regulate the fees of only 40% seats in private medical colleges which will lead to increase in the cost of medical education.
3. The bill that Ayush practitioners may be allowed to prescribe certain allopathic medicines after passing a bridge course.
There are other important things in this bill which should be mentioned here. These include –
1. Medical graduates will have to pass National Licentiate Examination for registration in National Medical Registration.
2. NEET is being given statutory status.
3. The power to allow opening a new medical college or a new medical course which is currently with the Central Government is being delegated to the Board under the Commission.
The Statement of Objectives and Reasons of the proposed bill is explicit in stating that the reason that this bill is being brought is that the Indian Medical Council Act, 1956 has not kept pace with time and therefore the bill proposes appointment of regulators through selection rather than election. It is therefore quite clear that minor changes in the bill are not likely to satisfy doctors who are mainly opposed to the appointment of regulators by nomination. SOR to the bill mentions that various bottlenecks have crept into the system with serious detrimental effects on medical education and, by implication, on delivery of quality health services.
This may be true but if we wish to cure this problem it is necessary to understand the nature of these “bottlenecks” and the reasons of their “creeping into” the system. When I was a medical student, calling a doctor’s practice a business was considered the biggest slur on his character. The term medical industry had not even been coined.
In our country like in many others medical profession has been transformed into a business and an industry so that doctors no longer control the profession.
It is now almost wholly controlled by the corporate houses which own large hospitals and private medical colleges.
Increasing complaints of unnecessary surgeries and procedures and extortionist behaviour is therefore not surprising because corporate houses owning them have only one motive –Profit.
It is interesting that there is no provision in the proposed bill to regulate these big businesses and corporate houses.
If it is being implied that elected regulators may not be willing to take action against their members, then one also needs to consider that nomination is no guarantee of integrity and a regulator which is not independent but subservient to the Government is not likely to be very effective. Independence of the regulator is an accepted norm all over the world.
Most other professions are facing similar challenges of unprofessional behaviour by their members. Advocates are regulated by the Bar Council. Chartered accountants are regulated by the Institute of Chartered Accountants. Media is regulated by the Press Council. Government has never considered bringing external regulation for these professions. There is no reason for singling out medical profession for external regulation.
It is anybodies guess how medical education can be better regulated without adequate representation of academic faculty of Medical Universities and Medical Colleges in the regulator. In my view all stakeholders should sit together to find a method of bringing in better regulation by greater participation of the profession and greater transparency.
Regulation of big hospitals and corporate houses should be done by the State by bringing in laws for regulation of medical businesses and medical industry. However, regulation of medical education and medical profession is best left to the profession. A better and nuanced response is therefore necessary which requires consultation with all stakeholders.
The referral of the bill to the Standing Committee definitely offers this opportunity, which should not be wasted.
(The writer is a senior IAS officer in Chhattisgarh. He can be contacted on dr.alokshukla@gmail.com)