Replacing MCI inadequate

Dr Vikrant Prabhakar
Associate Professor, Community Medicine, Adesh Medical Hospital, Kurukshetra 

OPINION is divided over the setting up of National Medical Commission (NMC) and the winding up of Medical Council of India (MCI). On one hand, the step has been hailed as overdue and along the lines of the Prof. Ranjit Roy Chaudhary Committee report. Another view is that the new norms will ruin the health care system and lead to bias in favour of urban and rich medical aspirants.

The Chaudhary committee was set up following charges of corruption and failure against MCI. At first glance, the report seems headed in the right direction: there is maldistribution of medical colleges with six states with 31 per cent of India’s population accounting for over half of MBBS seats; 700 million people have no access to specialist care; and, 80 per cent of specialists work in urban areas.

The acute shortage of doctors testifies the point that the system of medical education, as regulated by MCI, was unable to address the many needs of the health system and urgently needed reforms.

But how is MCI responsible for the irrational distribution of medical colleges and doctors? Directives and resources for medical colleges is the prerogative of the government. Thus, this unbalanced distribution of resources has to be linked with the policies and practices of governments, and not MCI.

In fact, the report fails to identify the root cause for any of the deficiencies observed in health care delivery or medical education. Moreover, some of the committee’s observations are bizarre. For example, it blames the MCI for the lack of confidence and skills among doctors in performing basic healthcare tasks but as a solution it wants the utilisation of the ‘huge pool of talented doctors in both public and private sector hospitals’. Where has this pool come from? Didn’t MCI help generate this pool or is the committee suggesting that these talented doctors got their degrees from elsewhere?

The committee, strangely, blames the MCI for graduate doctors not being exposed to primary and secondary health care conditions. But isn’t it a policy matter, not within the ambit of MCI?  In fact, the reason may be lack of coordination because most states have separate Ministers for the Department of Health and Department of Medical Education..

There is no denying that MCI has earned a bad name for itself. Its role was to check the status of infrastructure and faculty in a medical college, and compare it with recommendations. If the two matched, it was ‘assumed’ that the college will provide quality medical education. But there was no system to verify if this condition was met. The committee did not even deliberate on why this happened!

The committee observed that the MCI neither represents professional excellence nor its ethos: more than half its council was either from corporate hospitals or in private practice; even government-nominated doctors were with corporate hospitals. This could lead to churning out of ‘corporate curative physicians’, rather than ‘social preventive health care providers’.

India is at the center of medical tourism in the world, because it provides world class services at third world rates. Isn’t this a testament to excellence in medical education under the regulation of MCI? This fact was, surprisingly, missed by Chaudhary committee. Hence, saying that MCI failed to deliver will be entirely wrong. MCI has delivered what it was asked to deliver. The deficiency to entrust responsibility on MCI to address nation’s health needs lies elsewhere.

Health does not mean just providing ‘sick care’. India needs a very strong primary ‘preventive and promotive’ health care system. MCI should have been able to identify this need but this did not happen. There is no denying to the fact that doctors coming out of medical colleges have neither the aptitude, nor the desire to work in low resource underserved settings.

What are the remedies to address the requirements of the health system?

Though MCI did cater to the need for curative excellence, it failed on the preventive and promotive fronts. But it is also true that the Board of Governance (BoG), nominated after the dissolution of MCI in 2010, is yet to change the medical education sector.

Thus, the remedy lies at two levels:

At the policy level: 

1 Integrate the health services and medical education: The two are not complementary, but supplementary. Health education should fulfill the demands of health care delivery – at primary, secondary and tertiary level. Similarly, health care delivery systems should help medical education to train future health care service providers.

2 The sanctity of the hierarchy of health service delivery should be maintained. Medical Colleges/Research Institutions should be given the responsibility and accountability to be the mentors of health care delivery system

3 Mainstream AYUSH should also contribute in the nation’s efforts to improve health care delivery services

At National Medical Commission level: 

1 Synchronise medical education with health policy and the nations vision.

2 Build a health delivery team where the role of doctors and also paramedics and health workers are equally important. Medical Education must develop the capacity of delivering primary health care, and not just tertiary care.