The National Medical Commission (NMC) Bill, 2017 was introduced in Lok Sabha in December, 2017. It was examined by the Standing Committee on Health, which submitted its report during Budget Session 2018. The Bill seeks to regulate medical education and practice in India. In this post, we analyse the Bill in its current form.
How is medical education and practice regulated currently?
The Medical Council of India (MCI) is responsible for regulating medical education and practice. Over the years, there have been several issues with the functioning of the MCI with respect to its regulatory role, composition, allegations of corruption, and lack of accountability. For example, MCI is an elected body where its members are elected by medical practitioners themselves, i.e. the regulator is elected by the regulated. In light of such issues, experts recommended nomination based constitution of the MCI instead of election, and separating the regulation of medical education and medical practice. They suggested that legislative changes should be brought in to overhaul the functioning of the MCI.
To meet this objective, the Bill repeals the Indian Medical Council Act, 1956 and dissolves the current Medical Council of India (MCI) which regulates medical education and practice.
Who will be a part of the NMC?
The NMC will consist of 25 members, of which at least 17 (68%) will be medical practitioners. The Standing Committee has noted that the current MCI is non-diverse and consists mostly of doctors who look out for their own self-interest over larger public interest. In order to reduce the monopoly of doctors, it recommended that the MCI should include diverse stakeholders such as public health experts, social scientists, and health economists. In other countries, such as the United Kingdom, the General Medical Council (GMC) responsible for regulating medical education and practice consists of 12 medical practitioners and 12 lay members (such as community health members, and administrators from the local government).
How will the issues of medical misconduct be addressed?
The State Medical Council will receive complaints relating to professional or ethical misconduct against a registered doctor. If the doctor is aggrieved by the decision of the State Medical Council, he may appeal to the Ethics and Medical Registration Board, and further before the NMC. Appeals against the decision of the NMC will lie before the central government. It is unclear why the central government is an appellate authority with regard to such matters.
It may be argued that disputes related to ethics and misconduct in medical practice may require judicial expertise. For example, in the UK, the GMC receives complaints with regard to ethical misconduct and is required to do an initial documentary investigation. It then forwards the complaint to a Tribunal, which is a judicial body independent of the GMC. The adjudication and final disciplinary action is decided by the Tribunal.
What will the NMC’s role be in fee regulation of private medical colleges?
In India, the Supreme Court has held that private providers of education have to operate as charitable and not for profit institutions. Despite this, many private education institutions continue to charge exorbitant fees which makes medical education unaffordable and inaccessible to meritorious students. Currently, for private unaided medical colleges, the fee structure is decided by a committee set up by state governments under the chairmanship of a retired High Court judge. The Bill allows the NMC to frame guidelines for determination of fees for up to 40% of seats in private medical colleges and deemed universities. The question is whether the NMC as a regulator should regulate fees charged by private medical colleges.
A NITI Aayog Committee (2016) was of the opinion that a fee cap would discourage the entry of private colleges, therefore, limiting the expansion of medical education. It also observed that it is difficult to enforce such a fee cap and could lead medical colleges to continue charging high fees under other pretexts.
Note that the Parliamentary Standing Committee (2018) which examined the Bill has recommended continuing the current system of fee structures being decided by the Committee under the chairmanship of a retired High Court judge. However, for those private medical colleges and deemed universities, unregulated under the existing mechanism, fee must be regulated for at least 50% of the seats. The Union Cabinet has approved an Amendment to increase the regulation of fees to 50% of seats.
How will doctors become eligible to practice?
The Bill introduces a National Licentiate Examination for students graduating from medical institutions in order to obtain a licence to practice as a medical professional.
However, the NMC may permit a medical practitioner to perform surgery or practice medicine without qualifying the National Licentiate Examination, in such circumstances and for such period as may be specified by regulations. The Ministry of Health and Family Welfare has clarified that this exemption is not meant to allow doctors failing the National Licentiate Examination to practice but is intended to allow medical professionals like nurse practitioners and dentists to practice. It is unclear from the Bill that the term ‘medical practitioner’ includes medical professionals (like nurses) other than MBBS doctors.
