National Medical Commission (NMC) Act 2019

What does the National Medical Commission do?

The National Medical Commission Act, 2019 repealed the Indian Medical Council Act, 1956. It provides for a medical education system which ensures:

• Availability of adequate and high quality medical professionals,
• Adoption of the latest medical research by medical professionals,
• Periodic assessment of medical institutions, and
• An effective grievance redressal mechanism.  

Why do we need to replace the IMC with NMC?

The reason for replacing IMC with NMC is that IMC had failed to keep pace with time and various bottlenecks had crept into the system with serious detrimental effects on medical education and, by implication, on delivery of quality health services.

What are the highlights of the Act?

Highlights of the Act:

The Act sets up the National Medical Commission (NMC).  Within three years of the passage of the Bill, state governments will establish State Medical Councils at the state level. The NMC will consist of 25 members, appointed by the central government.  Functions of the National Medical Commission include:

• Framing policies for regulating medical institutions and medical professionals,
• Assessing the requirements of healthcare related human resources and infrastructure,
• Ensuring compliance by the State Medical Councils of the regulations made under the law,
• Framing guidelines for determination of fees for up to 50% of the seats in private medical institutions and deemed universities which are regulated under the Act.

Medical Advisory Council:  GOI will constitute a Medical Advisory Council.  The Council will be the primary platform through which the states & union territories can put forth their views and concerns before the NMC.  Further, the Council will advise the NMC on measures to determine and maintain minimum standards of medical education.

Autonomous boards:  It sets up autonomous boards under the supervision of the NMC.  Each autonomous board will consist of a President and four members, appointed by the central government.  These boards are:

• Under-Graduate Medical Education Board (UGMEB) and the Post-Graduate Medical Education Board (PGMEB)- two Boards:  These Boards will be responsible for formulating standards, curriculum, guidelines, and granting recognition to medical qualifications at the undergraduate and post graduate levels respectively.
• The Medical Assessment and Rating Board (MARB):  MARB will have the power to levy monetary penalties on medical institutions which fail to maintain the minimum standards as laid down by the UGMEB and PGMEB.  The MARB will also grant permission for establishing a new medical college, starting any postgraduate course, or increasing the number of seats.  
• The Ethics and Medical Registration Board:  This Board will maintain a National Register of all licensed medical practitioners, and regulate professional conduct.  Only those included in the Register will be allowed to practice medicine.  The Board will also maintain a separate National Register for community health providers.  

Community health providers (CHP):   NMC may grant a limited license to certain mid-level practitioners connected with the modern medical profession to practice medicine. These mid-level practitioners may prescribe specified medicines in primary and preventive healthcare. In any other cases, these practitioners may only prescribe medicines under the supervision of a registered medical practitioner.

Entrance examinations:  There will be a uniform National Eligibility-cum-Entrance Test (NEET) for admission to under-graduate and post-graduate super-speciality medical education in all medical institutions regulated under the law.  The NMC will specify the manner of conducting common counselling for admission in all such medical institutions.
NEXT: It proposes a common final year undergraduate examination called the National Exit Test for the students graduating from medical institutions

• To obtain the license for practice
• It will also serve as the basis for admission into post-graduate courses and 
• A screening test for students who graduate in medicine from foreign countries.

Are there concerns?

Critics say the following as objections to the Act:

The first one is over the CHPs being allowed to practice modern medicine. The Bill does not define who they are or what qualifications they hold and yet they are to be given licenses to the extent of one-third of the total number of licensed medical practitioners in India. It may open the door for persons with inadequate training in modern medicine to practice, putting patients at risk and lowering standards of healthcare.

National Exit Test (NEXT) is another point of contention. NEXT is for giving both licenses for practice (to those who have already cleared the MBBS exam) as well as for admission to post-graduate "broad-speciality courses". Critics say that the two objectives can't be reconciled since the level of knowledge and training required for both are very different. While for practising medicine, a minimum level of competence is required (passing the MBBS), admission to post-graduate courses calls for a higher level of competence and only the cream of the profession gets selected.

About fees. Earlier, state governments "regulated" fees for 85% of seats and the rest (15%) are for the management to decide. Now the NMC proposes to only frame guidelines for regulating fees for 50% of seats. States may decide on a higher number or the same. If they stay with 50%, it is a dilution of the previous regulation thus favouring the rich and denting merit. However, proponents of the Act say: Nearly 50 per cent of all the MBBS seats are in government colleges, which charge a nominal fee. The other 50 per cent seats would be regulated by the NMC. This means that almost 75 per cent of total seats in the country would be available at reasonable fees.

Another objection is about the power the Act gives to the central government to give policy and other directives to the NMC and its autonomous boards which will be binding and final.

This is contradictory to the very concept of autonomy of the four boards. The central government has also been empowered to give directives to state governments for implementing provisions of the Act, which will also be binding, reflecting the anti-federal character of the Bill.

There are apprehensions about the NMC being dominated by Central government nominees. This is not true. There will be 10 Vice-Chancellors of State Health Universities and nine elected members of State Medical Councils in the NMC. Thus, 19 of 33 members would be from States... ensuring that the NMC is representative, federal and inclusive.