By an amendment to the IMC Act 1956 the MOH has proposed a National Exit Exam for all MBBS graduates after their final MBBS exam. They are required to clear NEXT in order to obtain their license to practice. This is height of injustice. Asking medical graduates who have cleared 36 exams in their career with three dimensional (theory, clinicals and viva)examinations is nothing short of cruelty. Registration is the legitimate right of an MBBS graduate. If the objective of NEXT is to ensure standards of medicals education, the real attention should be on the faculty and infrastructure of medical colleges. IMA and the medical students of the county stand united in resisting NEXT.
- A national schedule for final MBBS Examination including date of declaration of result be made applicable for all the examining universities in the country.
- PG entrance examination for the purpose of commonality of the date of the commencement i.e. PG NEET to be conducted within 45 days from the date of declaration of the common MBBS final result, which is included in the declared schedule.
- The Rotating internship to begin on a common date, so that it also in the generic sense ends on the common date across the country.
The National Medical Commission Bill 2016
- Medical Council of India has 168 members, 2/3rds of them elected democratically.MCI reflects the true federal nature of the Indian UNION with representation to the states, universities and the doctors of the country. On the other hand the proposed NMC has only 20 members, all nominated by Central Government. It not only defranchises all the doctors it takes away the federal right of state Governments and the universities of the states to participate in the regulation of medical education and practice.
- Uptil now 15% of the seats in private medical colleges are being given to the management for their exclusive determination of fee. NMC permits Government control only up to 40% of the seats. This could be legally 1% or none at all.The rest are given to the private managements to auction to the highest bidder. This is a clause which has the potential to destroy the social fabric of the future medical community and the nation.
- It abolishes Medical Council of India and along with that the section 15.2.b of MCI Act which says that the basic qualification to practise modern medicine is MBBS.
- It introduces schedule IV to allow Ayurvedics, Homeopaths, and others to get registration in Modern Medicine.
- While it allows Ayurvedics and Homeopaths to practice modern medicine by back door,it requires legitimate MBBS students to take a licentiate exam after final MBBS exam.
- It opens the floodgates of PG seats in modern medicine to AYUSH graduates by providing registration to them in schedule IV.
- It brings non medical people like advocates, charted accountants and social activists into the highest body of medical governance changing its perspective and character for ever.
- It directly affects Patient Care and Patient Safety by allowing graduates of other systems to practise modern medicine.
Unscientific mixing of various systems of medicine and hazards to patients
The 3rd National Health Policy aims at improving the health scenario of our country by universal accessibility and universal health coverage. The policy approach is futuristic and is based on the scientific assessment of facts. The National Sample Survey has shown that the out of pocket expenditure is very high in our country . Universal accessibility to health should be based on decreasing out of pocket expenditure and increasing public funding. As per the national sample survey, 93% of the outpatients and 97% of the inpatients depend on modern medicine for their health care needs. Only negligible contribution is being provided by the AYUSH.
While Ayurveda and Sidha are traditional treatment methods, Homeo and unani systems are of foreign origin. While the modern scientific system of medicine is based on universally accepted, tested, validated and defined methods for diagnosis and treatment the traditional systems largely rely on untested, non validated beliefs and hypothesis . AYUSH systems neither subscribe to infection as a cause of disease nor approve of vaccination as a tool in prevention. Modern Medicine and AYUSH differ in basic concepts and methodology.
As a quick shortcut to solve the manpower deficiency there is an increasing trend to allow untrained persons to practice modern medicine. In many states, the Government is trying to appoint Ayush trained persons to manage Government facility for health care in modern medicine. This causes significant risk to patients. Modern medical practice requires aptitude and skill. Empowering AYUSH to practise modern medicine endangers the lives of the citizen.
The Medical Council of India act of 1956 has also mandated that the modern medical practice should only be allowed to persons who possess recognised training and degrees by the Medical council of India. Moreover in Mukthiiar Chand and Anr case, the Supreme Court also has made it clear that modern medical practise should be only done by persons who have recognised training and qualification by the medical council of India.
IMA is against unscientific mixing of different systems of medicine. Modern scientific system of medicine should be handled only by those who have recognised qualification and training.
West Bengal Clinical Establishment (Registration, Regulation and Transparency ) Bill 2017
- Doctors and hospitals are the main stake holders of West Bengal Clinical Establishment Bill 2017. The bill was neither available in public domain nor was referred to a subject committee of Legislative Assembly.
- Clause 34 compulsorily criminalizes all the violations of license and registration and provides for imprisonment in the same, without any discrimination between minor and major violations, and the word used is “shall”. Clause 34 is reproduced below:
- (1) Notwithstanding anything contained in this Act, if any person-
- violates the conditions of registration and license under this Act, he shall be liable for imprisonment which may extend to three years.
- The objective of the Act being to provide for regulation and registration it is illogical to provide for compensation for medical negligence and penal provisions like jail terms. The advent of regulatory commission and its quasi judicial powers have to be withdrawn.
- Fixing of package rates for services in private hospitals is ultravires the constitution. A professional costing of the infrastructure and services of Tertiary/ Secondary/ Primary/ Clinical establishments in Metropolitan/Urban/Rural areas has to be done. Contrary to the popular perception the margin in private hospitals especially small and medium ones is very low. Fixing of rates and charges affects the independence and privileges of the medical profession aswell. There cannot be a parameter to measure the skill and expertise of doctors.
- IMA is concerned at the resultant possibility of extinction of small and medium hospitals and reluctance of fresh medical graduates to establish individual medical practice. This will pave the way for corporate hospitals to enter primary and secondary care. Friendly neighbourhood clinics and small nursing homes which are an asset will disappear.
- Instead of a Registration and Licensing procedure the Act should provide for Registration and Accreditation procedure. Entry level Accreditation of NABH should confer Registration without inspection.
- If the objective of the Act is to maintain standards and quality of service, there is no reason why Government hospitals should be exempted .
- All single doctor primary care clinics , couple and family practices should be exempted from the act.
- Arachic clauses of 7.3 (j) and 7.3 (k) providing for service without payment are against the principles of natural justice and have to be withdrawn.
- All clinical establishments run by doctors as part of their professional practice should be classified separately from FOR PROFIT hospitals. They should be deemed as professional establishments and not as commercial establishments.