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The MCI has been in the news for the wrong reasons as the Parliamentary Standing Committee on Health in its 92nd report came down heavily on various aspects of the functioning of MCI. British medical Journal also had suggested radical revamp of the MCI. This articles focuses on the medical education governance in India.

source

Let’s understand the issues under the following heads:

  • Context
  • Background
  • Weaknesses Highlighted by Parliamentary panel
  • What are the major reforms needed in MCI?
  • Measures needed to overhaul and revamp MCI
  • Mandate of Lodha committee
  • Way forward

Context:

  • MCI has been criticised for being a ‘biased’ organisation, acting ‘against larger public health goals’ and an ‘exclusive club’ of medical doctors from corporate hospitals and private practice. The British Medical Journal (BMJ) and the Parliamentary Standing Committee in their recent report have called for a ‘radical prescription’ to reform the Medical Council of India (MCI) in order to eliminate corruption and lack of ethics in healthcare.
  • SC appointed a three-member committee headed by former Chief Justice of India R M Lodha to oversee MCI.

Background

  • The MCI was established under the Indian Medical Council Act 1933 and given responsibility for maintaining standards of medical education, providing ethical oversight, maintaining the medical register, and, through amendments in 1993, sanctioning medical colleges has failed to deliver quality and integrity in the health services across India.
  • The Medical Council of India (MCI) is a statutory body entrusted with the responsibility of establishing and maintaining high standards of medical education in India.

Weaknesses Highlighted by Parliamentary panel

In its scathing report, the standing committee felt that the MCI has repeatedly failed on all its mandates over the years. The committee noted the following as some of the prominent failures of MCI.

  • Failure to create a curriculum that produces doctors suited to working in Indian context especially in the rural health services and poor urban areas. The committee felt that this has created disconnect between medical education system and health system.
  • Failure to maintain uniform standards of medical education, both at the undergraduate and post-graduate levels.
  • Devaluation of merit in admission, particularly in private medical institutions due to prevalence of capitation fees, which make medical education available only to the rich and not necessarily to the most deserving.
  • Non-involvement of the MCI in any standardized summative evaluation of the medical graduates and post-graduates.
  • Failure to put in place a robust quality assurance mechanism.
  • Very little oversight of PG medical education leading to huge variation in standards.
  • Failure to create a transparent system of medical college inspections and grant of recognition or de-recognition.
  • Failure to oversee and guide the Continuing Medical Education in the country, leaving this important task in the hands of the commercial private industry.
  • Failure to instill respect for a professional code of ethics in the medical professionals and take disciplinary action against doctors found violating the code of Ethics.

What are the major reforms needed in MCI?

  1. There is a need to restructure the MCI. It should not be an elected body dominated by vested interest but should represent all stakeholders through nomination. The MCI, as presently elected, neither represents professional excellence nor its ethos. The current composition of the Council reflects that more than half of the members are either from 21 corporate hospitals or in private practice.
  2. The MCI currently sets standards for recognition, inspects and licenses medical colleges; overseas Registration and Ethical Conduct of Doctors. It now proposes to undertake accreditation as well. Such concentration of powers creates a serious conflict of interest and provides a fertile ground for misuse of authority. So there is a need to create a transparent system of licensing of medical colleges.
  3. There should be bifurcation of the functions of MCI and recommends that different structures be created for discharging different functions.
  4. There is a need to revisit ICT tools and revisit minimum standards which are required under the act to establish medical colleges.
  5. A code of ethics which is in line with the international standards needs to be developed for the medical professionals to reduce the corrupt practices.
  6. It needs to see a balance between the number of seats available for medical courses at undergraduate and postgraduate level.

Measures needed to overhaul and revamp MCI

  1. The Parliamentary committee made a number of recommendations to overhaul the system. Some of the important recommendations of the committee are the following,
  2. Doctor – Population ratio in India is 1:1674 as against the WHO norm of 1:1000, hence the government should immediately spell out policy stance in great detail to augment the capacity of production of doctors including specialists and super-specialists at the scale and speed required to meet India’s health needs.
  3. The regulatory framework of medical education and practice should be comprised of professionals of the highest standards of repute and integrity, appointed through a rigorous and independent selection process.
  4. Urgent measures have to be taken to restructure the composition of MCI to encourage diversity so that it does not become an exclusive club of doctors.
  5. Physical infrastructure requirement should be pruned down in such a way that it should have just about 30 to 40 percent standing value in the total assessment of a medical college.
  6. Support to convert district hospitals into medical colleges. If a district hospital is converted into a medical college, it will not only be equipped with specialists of all disciplines, providing the healthcare services across the whole spectrum but will also produce some doctors in its area of operation and will thus help reduce geographical mal-distribution of doctors.
  7. The PG entrance exam should be held immediately after the final MBBS examination so that the graduate doctor could concentrate on practical skills during his internship.
  8. Ethics should be made one of the cornerstones of the syllabus of medical education.
  9. Introduction of Common Medical Entrance Test (CMET) should be done across the nation barring those States who wish to remain outside the ambit of the CMET. A common exit test should be introduced for MBBS doctors.

