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A walk in the Park

This blog is dedicated to everyone who has struggled with Community Medicine. Through my posts I hope to simplify and demystify community medicine. The emphasis will be on clarifying concepts rather than providing ready-made answers to exam questions.

Feedback is crucial for the success of this endeavour, so you are encouraged to comment and criticize if you cannot understand something.

If you want a topic to be discussed sooner rather than later, please let me know via

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A single example may not be able to explain 100% of a given topic, so multiple examples may be provided to explain different parts of a single concept.

If something doesn’t seem right:

a. Write to me about it (at communitymedicine4asses@yahoo.com), and

b. Cross check with another source (textbook, expert, etc.)

I hope that my exertions will make your experience with community medicine seem like a “Walk in the Park”

Note 1. Those who wish to contact me on facebook are requested to kindly send a personal message introducing themselves along with the request. This will help save time and effort of all concerned. Please do not expect me to visit your page to try and identify you/ your areas of work/ interest, etc. It is common courtesy to introduce oneself to another when interacting for the first time. I am merely requesting that the same civil courtesy be extended here, too. Henceforth, I may not accept any friend requests/ requests to join the group on facebook unless accompanied by a note of introduction (except when I already know the sender).  

Note 2. Please understand that this blog (and the corresponding facebook page/ group) is maintained in my spare time. I have a full time job, and am available to pursue these activities only after regular working hours (after 5 pm Indian Standard Time). However urgently you may wish to receive a response from me, I will be able to respond only upon returning home from work (I am offline the rest of the time).

Note 3. Please mind your language when interacting with me/ in the group linked to this blog. Rude/ offensive language will result in expulsion from both my friends list and the said group.

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National Medical Commission Bill 2019: Essential Information- Part 2

This is the second part of a mini-series on the National Medical Commission Bill (NMC Bill)2019.

Background Information:

“Medicine” means modern scientific medicine in all its branches and includes surgery and obstetrics, but does not include veterinary medicine and surgery.

Key Messages:

The NMC Bill proposes the creation of four Autonomous Boards under the National Medical Commission:

  1. the Under-Graduate Medical Education Board
  2. the Post-Graduate Medical Education Board
  3. the Medical Assessment and Rating Board
  4. the Ethics and Medical Registration Board

Composition of Autonomous Boards

Each Autonomous Board will consist of

  • 1 President (term of 4 years; no extension/reappointment)
  • 2 whole-time Members (term of 4 years; no extension/reappointment)
  • 2 part-time Members (term of 2 years; no extension/reappointment)

The above may hold office up to the age of 70 years.

Under-Graduate Medical Education Board:

The functions of the Under-Graduate Medical Education Board are listed in the map below:

Functions of Under-Graduate Medical Education Board

a. Under-Graduate Medical Education Board

Post-Graduate Medical Education Board:

This body has the same functions as the Under-Graduate Medical Education Board, albeit for postgraduate and super-specialty courses.

In addition, it is supposed to ‘promote and facilitate postgraduate courses in family medicine’.

Medical Assessment and Rating Board:

The functions of this body are listed in the map below:

Functions of Medical Assessment and Rating Board

c. Medical Assessment and Rating Board

It is important to note that assessment and rating of medical institutions may either be performed by the MARB itself, or it may engage a third party agency/ persons for the same. In the latter case, medical institutions are obliged to provide access to such agency or persons.

Ethics and Medical Registration Board:

The functions of the Board are listed in the map below:

Functions of Ethics and Medical Registration Board

d. Ethics and Medical Registration Board

National Register and State Register

The Ethics and Medical Registration Board will maintain a National Register that

  • will inter alia contain the name, address, all recognised qualifications possessed by a licensed medical practitioner
  • will be maintained in such form, manner as specified
  • will be a public document, available to the public by placing it on the website of the Ethics and Medical Registration Board
  • will be electronically synchronised with the State Registers so that any change in one Register is automatically reflected in the other Register
  • will maintain a separate National Register containing specified particulars of Community Health Providers

Community Health Providers

These will be persons connected to modern scientific medicine who satisfy specified criteria

They will be granted limited licence to practice medicine.