Further, the Bill does not specify the validity period of this licence to practice. In other countries such as the United Kingdom and Australia, a licence to practice needs to be periodically renewed. For example, in the UK the licence has to be renewed every five years, and in Australia it has to renewed annually.
What are the issues around the bridge course for AYUSH practitioners to prescribe modern medicine?
The debate around AYUSH practitioners prescribing modern medicine
There is a provision in the Bill which states that there may be a bridge course which AYUSH practitioners (practicing Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy) can undertake in order to prescribe certain kinds of modern medicine. There are differing views on whether AYUSH practitioners should prescribe modern medicines.
Over the years, various committees have recommended a functional integration among various systems of medicine i.e. Ayurveda, modern medicine, and others. On the other hand, experts state that the bridge course may promote the positioning of AYUSH practitioners as stand-ins for allopathic doctors owing to the shortage of doctors across the country. This in turn may affect the development of AYUSH systems of medicine as independent systems of medicine.
Moreover, AYUSH doctors do not have to go through any licentiate examination to be registered by the NMC, unlike the other doctors. Recently, the Union Cabinet has approved an Amendment to remove the provision of the bridge course.
Status of other kinds of medical personnel
As of January 2018, the doctor to population ratio in India was 1:1655 compared to the World Health Organisation standard of 1:1000. The Ministry of Health and Family Welfare stated that the introduction of the bridge course for AYUSH practitioners under the Bill will help fill in the gaps of availability of medical professionals.
If the purpose of the bridge course is to address shortage of medical professionals, it is unclear why the option to take the bridge course does not apply to other cadres of allopathic medical professionals such as nurses, and dentists. There are other countries where medical professionals other than doctors are allowed to prescribe allopathic medicine. For example, Nurse Practitioners in the USA provide a full range of primary, acute, and specialty health care services, including ordering and performing diagnostic tests, and prescribing medications. For this purpose, Nurse Practitioners must complete a master’s or doctoral degree program, advanced clinical training, and obtain a national certification.
Explainer: The Central Educational Institutions (Reservation in Teachers’ Cadre) Bill, 2019
The Central Educational Institutions (Reservation in Teachers’ Cadre) Bill, 2019 was passed by Parliament today. It replaces an Ordinance that was promulgated in February 2019. The Bill brings about two major changes in reservation of teaching posts in central educational institutions. Firstly, it establishes that for the purpose of reservation, a university/college would be considered as one single unit. This means that posts of the same level across all departments (such as assistant professor) in a university would be grouped together when calculating the total number of reserved seats. Secondly, it extends reservations beyond Scheduled Castes (SC) and Scheduled Tribes (ST), to include socially and educationally backward classes (OBC) and economically weaker sections (EWS).
In this post, we look at how the Bill will impact the reservation of teaching posts in central educational institutions.
How has teachers’ reservation been implemented in the past?
In 2006, the University Grants Commission (UGC) issued guidelines for teacher reservations in central educational institutions.[1] These guidelines required central educational institutions to consider a university as one unit for the purpose of reservation. It stated that reservations would be calculated using a roster system specified by the Ministry of Personnel, Public Grievances, and Pension.[2]
However, the UGC Guidelines (2006) were challenged in the Allahabad High Court in 2017. The question before the Court was whether a university should be taken as a unit when applying the roster.[3] The Court found that individual departments should be taken as a unit for the purpose of reservation, instead of universities. It held that taking a university as a unit could result in some departments having only reserved candidates and others having only unreserved candidates. Following the judgment, departments were treated as a single unit for reservation at central educational institutions.
In March 2019, the Central Educational Institutions (Reservation in Teachers’ Cadre) Ordinance, 2019 was promulgated, and passed as a Bill in July 2019. The Bill overturns the Allahabad High Court judgment and reverts to the system where a university is regarded as one unit for the purpose of reservation.
