Education

India’s Medical Council Needs Urgent Reforms, But the Proposed Draft Bill Is Flawed

The National Medical Commission Bill does not address several issues like establishing minimum qualifying marks for common medical entrance tests, regulating the fee for private colleges and the need for a strict code of ethics.

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The proposed National Medical Commission Bill, 2016 has several flaws. Credit: Reuters/Regis Duvignau

The Medical Council of India (MCI) was established in 1934 under the Indian Medical Council Act, 1933, which was repealed and replaced by the Indian Medical Council Act, 1956. The main functions of the council include the maintenance of uniform standards of medical education, recognition/de-recognition of medical qualifications and medical colleges, and the registration of doctors. However, the council has failed to perform the above functions efficiently and some of its members have also been involved in corrupt practices.

Hence, two separate committees – the Ranjit Roy Chaudhury committee and the department-related parliamentary standing committee (PSC) on Health and Family Welfare – reviewed the 1956 Act. In March, the PSC presented its report in the Rajya Sabha along with its recommendations, based on which the NITI Aayog Committee drafted the National Medical Commission Bill, 2016 to replace the 1956 Act.

In the 92nd report, the PSC noted that much of the power was concentrated in a single body – the Medical Council of India – and therefore recommended for a complete reformation of the institutional structure in the council. The NITI Aayog Committee accepted the recommendations and has since proposed the formation of two separate bodies – one as an advisory body and the other as a policy making commission which will supervise the four autonomous boards.

The advisory body would entirely comprise members who have medical qualifications and will help frame the agenda and provide guidance to the commission. The commission would consist of medical as well as non-medical members. The four boards would function separately with autonomous powers.

Appointment of the members

The proposed Bill in its current form has been severely criticised by the Indian Medical Association. They are of the opinion that through the Bill, the government wants to do away with the self-regulating authority of the council. This criticism is for the appointment of the members to the commission.

According to the proposed Bill, the previous procedure of electing members would be replaced by the nomination carried out by the search and selection committee, which would be appointed by the central government.

This proposal is based on the careful examination of the current composition of the council, which is majorly dominated by members from private medical institutions. Prior to the PSC, the Ranjit Roy Chaudhury committee had also emphasised the need for doing away with the election procedure and instead adopting a transparent system of selection.

The report highlighted that the medical councils across the world do not have elected members, and in countries like the UK, US, Japan, Canada and Australia, the members are appointed through transparent processes. This is because elections increase the possibility of using money, which gives an undue advantage to candidates belonging to the private institutions.

Moreover, the number of private medical colleges is increasing in our country. The over-representation of private medical college would affect the role and responsibilities of the MCI as it could create a virtual conflict of interest and impact.

Professional diversity among the nominated members

A proposal has been made to appoint five non-medical members in the commission of 20 people. These five members would be from backgrounds including management, economics, law, consumer or patient rights advocacy, health research, science and technology.

This composition is similar to that of the General Medical Council of UK, which has 50% non-doctor members and is supposed to be the father of the Medical Council of India in terms of its design and structure.

Similarly, the Canadian and the Australian Medical Councils also have non-doctors as their members. The rationale for the proposal is that members belonging to diverse professions would help in safeguarding the quality of medical education in accordance with the needs of the Indian healthcare system. Therefore, the interest of the public must be prioritised over the protection of elected character of the regulatory framework.

Common entrance and exit exams               

An all-India NEET is a progressive reform that removes the complexity of multiple entrance exams. The admissions would be based on rank in the entrance exam. However, no provision has been made for minimum qualifying marks for NEET. Unless it is specified, a student who has scored 80% in the exam, but does not have the means to pay the fees at private colleges, could lose the seat to a student who may have scored only 30% but has the means required to pay the fees. Therefore, the notion of admission based on merit would not be applicable and hence, the commission must define the minimum qualifying marks required to be eligible for admission.

The idea behind the common licentiate exam is to issue the licence after testing the standards of knowledge and the skills of the graduating students. The same licentiate exam will also be considered as NEET for postgraduate admissions. In this scenario, the students would concentrate more on preparing for the exam instead of focusing on the training during the internship period. Therefore, the exam should be conducted before the internship begins instead of after the completion of the degree.

Fees regulation

It is known that the private medical colleges charge a high fee from their students. Therefore, one major challenge for the medical commission to ensure that medical education is affordable, especially for students belonging to traditionally marginalised communities. For that, the fee of private medical colleges has to be monitored, without which the objective of a fair and transparent system for providing excellent medical education would be defeated.

Under the MCI, the fee of private medical colleges was not monitored. In this regard, the PSC was of the opinion that “since the Ministry of Health and Family Welfare plays a critical role in supporting the regulation of medical education, it should be enabled to play a role in regulating fee structure in private medical colleges so that the right quantum of tuition fees is charged by private medical colleges and there is uniformity in the fees across the country amongst the public and private sector medical colleges/institutions. The fee structure should be strictly enforced and action should be taken against erring managements”.