The number of limited licence granted shall not exceed one-third of the total number of licenced medical practitioners registered (in the National Registry).

Limited licence means:

  • they may independently prescribe specified medicine only in primary and preventive healthcare in specified circumstances and for specified duration.

In all other situations, they may prescribe medicine only under supervision of a licenced medical practitioner.

Note: The Bill clearly states that Community Health Providers must be connected with modern scientific medicine. This excludes practitioners of alternative systems of medicine (AYUSH) from becoming Community Health Providers. Community Health Providers could possibly be nurses or paramedical personnel. Claims that this clause is intended to allow AYUSH practitioners to practice modern medicine/ this is indicates/ permits a ‘bridge course’ are in error.

Licenced Medical Practitioner

This is a person who

  • possesses recognised medical qualifications as specified by the NMC (this includes qualifications awarded by statutory bodAIIMS, PGIMER, JIPMER, NIMHANS, NBE, etc.; and recognised qualifications granted by any University/ medical institution in India)
  • has passed the National Exit Test (for those who obtained medical qualification from a foreign country, for instance)

Diplomate of National Board (DNB) in broad specialty and super-specialty qualifications granted in a medical institution with attached hospital or in a hospital with 500 or more beds by the National Board of Examinations (NBE) will be equivalent in all respects to the corresponding postgraduate/ super-specialty qualification granted under the NMC Act. In all other cases, senior residency in a medical college for an additional period of one year will be required for such qualification to be equivalent.

Bar to practice

No person other than those who are enrolled in the State/ National Register shall

  • be allowed to practice medicine as a qualified medical practitioner
  • hold office as a physician/ surgeon
  • be entitled to sign/ authenticate medical/ fitness/ any other certificate required by law to be signed by a qualified medical practitioner
  • be entitled to give evidence as an expert on any matter relating to medicine

Punishment for contravention of the above will be punished with

  • imprisonment up to one year and/or
  • fine up to 100,000 rupees

Additional comments:

One of the claims pertains to fees in private medical institutions and deemed to be universities. There is a suggestion that fees will be unregulated for 50% seats in such institutions. This is untrue, since the NMC Bill as passed by the Lok Sabha states that the Commission will lay down regulations for the regulation of fees of 50% seats in private medical institutions and deemed to be universities (section 10(i)).  This also deflates arguments claiming the NMC Bill would make medical education unaffordable, with private medical institutions charging exorbitant fees as a result of fee deregulation.

Claims regarding potentially adverse consequences of permitting limited licence to Community Health Providers are based on assumptions of incompetence of such providers. However, the Government of India has provided examples of successful experiments involving healthcare by such providers in Assam and Chhattisgarh. There is evidence that such a provision will improve healthcare in underserved areas provided the quality of personnel is regulated tightly. In any case, if healthcare is provided by trained personnel instead of unqualified persons, the consequences cannot be worse than a situation where care is provided by unqualified persons alone. Large-scale protests against this provision by sections of the medical fraternity are unfortunate, since the healthcare crisis in rural India is largely a result of most doctors’ refusal to work in those areas. 

It is heartening to note that the NMC Bill emphasizes family medicine and community medicine. This is a welcome step that is likely to restore balance in a healthcare system heavily biased in favour of specialization and super-specialization.

Useful Links:

Link to the first article in this mini-series:

https://communitymedicine4asses.com/2019/08/11/national-medical-commission-bill-2019-essential-information-part-1/?fbclid=IwAR30yfnCuNc2uj-05MR0K_JKFr7oUmWnbasw9VysfEv_jvb42GM5NGp2fhw

Link to the NMC Bill as passed by Lok Sabha:

https://www.nhp.gov.in/NHPfiles/185-C_2019_LS_Eng.pdf

Link to Frequently Asked Questions on the NMC Bill:

http://pib.nic.in/newsite/PrintRelease.aspx?relid=192491

 

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