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Parliamentary Panel Suggests Compulsory Domestic Medical Service for Doctors

Parliamentary Panel Suggests Compulsory Domestic Medical Service for Doctors

The committee has recommended a “minimum compulsory period” of domestic medical service for those who study in tax-funded government colleges. Credit: Pixabay

New Delhi: The Parliamentary Standing Committee on Health has today submitted its report on the National Medical Commission Bill 2017. This Bill seeks to regulate medical education in India and dissolve the Medical Council of India. The standing committee was originally due to submit this report in the first week of the budget session of parliament in February.

The report has proposed several important changes to the government’s version of the Bill which was tabled in parliament in December. Many contentious issues have been dealt with by the standing committee after considering the views of state governments, government departments, various organisations, associations and individuals.

Some of the keys issues it has dealt with include the “bridge course” proposal for AYUSH doctors, the regulation of fees in medical colleges and the entry and exit exams for medical graduates and aspirants.

Recommendations for the “shortage” of doctors in India

The committee has recommended a “minimum compulsory period” of domestic medical service for those who study in tax-funded government colleges. The committee has also recommended one year of rural posting for all doctors. This is a suggestion that has gone in and out of the government several times over the years.

On the controversial “bridge course” for AYUSH practitioners, the standing committee has recommended that it not be made mandatory. Instead, the committee has fallen back upon old and oft-repeated ideas of “adequate budgetary resources” and recommends penal provisions for those who practice medicine without required qualifications. The report has not mentioned what kind of penal provisions could be included.

The “bridge” proposal in clause 49 of the government’s Bill had recommended that AYUSH doctors could make prescriptions in a defined and limited area of modern medicine, in order to meet the shortages of doctors, especially in rural and underserved areas.

The Wire has earlier reported that not just the allopathic lobbies, but even the AYUSH lobbies were against this move, albeit for different reasons.

Regulating the high prices of medical fees

Clause 10 of the government’s Bill in December had recommended the regulation of fees for at least 40% of seats in private medical institutions and deemed universities.

Many saw this as insufficient, saying that the government needed to regulate fees even more.

The standing committee recommends instead that the government regulate fees for at least 50% of the seats in private medical colleges, deemed universities and deemed-to-be-universities. “The provision of regulating fees is a step in the right direction,” says the committee’s report.

This move to regulate fees, whether for 40% or 50%, is, in fact, a huge change from the status quo. So far, there is no formal mandate for the regulation of fees in India, under the existing legislation of the Indian Medical Council Act. This was left to states to do by themselves and for private medical colleges.

The government cautioned the standing committee against high rates of fee-regulation. Their argument is that increasing the percentage of seats with their fees regulated would “discourage entry of private colleges thereby undermining the objective of rapid expansion of medical education.”

Entry and exit exams for UG and PG

Last year, the government implemented the National Eligibility cum Entrance Test (NEET) for admissions in undergraduate (UG) and postgraduate (PG) medical education.

For years, the government has considered having an “exit exam” or the National Licentiate Examination (NLE) for students at the UG and PG levels. The results of this exam could determine if these students would get a license to practice after their UG or PG degrees, or if they could be admitted into a PG course.

“The Committee is of the view that a licentiate exam is a good instrument to maintain a minimum standard across all graduates,” says the report.

The government had been considering merging the final UG exams with the NLE or to consider the NLE as the entry exam to a PG degree.

The committee proposes this exit exam or licentiate exam in two mechanisms. At the UG level, the standing committee says “the Licentiate examination be integrated with the final year MBBS examination and be conducted at the State Level.” They say that the common final UG exams can be conducted by states and state universities.

The committee does not, however, recommend merging the PG entrance exam with the licentiate exam. They say it is their “firm view that to use the same instruments for merit ranking for post-graduate entrance may not serve the purpose because a qualifying examination and a rating examination should not preferably be equated.” They also fear that by merging the two exams, “students will concentrate only on performing in the entrance examination, during their undergraduate days and internship.”

Both the entry and exit exams were ferociously opposed. While the NEET was implemented with considerable difficulty, the exit exam remained unresolved.

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