Over the years, there has been deliberation on whether the university or department should be taken as a unit for reservation of teaching posts. This has to do with the manner in which the roster system [4]specified by the Ministry of Personnel, Public Grievances, and Pension is applied in both situations.
What was the roster system specified by the Ministry of Personnel, Public Grievances, and Pension?
The roster system calculates reservation based on cadre strength. A cadre includes all posts available to be filled within a unit, i.e. either department or university. For instance, all associate professor positions within a university or within a department would be considered a cadre.
At present, the roster system is applied in two ways, i.e., the 13-point system or the 200-point system. For initial recruitment in both systems, all posts in a cadre are numbered and allocated. This means that in a cadre with 18 posts, each post will be assigned a number from 1 to 18 and allocated to a particular category, i.e., either SC, ST, OBC, EWS or unreserved. Therefore, hiring of teachers for all posts takes place on the basis of this list.
However, there are two fundamental differences between the 200 point and 13 point systems.
When a university is taken as the unit for reservation, the 200-point system is used, as there tend to be more than 13 posts in a university. However, when a department is taken as a unit, the 13-point system or the 200-point system may be used, depending on the size of the department.
How are the number of reserved seats calculated in the roster system?
For both the systems, the number of seats reserved for SC, ST, OBC, and EWS is determined by multiplying the cadre strength with the percentage of reservation prescribed by the Constitution. The percentage of reserved seats for each category is as follows: (i) 7.5% for ST, (ii) 15% for SC, (iii) 27% for OBC, and (iv) 10% for EWS.
If the number of posts needed to be filled is 200, and the percentage of reservation for ST is 7.5%, we would use the following formula to calculate the number of reserved posts for that class:
Number of posts needed to be filled x percentage of reservation/100
= 200 x 7.5/100
= 15
Thus, the number of seats reserved for ST in a cadre with the strength of 200 posts is 15. Using the same formula, the number of seats reserved for SC is 30, OBC is 54, and EWS is 20.
How are these reserved seats distributed across posts?
To determine the position of each reserved seat in the roster systems, 100 is divided by the percentage of the reservation for each category. For instance, the OBC quota is 27%. Therefore, 100/27 = 3.7, that is, approximately every 4th post in the cadre list. Likewise, SC is approximately every 7th post, ST is approximately every 14th post, and EWS will be approximately every 10th post.
What is the difference in the application of the roster between the department and university systems?
To demonstrate the difference between the department and university systems, a hypothetical example of a university with 200 posts for associate professors, and nine departments with varying number of posts is provided below.
When the university is taken as a unit
|
If the university is taken as the unit for reservation, then the total number of posts for the reserved categories would be 119 (i.e., 30 for SC, 15 for ST, 54 for OBC, and 20 for EWS), whereas the number of unreserved (UR) seats would be 81. This is mentioned in Table 1. The method of calculation of these numbers is based on the roster system prescribed by the Ministry of Personnel, Public Grievances, and Pension. |
Table 1: No. of posts reserved when university is taken as a unit
|
When departments are taken as separate units
|
If different departments of a university are taken as separate units for reservation, then the total number of posts for the reserved categories would be 101 (i.e., 25 for SC, 9 for ST, 49 for OBC, and 18 for EWS), whereas the number of unreserved (UR) seats would be 99. This is mentioned in Table 2. The method of calculation of these numbers is based on the roster system prescribed by the Explainer: The Central Educational Institutions (Reservation in Teachers’ Cadre) Bill, 2019 The Central Educational Institutions (Reservation in Teachers’ Cadre) Bill, 2019 was passed by Parliament today. It replaces an Ordinance that was promulgated in February 2019. The Bill brings about two major changes in reservation of teaching posts in central educational institutions. Firstly, it establishes that for the purpose of reservation, a university/college would be considered as one single unit. This means that posts of the same level across all departments (such as assistant professor) in a university would be grouped together when calculating the total number of reserved seats. Secondly, it extends reservations beyond Scheduled Castes (SC) and Scheduled Tribes (ST), to include socially and educationally backward classes (OBC) and economically weaker sections (EWS). In this post, we look at how the Bill will impact the reservation of teaching posts in central educational institutions. How has teachers’ reservation been implemented in the past? In 2006, the University Grants Commission (UGC) issued guidelines for teacher reservations in central educational institutions.