Draft bill for new regulatory structure for medicine in India prompts criticism

BMJ 2016; 354 doi: (Published 17 August 2016) Cite this as: BMJ 2016;354:i4541
  1. Ganapati Mudur
  1. New Delhi

An Indian government committee’s proposal for a new regulatory structure to replace the Medical Council of India (MCI) has been met with cautious optimism as well as anger at what some say is a government attempt to end the self regulation of the medical profession.

The four member committee operating under the National Institution for Transforming India, the government’s policy-making think tank, sought public comments on its draft bill that proposed creating a 20 member National Medical Commission (NMC), a new apex body for medical education.

Under the bill’s provisions, members of the NMC will be appointed by the government and will include a mix of senior doctors; officials from the ministries of health, rural development, human resource development, and the department of pharmaceuticals; and individuals from backgrounds such as economics, law, and consumer or patients’ rights. The committee said that the members would be chosen through an “open and transparent selection process.”

The NMC would coordinate four “mutually independent and autonomous boards.” They would regulate undergraduate medical education, postgraduate medical education, accreditation and assessment of medical colleges, and the practice of the profession. The bill also proposed the creation of a Medical Advisory Council to represent the interests of different states.

The draft bill followed a parliamentary panel’s report earlier this year that asked the government to dismantle the MCI saying it had failed to regulate medical education and practice—concerns that have long been shared by doctors and health activists.1 2 3

Some doctors welcomed the government’s acknowledgement that change was needed. Sanjay Nagral, a gastrointestinal surgeon in Mumbai and chairperson of the Forum for Medical Ethics Society, told The BMJ: “The government has chosen to act. This is a move forward, but the real test will be in appointments. It should not be about selecting eminent individuals, they need to be people with no conflict of interest, no vested interests, no entanglements.”

Samiran Nundy, a senior gastrointestinal surgeon in New Delhi and member of the Indian Doctors for Ethical Practice said: “This looks like a good set of proposals—the government will need to appoint the right people, and it is also important to have individuals from outside medicine as part of the regulatory structure.” 

But members of the Indian Medical Association (IMA) said that they planned to oppose the bill. A document circulated among its members this week said: “The NMC bill must be opposed in total as it is undemocratic, unrepresentative of the medical fraternity, and intends to usurp everything related to the medical profession, subverting the self regulatory status provided to the medical profession by the laws of our country, as in many other countries.”

Bevinje Srinivas Kakkilaya, a physician in Mangalore, who drafted the document, told The BMJ: “There should be no confusion about the reasons for the MCI’s failures. The failures are not because of bad structure, but because of its poor functioning and the poor choice of individuals at the helm of its affairs and the influences they came under—the MCI can be cleaned up through appropriate amendments. We do not need a new regulatory system.”

Arun Gadre, a gynaecologist in Pune and member of a coalition of doctors seeking stronger regulatory oversight of the medical profession, said that the coalition was yet to finalise an appropriate response to the draft bill.

But he said that the committee that drafted the bill had not had enough dialogue with doctors who have been concerned about the current state of affairs. Gadre said: “After drafting the bill, they have asked for suggestions. This is one way traffic, this is not proper dialogue.”

The IMA has said that it is also opposed to a provision in the bill that would make it mandatory for all medical graduates to pass a common exam to obtain a licence to practice.

The committee has justified the need for the exam as a move to “ensure common standards of knowledge and skills for doctors on a nationwide basis.”

The draft bill also proposed letting “for profit” institutions establish medical colleges, and replacing the existing system of inspection of colleges with a rating system.


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