Why doctors oppose Modi's medical bill

'This government wants to keep control of everything in its hands.'
'If they have their stooges sitting on the National Medical Commission, they will do only the government's bidding.'
'Imagine a scary situation where people who have no knowledge about medicine sit on a commission that will take decisions on matters related to medical education, doctors and medical ethics.'

Dr Shivkumar Shankar Utture, president, Maharashtra Medical Council, tells Rediff.com's Prasanna D Zore why the Medical Council of India, the Indian Medical Association and Maharashtra Medical Council are vociferously opposing certain provisions of the National Medical Commission Bill.

The Bill, Dr Utture, below, left, will allow doctors practicing alternative medicine to practice allopathic medicine.

What clauses of the National Medical Commission Bill are you opposed to?

The fundamental opposition is to the dissolution of the Medical Council of India and bringing the National Medical Commission in its place.

In a democracy we expect representation of elected members. Now, what has happened over here is out of the 25 NMC members only five will be elected by the doctors from the medical fraternity all over India. And even they will be part-time members.

There are almost 800,000 doctors in India and the NMC will have just five elected representatives from the medical profession.

Strangely, there will be just five doctors from five different states that will be representatives of 29 states of India.

Health and medical education being a concurrent (list) subject, all states should also have a say in its composition and decision-making is what we feel.

But what will happen because of the NMC is that a big state like Maharashtra, with over 100,000 doctors and 33 medical colleges, will get its turn (to be a member of the NMC) once in 24 years.

So, this composition will not get proper representation of states and is hence fundamentally flawed.

Even among the rest 20 members (out of the 25 in the NMC), 15 will not necessarily be from the medical fraternity. At least, that is what the NMC Bill says.

That is like saying that the Bar Council should be made up of doctors!

Imagine a scary situation where people who have no knowledge about medicine sit on a commission that will take decisions on matters related to medical education, doctors and medical ethics.

Given these critical issues raised by the Indian Medical Council, why is the government trying to enact a legislation that is as controversial as you state it is?

Somehow, this government wants to keep control of everything in its hands.

If they have their stooges sitting on the NMC, they will do only the government's bidding.

Today, under the Constitution, the Medical Council of India is supposed to be a statutory and autonomous body.

This means, it is not necessary that today the MCI is listening to everything that the government is saying or wants it to do. But this will change only if the government will have its own stooges on the NMC.

The other thing that we are opposed to is that as far as the admissions (to medical colleges) are concerned, we at the IMA (Indian Medical Association) have fought for years against the practice of capitation fees, which would be in lakhs of rupees, for getting admissions into private and deemed medical colleges and we got a Supreme Court judgment just last year saying that admissions to these colleges should be based on the NEET (National Eligibility and Entrance Test) scores.

What the NMC Bill says is that up to 40 per cent seats should be controlled by the government.

Mark this clause 'up to 40'; it doesn't even say exactly 40!

This effectively means that private medical colleges and deemed medical universities will have the right to charge whatever fees they want for 60 per cent or more medical seats.

Tomorrow, how could a candidate from the economically lower or middle class family afford Rs 16 lakh to Rs 20 lakh fees that these private colleges charge per year?

For the remaining seats, the government may decide the fees, say Rs 4 lakh per year, or whatever it deems fit.

That is what we are doing today for the 85 per cent of the seats coming the government's way and only 15 per cent seats going to private medical colleges.

These 85 per cent admissions are decided as per NEET merit and the government has put a moratorium on how much fees they can charge because we have got a committee that decides the fee structure.

The biggest losers of this provision will be meritorious students who will not be able to pay such astronomical fees.

So, what we are asking is that the government should keep this 85:15 quota intact and not replace it with 'up to 40 per cent with the government and more than 60 per cent with the private colleges' structure.

Why should the government allot more than 60 per cent seats to private medical colleges and allow them to charge whatever fees they want?

The entire course fee for the five-and-a-half year MBBS course would run upwards of Rs 1 crore.

Do you think meritorious students who are not financially strong will be able to afford such high cost of medical education?