[1] These guidelines required central educational institutions to consider a university as one unit for the purpose of reservation. It stated that reservations would be calculated using a roster system specified by the Ministry of Personnel, Public Grievances, and Pension.[2] However, the UGC Guidelines (2006) were challenged in the Allahabad High Court in 2017. The question before the Court was whether a university should be taken as a unit when applying the roster.[3] The Court found that individual departments should be taken as a unit for the purpose of reservation, instead of universities. It held that taking a university as a unit could result in some departments having only reserved candidates and others having only unreserved candidates. Following the judgment, departments were treated as a single unit for reservation at central educational institutions. In March 2019, the Central Educational Institutions (Reservation in Teachers’ Cadre) Ordinance, 2019 was promulgated, and passed as a Bill in July 2019. The Bill overturns the Allahabad High Court judgment and reverts to the system where a university is regarded as one unit for the purpose of reservation. Over the years, there has been deliberation on whether the university or department should be taken as a unit for reservation of teaching posts. This has to do with the manner in which the roster system [4]specified by the Ministry of Personnel, Public Grievances, and Pension is applied in both situations. What was the roster system specified by the Ministry of Personnel, Public Grievances, and Pension? The roster system calculates reservation based on cadre strength. A cadre includes all posts available to be filled within a unit, i.e. either department or university. For instance, all associate professor positions within a university or within a department would be considered a cadre. At present, the roster system is applied in two ways, i.e., the 13-point system or the 200-point system. For initial recruitment in both systems, all posts in a cadre are numbered and allocated. This means that in a cadre with 18 posts, each post will be assigned a number from 1 to 18 and allocated to a particular category, i.e., either SC, ST, OBC, EWS or unreserved. Therefore, hiring of teachers for all posts takes place on the basis of this list. However, there are two fundamental differences between the 200 point and 13 point systems.
When a university is taken as the unit for reservation, the 200-point system is used, as there tend to be more than 13 posts in a university. However, when a department is taken as a unit, the 13-point system or the 200-point system may be used, depending on the size of the department. How are the number of reserved seats calculated in the roster system? For both the systems, the number of seats reserved for SC, ST, OBC, and EWS is determined by multiplying the cadre strength with the percentage of reservation prescribed by the Constitution. The percentage of reserved seats for each category is as follows: (i) 7.5% for ST, (ii) 15% for SC, (iii) 27% for OBC, and (iv) 10% for EWS. If the number of posts needed to be filled is 200, and the percentage of reservation for ST is 7.5%, we would use the following formula to calculate the number of reserved posts for that class: Number of posts needed to be filled x percentage of reservation/100 = 200 x 7.5/100 = 15 Thus, the number of seats reserved for ST in a cadre with the strength of 200 posts is 15. Using the same formula, the number of seats reserved for SC is 30, OBC is 54, and EWS is 20. How are these reserved seats distributed across posts? To determine the position of each reserved seat in the roster systems, 100 is divided by the percentage of the reservation for each category. For instance, the OBC quota is 27%. Therefore, 100/27 = 3.7, that is, approximately every 4th post in the cadre list. Likewise, SC is approximately every 7th post, ST is approximately every 14th post, and EWS will be approximately every 10th post. What is the difference in the application of the roster between the department and university systems? To demonstrate the difference between the department and university systems, a hypothetical example of a university with 200 posts for associate professors, and nine departments with varying number of posts is provided below. When the university is taken as a unit
When departments are taken as separate units
As can be seen in the above example, if departments are taken as separate units, there is a decrease in the number of reserved posts. The number of reserved posts decreased by five for SC, six for ST, five for OBC, and two for EWS. This example is corroborated by the special leave petition filed by the Ministry of Human Resource Development in the Supreme Court against the 2017 order of Allahabad High Court. It demonstrates that the number of reserved seats in Banaras Hindu University (BHU) decreased when departments were taken as separate units. The number of reserved posts decreased by 170 for SC, 114 for ST, and 90 for OBC.[5] EWS was not included in the reservation system when the BHU numbers were calculated. Thus, the trade off between the two systems is as follows. On the one hand, when the university is taken as a unit there is a possibility that some departments would only have reserved candidates and others would have only unreserved candidates. However, when a department is taken as a unit, there is a decrease in the total number of reserved posts within the university.