Mandate of the Lodha committee

  1. Lodha Committee would have complete authority to oversee all statutory functions under the MCI Act.
  2. All policy decisions of the MCI will need approvals from the Committee. It will also be free to issue remedial directions.
  3. The Committee will function for 1 year, unless a suitable mechanism is brought in earlier by it.
  4. Initially the panel will function for a year, unless suitable mechanism is brought in place earlier which will substitute the said committee.

Way forward

  • The abysmal doctor-patient ratios in India’s rural areas and poorer districts, the sanctioning of new medical colleges without ensuring trained medical faculty, the failure to produce adequate specialist doctors, and corruption in the conduct of inspections and in granting sanctions to medical colleges have wrecked the MCI’s credibility.So, there is a need to bring back the integrity which MCI has lost over the years.
  • Whether Lodha Committee manages to inculcate the changes needed in MCI or ends up being one of the numerous other attempts at cleaning up the medical education scene remains to be seen.

References:

Any doubts?


  1. Tahir Qureshi

    Nicely explained. Loved it. 🙂

  2. Root

    Updated with Explainer & Questions

    1. Ias Bharat Sarkar

      What a comprehensive compilation. Sweet!

      Although, can it answer the drawbacks of NMC Bill 2016?

      1. Discuss

        Go ahead and make an attempt. Would love to hear your thoughts. Tag people who you think can contribute to it.

        1. Ias Bharat Sarkar

          @discuss Will do so! 🙂

Cabinet clears Bill to replace Medical Council of India

Note4students

Mains Paper 2: Governance | Issues relating to development & management of Social Sector/Services relating to Health, Education, Human Resources

From UPSC perspective, the following things are important:

Prelims level: National Medical Commission Bill, Medical Council of India (MCI)

Mains level: Corruption and unethical practices in medical sector


News

National Medical Commission Bill now needs Parliament approval

  1. The Union Cabinet has cleared the National Medical Commission Bill, which does away with the Medical Council of India (MCI)
  2. The bill replaces MCI with a regulator that will do away with “heavy-handed regulatory control” over medical institutions
  3. It will also bring in a national licentiate examination

Key provisions of the bill

  1. Ease the processes for colleges to manage undergraduate and postgraduate courses
  2. Earlier, the MCI approval was needed for establishing, renewing, recognizing and increasing seats in a UG course
  3. Under the new proposal, permissions need only be sought for establishment and recognition
  4. The Bill proposes a government-nominated chairman and members, who will be selected by a committee under the Cabinet Secretary
  5. The 25-member NMC will have 12 ex-officio members, including four presidents of boards from leading medical institutions such as AIIMS and the ICMR; 11 part-time members and, a chairman and member-secretary

NMC to be less draconian

  1. Deterrence for non-compliance with maintenance of standards is in terms of monetary penalty
  2. The new commission will also have the power to frame guidelines for fees for up to 40% seats in private colleges and deemed universities

Why this bill?

  1. The Bill is aimed at bringing reforms in the medical education sector which has been under scrutiny for corruption and unethical practices

Medical panel Bill finalised, sent to Cabinet

Note4students

Mains Paper 2: Issues relating to development and management of Social Sector/Services relating to Health.

The following things are important from UPSC perspective:

Prelims: MCI, New Medical Commission Bill.

Mains: This article talks about the New Medical Commission Bill and the need for it.

 


News

  • A Bill that will bring to an end the current system of regulation of medical education through the Medical Council of India (MCI) has been finalised and sent to the Cabinet.
  • The Bill has already been cleared by a Group of Ministers, so it is unlikely to face major problems in clearing the Cabinet.

About New Medical Commission Bill

  1. The National Medical Commission Bill envisages a four-tier structure for the regulation of medical education, with a 20-member National Medical Commission (NMC) at the top.
  2. The commission will perform overall supervision over four autonomous boards that will deal with undergraduate and post-graduate education, assessment and rating of medical institutions and registration of medical practitioners and enforcement of medical ethics.
  3. There will also be a Medical Advisory Council, constituted by the central government, like the commission and the boards.
  4. The council, which will be advisory in nature, will meet at least once a year.
  5. It will serve as the primary platform through which states will put forward their views and concerns before the NMC and help shape the overall agenda in the field of medical education and training.