However, the NITI Aayog drafting committee has a different view. They are of the opinion that “monitoring the fees at the micro level might encourage ‘rent seeking behaviour’ in the commission, and moreover, a fee cap would discourage the entry of private colleges thereby undermining the objective of rapid expansion of medical education.”

Therefore, to balance the equation, they have proposed monitoring the fees not exceeding 40% of the seats at private medical colleges, and the fees for the remaining seats to be determined by the college administration. Even though it seem like a logical step, the fact that the proposal says ‘not exceeding 40%’, can be interpreted to mean that fee needs to be regulated for a maximum of 40% of the seats and a college could even get away with as little as 5% of the seats being subject to regulation and this could vary according to the decision of the commission.

This also means that no ceiling has been proposed on the market-led fee structure which would have its own impact on students who may graduate with huge student loans. The norms for the fees regulation must clearly define a minimum percentage of seats and not give an open-ended upper limit.

Shortage of medical practitioners

India is the largest producer of medical manpower in the world in spite of which there is an acute shortage of medical staff at public health centres.

As of March 31, 2025, there were 25,308 primary health centres (PHC) for a rural population of about 83.3 crore. The shortfall of staff at the PHCs is “83.4% of surgeons, 76.3% of obstetricians and gynecologists, 83.0% of physicians and 82.1% of pediatricians.”

Similarly, at the community health centres, out of the sanctioned posts, “74.6% of surgeons, 65.4% of obstetricians and gynecologists, 68.1% of physicians and 62.8% of pediatricians” were vacant as of March 31, 2015. The data clearly indicates the severe shortage of medical staff at these health centres. Therefore, the committee should make rural health service mandatory for the medical students, which will help to address the shortfall of medical staff at these health centres which, at times, are the only healthcare options that are available to the rural and marginalised people.

Expansion of medical colleges

According to the 2006 report, the World Health Organisation identified India among the 57 countries facing a critical shortage of health workforce. India has one doctor for every 2,000 people instead of the 1,000 people norm of the WHO. According to the data provided by the Ministry of Health and Family Welfare for the year 2015-2016, there were 200 government medical colleges (27,143 medical seats) and 222 private medical colleges (29,995 medical seats) throughout India. Moreover, it can be inferred from the data that six states with 31% of India’s population account for 58% of the MBBS seats, while the other eight states, which comprise 46% of India’s population, have 21% of the MBBS seats.

Considering the shortage of medical seats, the committee has expressed views of expanding large district level hospitals and major private hospitals into medical colleges to impart postgraduate education.

The committee believes that the expansion will be achieved without spending much on the infrastructure, and it will provide for the utilisation of the doctors employed in private hospitals. In fact, the expansion of large district hospitals into medical colleges is a logical step as it will increase the number of medical seats and will cater to the medical aspirations of students belonging to that particular district.

However, the question remains whether these large district hospitals be equipped with the infrastructure necessary to provide quality education and training to the students. It is also known that most private hospitals charge a high fee based on the attending doctor’s reputation who may not encourage the junior doctors to train by attending to the patients.

Therefore, the above proposal would be fruitful only if the infrastructure of the concerned hospitals is upgraded to provide quality education with some minimum hours of practice under senior doctors. The commission would also need to ensure strict regulation and accreditation of the teaching faculty at these hospitals.

Proposal for allowing ‘for-profit’ medical colleges

The proposed Bill has recommended the removal of the ‘not-for-profit’ clause from the Act and permitting the establishment of ‘for-profit’ colleges. The committee believes that the medical expansion through private institutions is required to meet the shortage of medical practitioners in our country. It is true that the private institutions need to participate, but commercialisation and profit making from medical education is not the solution.

The privatisation of medical education was started to meet the rising demand of doctors, which received a further impetus after the liberalisation of the Indian economy in 1991. India is the only country where many medical colleges illegally charge ‘capitation fees’, which may range from Rs 25 lakh to Rs 1 crore. This illegal practice often becomes a hindrance to a medical aspirant who belongs to a financially deprived background.

Under the previous Act, not-for-profit colleges were allowed, but at present, the number of private medical colleges is greater than the number of government colleges, which clearly indicates that the private sector already has a significant presence medical education.

The ‘for-profit’ clause in the Bill, however, will allow medical colleges to make a profit according to their will, which would lead to the rise in education fees as well as an increase in healthcare expenditure. This would also provide an opportunity for foreign medical institutions to establish partnership colleges/institutions in India with the assistance of Indian corporate houses. Therefore, in order to achieve a greater participation from the private and the government sector in medical education, there is a need to remove the rigid barriers to the establishment of medical colleges.

The medical council has several mandated norms like a minimum land requirement of 20 acres, a minimum number of classrooms and norms on the size of lecture halls, examination hall and library required to establish colleges, all of which leads to an increase in the investment amount and a higher investment leads to a higher fee for the students.