[1] Circular No. F. 1-5/2006(SCT), University Grants Commission, 2006. [2] O.M. No. 36012/2/96-Esst. (Res), ‘Reservation Roster- Post based- Implementation of the Supreme Court Judgement in the case of R.K. Sabharwal Vs. State of Punjab, Department of Personnel and Training, Ministry of Personnel, Public Grievances, and Pension, July 1997, http://documents.doptcirculars.nic.in/D2/D02adm/36012_2_96_Estt(Res).pdf. [3] Vivekanand Tiwari v. Union of India, Writ petition no. 43260, Allahabad High Court, April 2017. [4] O.M. No.36039/1/2019-Estt (Res), ‘Reservation for Economically Weaker Sections (EWSs) in direct recruitment in civil posts and services in the Government of India’, Department of Personnel and Training, Ministry of Personnel, Public Grievances, and Pension, https://dopt.gov.in/sites/default/files/ewsf28fT.PDF. [5] Special Leave Petition filed in Supreme Court by Ministry of Human Resource Development, January 2019, as reported in Indian Express, https://indianexpress.com/article/explained/simply-put-the-unit-in-teachers-quota-5554261/. Ministry of Personnel, Public Grievances, and Pension. |
Table 2: No. of posts reserved when department is taken as the unit
Note: Number of posts in each department are hypothetical. |
As can be seen in the above example, if departments are taken as separate units, there is a decrease in the number of reserved posts. The number of reserved posts decreased by five for SC, six for ST, five for OBC, and two for EWS. This example is corroborated by the special leave petition filed by the Ministry of Human Resource Development in the Supreme Court against the 2017 order of Allahabad High Court. It demonstrates that the number of reserved seats in Banaras Hindu University (BHU) decreased when departments were taken as separate units. The number of reserved posts decreased by 170 for SC, 114 for ST, and 90 for OBC.[5] EWS was not included in the reservation system when the BHU numbers were calculated.
Thus, the trade off between the two systems is as follows. On the one hand, when the university is taken as a unit there is a possibility that some departments would only have reserved candidates and others would have only unreserved candidates. However, when a department is taken as a unit, there is a decrease in the total number of reserved posts within the university.
[1] Circular No. F. 1-5/2006(SCT), University Grants Commission, 2006.
[2] O.M. No. 36012/2/96-Esst. (Res), ‘Reservation Roster- Post based- Implementation of the Supreme Court Judgement in the case of R.K. Sabharwal Vs. State of Punjab, Department of Personnel and Training, Ministry of Personnel, Public Grievances, and Pension, July 1997, http://documents.doptcirculars.nic.in/D2/D02adm/36012_2_96_Estt(Res).pdf.
[3] Vivekanand Tiwari v. Union of India, Writ petition no. 43260, Allahabad High Court, April 2017.
[4] O.M. No.36039/1/2019-Estt (Res), ‘Reservation for Economically Weaker Sections (EWSs) in direct recruitment in civil posts and services in the Government of India’, Department of Personnel and Training, Ministry of Personnel, Public Grievances, and Pension, https://dopt.gov.in/sites/default/files/ewsf28fT.PDF.
[5] Special Leave Petition filed in Supreme Court by Ministry of Human Resource Development, January 2019, as reported in Indian Express, https://indianexpress.com/article/explained/simply-put-the-unit-in-teachers-quota-5554261/.
