July 2019

Dear Members,
Season’s Greetings.
In a move to ensure transparency, accountability and quality in the governance of medical education, a new
bill – was passed by both Houses of Parliament—the Indian Medical Council (Amendment) Bill, 2019. It seeks
to replace the Indian Medical Council (Amendment) Second Ordinance issued by the previous government.
The Bill will supersede the Indian Medical Council (MCI) for a period of two years, during which ‘a 12-
member board of governors, instead of the earlier seven, will run the regulatory body for medical education.
During this period, the board of governors shall exercise powers and functions of the MCI as assigned under
the IMC Act, 1956.
It is a moot question as to why there is so much turmoil in taking control of medical education. Public health
has two components—providing healthcare services and providing training and producing medical doctors.
As per the Constitution, while the first is a state subject, the second is a central subject.
Even though it is a central subject, the MCI has autonomous control and is an elected bod’. Politicians and
industrialists  want  to  take  control  of  medical  education  in  India.  Till  2009,  only  non-profit  trusts  and
societies could own medical colleges. But if one wanted to privatise them, the only answer was to take
control of the autonomous MCI by politicians in the name of the central government.

The first step in this regard was taken in February 2010 when “firms under the Company Act” could enter the
field, though without commercialising it. This was by way of non-profit companies. By this time, the MCI was
dissolved and taken up by a board of governors to run it under the control of the government for the next
four years.

In August 2016, there was a paradigm shift as the government allowed private for-profit companies to run
medical  colleges.  This  opened  a  new  business  opportunity  for  big  private  hospitals.  In  January  2017,
another change took place. Now, existing non-profit trusts and societies already running medical colleges
could convert them to profit-making ventures. This means that all non-government medical colleges had
the chance to convert themselves into commercial ventures. But still the problem was the controlled fee
instituted by state governments under a Supreme Court decision. In 2018, the MCI was again taken over by
a board of governors.

This was supposed to continue for the next two years. Then, in May 2019, the government allowed two to
four entities, including trusts, societies, companies or universities, to set up medical colleges. And thus
started the commercialisation of medical colleges under private-public partnerships.

Still, this was not enough, and the government mooted an idea through the recent new educational policy
for “fee regulation” to be done away with in professional courses. This will leave non-governmental. medical
education open to being totally commercialised.

Even if the original MCI is restored or the proposed National Medical Commission takes over, the damage is
already done. Private medical education and healthcare services will remain commercialised. The current
patient-doctor or hospital-doctor mistrust is also basically over the costly, unaffordable healthcare services
in the private sector and non-availability of the same in the government sector.

The basic purpose of becoming a doctor is and will remain to alleviate the sufferings and pain of the patient.
That means that emergent care cannot and should not be commercialised. But now with medical education
being privatised and run for profit, the basic purpose of becoming a doctor does not remain intact unless he
provides affordable emergent care. There are enough opportunities for the health sector to earn from non-
emergent care. This will give enough time to patients to arrange money for their treatment even when they
are not covered by insurance.

But the “no admission unwritten policy” by most government hospitals for patients on ventilators, non-
booked delivery cases, out of hospital patients on dialysis and patients requiring acute terminal care or long-
term  terminal  care  has  encouraged  commercial  private  hospitals  to  exploit  the  situation  and  charge
exorbitantly  for  emergent  care.  Commercialisation  of  medical  education  and  private  healthcare  is
acceptable as long as emergent care is left affordable, free or subsidised. Under Section 3 of the Essential
Commodities Act, central and state governments have enough powers to take over emergent   care and
introduce a national list of essential drugs, devices, investigations and reagents needed for emergent care.
Medical education is also dependent on allowing trainee doctors to see patients, especially those who are in
an emergency situation. However, commercialising emergent care would mean that these young doctors
won’t have enough to learn as the patient numbers will be fewer due to the costs involved.

Also, converting the MCI to a National Medical Commission (NMC) will be a move towards a non-federal
structure. Today, all state governments, councils and universities have representation in the MCI. However,
once the new Commission starts, these bodies will have practically no representation.

A non-autonomous, government-controlled NMC will tend to move towards commercialisation of medical
education. If that happens, a student in any private medical institution will be brainwashed into thinking
that his primary objective is to make money. But the medical profession is meant to alleviate pain and
suffering and earning money should be the secondary aim.

IMA has won the first battle in our struggle against violence.

Union Government has constituted an inter ministerial committee to go into the Central legislation against
assault on Doctors and Hospitals.

Inter ministerial committee formed by Government Of India in its 1 st meeting has formed a Sub committee
under leadership of IMA National President Dr Shantanu Sen to prepare draft of the proposed law. This sub
committee will meet in coming week and will submit its draft to inter ministerial committee by month end.
Another step towards a Central law for Violence against Doctors and Helthcare providers by IMA.

Congratulations to the entire Medical fraternity.
Long Live IMA