Why such a bill?

  1. As a concept, the NMC has been in the making for years, given the perception of corruption in the MCI and recommendations from many committees including the Ranjit Roychowdury Committee and Parliamentary Standing Committee for Health and Family Welfare.
  2. The standing committee said that the main objective of the regulator of medical education and practice in India is to regulate quality of medical education, tailor medical education to the healthcare needs of the country, ensure adherence to quality standards by medical colleges, produce competent doctors possessing requisite skills and values as required by our health system and regulate medical practice in accordance with the professional code of ethics.
  3. However, the Medical Council of India was repeatedly found short of fulfilling its mandated responsibilities.
  4. It was the Niti Aayog that pushed for a change in the appeal structure.

The draft sent to the Cabinet incorporates two significant changes from what the Health Ministry had proposed:

  1. Only five members of the NMC will be elected while the others will be nominated by the government and the government will be the second appellate authority in case disputes arise.
  2. The first change was made after the PMO sought a reduction in the number of elected members.
  3. It would ensure that the government has more leverage and prevent the system from descending into the present state where the MCI and government are often at loggerheads on many issues.
  4. There are also ex-officio members in the commission that include nominees from the Ministry of Health, Department of Pharmaceuticals, Human Resource Development and Director General of Health Services.
  5. The real challenge for the government will be in pushing it through in Parliament, where medical education has always been a touchy subject across party lines.

 


Back2basics

About MCI

  1. The MCI was established in 1934 under the Indian Medical Council Act, 1933as an elected bodyfor maintaining the medical register and providing ethical oversight, with no specific role in medical education.
  2. The Amendment of 1956, however, mandated the MCI to maintain uniform standards of medical education, both under graduate and postgraduate; recommend for recognition/de-recognition of medical qualifications of medical institutions of India or foreign countries; accord permanent registration/provisional registration of doctors with recognised medical qualifications; and ensure reciprocity with foreign countries in the matter of mutual recognition of medical qualifications.
  3. The second amendment came in 1993,under this amendment, the role of the MCI was reduced to an advisory body with the three critical functions of sanctioning medical colleges, approving the student intake, and approving any expansion of the intake capacity requiring prior approval of the Ministry of Health and Family Welfare.

[op-ed snap] Heal thyself

Image result for Medical Council of India (MCI)

Image source

Note4students

Mains Paper 2: Governance | Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

From UPSC perspective, the following things are important:

Prelims level: Medical Council of India (MCI)

Mains level: MCI- problems; National Medical Commission Bill of 2016- provisions, challenges etc


News

Context

  1. Medical education scams continue unabated under the MCI’s stewardship. But merely replacing it is not the solution

  2. The regulator of medical education is itself in need of regulation

Medical Council of India (MCI)-Issues

  1. Volume of litigation that the MCI faces suggest that the regulator is neither in command nor perceived to be so
  2. It has imposed a uniform benchmark for admissions at the undergraduate and postgraduate levels
    • But different syllabi and diverse languages in different states tilt the level playing field.
  3. While the MCI is standardising entrance tests, it is failing to assure uniform, quality education for entrants who qualify.
  4. As an implication, the promise that India holds as a destination for medical tourism and education stands compromised.

National Medical Commission Bill of 2016

  • It proposes to trifurcate the functions of the MCI to reducer corruption, may prove to be superficial

Why?

  1. It would eventually leave the monopoly in accreditation intact, and opaqueness would remain a problem
  2. Intersection of private enterprise and medical education and practice is laden with incentives for corruption.
  3. Marketing of pharmaceuticals and equipment exert unhealthy influences
  4. Inspection of teaching hospitals is a scandal, with doctors and even patients being “rented” for the day.
  5. The scarcity of seats and their marked-up price tag is also a reason for corruption

Way forward

  1. Merely replacing the MCI will not suffice. Its successor must be armed with rules-based transparency to prevent rent-seeking.
  2. Examination reform could have followed

Back2basics

National Medical Commission Bill, 2016 

Salient Provisions

The bill seeks to address the following:

  1. Ensure adequate supply of high quality medical professionals at both undergraduate and postgraduate levels.
  2. Encourage medical professionals to incorporate the latest medical research in their work and to contribute to such research.
  3. Provide for objective periodic assessments of medical institutions.
  4. Facilitate the maintenance of a medical register for India and enforce high ethical standards in all aspects of medical services.
  5. Ensure that the medical institutes are flexible enough to adapt to the changing needs of a transforming nation.