Moreover, despite the ban on animal experiments in our country, unnecessary labs such as ‘mammalian amphibian and experimental pharma labs’ are required to be maintained by the colleges, which puts an additional financial burden on them. It takes more than Rs 200 crore to establish a medical college and about Rs 1,500 crore to set up an institution like AIIMS. Therefore, the committee should retain the previous clause of ‘not-for-profit’, and lay emphasis on replacing the obsolete infrastructural norms with the essential norms in accordance with the healthcare of the country. With the reduction in the investment amount, the government, as well as other private institutions would be able to establish more colleges.

Regulation for unethical code of conduct

In the proposed Bill, the code of ethics has been put under the regulation of the Board for Medical Registrations and has not been given adequate attention. The committee needs to understand the importance of doctors following a strict code of ethics and the fact that its compliance needs to be strictly enforced and monitored.

Despite anecdotal data indicating that the number of unethical practices has increased in India, only 109 doctors have been blacklisted by the MCI in the period between 1963 and 2009. In UK, the disciplinary actions are taken by separate tribunals, which are separate bodies independent of the GMC. In India on the other hand, the state medical commissions are responsible for ensuring the medical code of conduct, and they have not been efficient as it can be inferred from the data.

The committee has failed to adopt the recommendations made by the PSC for the formulation of a separate board of medical ethics which could be constituted on the lines of the GMC or the Australian Medical Council and comprise non-doctor members.

The Medical Assessment and Rating Board has been assigned powers to conduct the assessment of medical institutions. However, there is no provision in the Bill for the accreditation or for the regulation of teachers at medical colleges, nursing homes, hospitals, clinics, pharmacy and chemists.

In a particular instance, when the MCI took action against a super specialty hospital for certain lapses, the hospital approached the Delhi high court stating that they did not fall under the MCI and the judgment was made in favour of the hospital. Similarly, it has been reported that certain pharmaceutical companies organise pleasure trips for doctors in order to seek favour for the medicines they produce.

In September, the Income-Tax Appellate Tribunal passed a judgment stating that the practice of entertaining and offering pleasure trips to doctors by pharmaceutical companies was illegal. It is for the first time that such a practice has been nabbed, and that too by the Income-Tax Appellate Tribunal and not by the MCI. Therefore, teachers, clinics, hospitals and pharmacies should be accredited, and brought under the ambit of the medical commission. Moreover, as mandated by leading universities across the world, students should assess the teachers rather than an external body.

Archaic medical education in India

Admission to medical colleges, which is based on exams that have multiple-choice questions, tests the memory and not true knowledge of the students. In addition, there is no provision for evaluating the humanitarian aspect of the aspirant, which is an essential characteristic for an ethical doctor. Hence, the exam allows for anyone with the ability to memorise medical information to become a doctor.

In the UK, the undergraduate admissions are based on applications and the Bio Medical Admissions Test, which assesses the scientific aptitude, critical thinking and written communication skills. Based on the test, offers of admission are made to students after an interview process. The proposed Bill fails to address this aspect.

Further, the Bill provides for ‘developing a competency based dynamic curriculum (including assessment) at the undergraduate and postgraduate level, as per the needs of the country and keeping in mind the global norms.’ The Bill, however, fails to address the ‘traditional long case-short case system,’ which is based on memorising a lot of facts rather than emphasising on clinical experience. On the other hand, most  foreign countries follow the ‘Objective Structural Clinical Exams’ to test the competency of the students.

Hence, the commission has to ensure that the medical curriculum should be implemented with the integration of subjects such as medical ethics, behavioral science, communication skills, managerial skills, which receives little attention in the current scenario, along with greater prominence on clinical skills and experience.

The draft Bill of 2016 has been introduced to bring a complete reformation in the structure and the functioning of the medical commission, however, the Bill is not free from flaws, some of which need urgent reconsideration:

  • Minimum qualifying marks in the NEET need to be defined.
  • Fixing of the fees for a minimum percentage of seats in the private medical institutes instead of the open-ended clause ‘not exceeding 40% seats’
  • The ‘not-for-profit’ status of the medical colleges should be retained.
  • Replacement of the outdated norms to establish colleges.
  • Accreditation of teachers, clinics, pharmacies, chemists, hospitals should be made mandatory.
  • Rural service at the primary and community health centers should be made mandatory for the medical students and as part of their curriculum.
  • A separate board of medical ethics should be created to investigate and prosecute cases of unethical practices by doctors.

Nevertheless, the Bill contains some positive reforms that are reflected through the complete reformation of the administrative structure of the commission. However, the core objectives of the commission have to be upheld, which include creating and training a medical workforce that can work effectively in our country.

Moreover, the proposed Bill will not prove to be fruitful if it does not emphasise on strict regulatory and enforcement practices. Therefore, instead of emphasising on the creation of medical colleges, the prime focus should be on the quality and skills of the doctors being produced who will effectively cater to the increasing requirement of healthcare in our country with the right ethical code of conduct.

Abhishek Jain is a Research Assistant to Legislators at the Rajiv Gandhi Institute for Contemporary Studies, Delhi