Medical advisory council

The bill seeks to constitute a Medical Advisory Council which will undertake the following functions:

  1. The Council shall serve as the primary platform through which the states would put forward their views and concerns before the National Medical Commission (NMC) and shall help shape the overall agenda in the field of medical education & training.
  2. The Council shall advise the NMC on the measures to determine, maintain and coordinate the minimum standards in the discipline of medical education, training and research.
  3. The Council shall advise the NMC on measures to enhance equitable access to medical education

Making medical education a public good II

  1. These factors are reportedly compelling the U.S. to revert to making higher education a public good
  2. The NITI Aayog recommendations for reforming medical education need to be viewed in this backdrop
  3. The 3-point recommendation — allowing private investors to establish medical colleges, freedom to levy fees for 60% of the students
  4. And making the exit examination the marker for quality and for crowding out substandard institutions — is expected to trigger healthy competition, reduce prices and assure quality
  5. This policy response could make the situation worse

Making medical education a public good I

  1. Issue: Commercialising medical education
  2. Benefits: Incentivise investors to set up medical colleges, increase the supply of doctors, induce competition and reduce the cost of tuition fees and services
  3. Same approach in the US resulted in the entry of banks, hedge funds, private equity, venture capital, for establishing colleges
  4. This has resulted in increase in student debt, post 2002, student debt has climbed to $1.2 trillion
  5. In 2009, a review showed that in the 30 leading for-profit universities, 17% of their budget was spent on instruction
  6. But 42% on marketing, and paying out existing investors

States approve proposal to replace Medical Council of India- II

  1. Representation: States have asked for more representation in the commission
  2. Consultative committee: It will be formed separately, whose function will be to advise the commission
  3. Background: In March 2016, a Parliamentary Standing Committee report had called for radical reform of the MCI
  4. It said that MCI neither represents professional excellence nor its ethos and that its composition is opaque

States approve proposal to replace Medical Council of India- I

  1. Context: Question mark on ethical and professional competence of MCI
  2. Proposal: MCI to be replaced by National Medical Commission
  3. It was formulated by NITI Aayog
  4. Recommendations by states: Instead of just one chairman of the new regulatory body, there should be some members also

Parliament passes bills assigning constitutional status to NEET

  1. Aim: To bring private colleges under the ambit of the Indian Medical Council (Amendment) Bill and Dentist (Amendment) Bill
  2. The bill aims to end the multiplicity of medical examinations and pave the way for fair and transparent examinations
  3. Concerns: Regional Language inclusion, disparity in fee structure and state quotas still need to be figured out

Lok Sabha nods for NEET

  1. News: The Lok Sabha passed a bill awarding statutory status to the controversial National Eligibility cum Entrance Test (NEET) from the next academic session
  2. Aim: NEET aims to ensure a uniform medical and dental entrance exam
  3. The bills: The Indian Medical Council (Amendment) Bill, 2016 and The Dentists (Amendment) Bill, 2016 will amend the Indian Medical Council Act, 1956 and the Dentists Act, 1948
  4. Objectives: To end the multiplicity of examinations, have fair and transparent examinations and adopt non-exploitative process
  5. The new system will not disturb the State quotas – all India quota of 15% and State quota of 85% seats will remain

Learn about Medical Council of India

  1. Basics: The MCI was established under the Indian Medical Council Act, 1933
  2. Objective: It has given responsibility for maintaining standards of medical education, providing ethical oversight, maintaining the medical register and sanctioning medical colleges
  3. Criticism: It failed to create a transparent system for accrediting medical colleges
  4. It has led to geographical mal-distribution and creation of ‘ghost faculties’ in private medical colleges

British Medical Journal calls for radical revamp of MCI

  1. News: The British Medical Journal has called for a ‘radical prescription’ to reform the Medical Council of India (MCI)
  2. Background: The parliamentary panel has highlighted the MCI’s failure to oversee quality and integrity in health services in the country
  3. Purpose: To eliminate corruption and lack of ethics in healthcare
  4. Challenge: The citizens of India are strained by the dual burden of expensive and unethical healthcare

Questions (attempt in the comments section)

1

In recent years functioning of the Medical Council of India (MCI) has been controversial for many reasons. Examine what these reasons are and suggest how government should regulate such erring regulators.

2

Recently, the Parliamentary Standing Committee (PSC) on the need to reform the Medical Council of India (MCI) submitted its report. Critically comment on its recommendations.

3

British Medical Journal and the Parliamentary Standing Committee in their respective reports have pointed about rampant corruption and lack of quality and integrity in the medical services across the country. What are the major reforms needed in MCI? Also discuss about the mandate of Lodha committee formed by SC in this regard.







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