Why is the government trying to enact such a law?

You will have to ask the government (about this).

Majority of the private medical colleges belong to politicians and because of the Supreme Court judgment their source of income has dried up as they cannot charge capitation fees because of the law against it.

The other way (source of income of private medical colleges) is to go on increasing tuition fees in these colleges.

Are you suggesting that the private medical college lobby is behind the NMC Bill?

Obviously.

There is also a provision in the NMC Bill to allow people who practice alternative medicine, like yoga or ayurveda, to practice allopathy after doing a 'bridge course'. What do you think are the dangers of this provision?

Today, an MBBS candidate studies a five-and-a-half year curriculum and then goes for training and then practices allopathic medicine.

Imagine someone who has not understood modern medicine and studied ayurvedic medicine or homeopathy, prescribing allopathic medicines. Also, see the contradictions here.

The homeopaths do not believe in immunisation therapy; ayurveda believes only in herbal therapy.

Suppose these people after they study homeopathy and ayurveda, doing a small 'bridge course' of six months or one year we do not know, are allowed to prescribe allopathic medicines.

Imagine what havoc they will create as far as the health of the common man is concerned.

Just to give you an example, this is like saying that a truck driver after a few months of flight training is allowed to fly aeroplanes.

With a license to drive a light motor vehicle, can I drive a truck?

Shouldn't I get adequate training, pass certified exams and then be allowed to drive a truck?

When you are treating a patient, isn't the patient's life in your hands?

Modiji, on one hand is saying ayurveda is a great medicine practice; we too respect ayurveda.

He is asking them to do research in ayurveda and now he will be passing a bill that will allow these ayurvedic doctors to practice allopathy.

In that case, what is going to happen to your (Prime Minister Darendra D Modi's) emphasis on ayurveda?

This bill, if it becomes a law, will deliver a death-knell to alternative medicine.

Do you have any idea what syllabus will a student be taught in this 'bridge course' and how will it make these students proficient in prescribing allopathic medicines?

No idea whatsoever. The (NMC) Bill just talks about this 'bridge course'. There are no details.

The Bill only says 'as prescribed', which means it is left for the government to decide.

Will patients risk their lives going to such medical practitioners who prescribe or deliver allopathic medical treatment after doing just a 'bridge course'?

If I just write 'clinic of Dr Utture', will the patient coming to me have any idea about what type of doctor I am -- if I am an allopathic, homeopathic or ayurvedic doctor.

But that's how medical services are delivered in rural India, aren't they?
Don't you think these doctors also form an important part of an ecosystem that delivers medical services to inaccessible rural India?

They do form an important link. But let them practice their system of medicine and if they have a problem they can always refer these cases to doctors who have studied modern medicine or who they think can better handle a case.

All we are asking this government is if you are that much interested (in allowing alternative medicine doctors to prescribe allopathic medicine) then you convert all the homeopathic and ayurvedic colleges into MBBS colleges, so that doctors who come out of these colleges are properly trained in that system of medicine.

Why doesn't the government do that?

Here too there is a huge scam because hundred per cent of the homeopathic colleges and 90 per cent of the ayurvedic colleges are again owned by private entities and that means by politicians.

In Maharashtra, only four ayurvedic colleges are owned by the government and the rest 28 to 30 colleges are owned by the politicians.

Not even one homeopathic college is owned by the Maharashtra government.

There is a hidden agenda somewhere in all this happening, but the ultimate sufferers will not be practitioners of allopathic medicine today, but the public who will have to go these half-trained doctors.

The simple solution (to overcome the problem of shortage of trained doctors) would be to increase the number of medical seats; give proper training to these doctors and then give them the license to practice medicine.

Don't let loose half-baked doctors on the public; don't take people for granted.

Union Health Minister J P Nadda maintains that 'the NMC Bill is beneficial to the medical profession'. What do you make of this statement given the reasons you have cited for opposing the NMC Bill in its current form?

If this was so beneficial for the medical profession, then are we fools to fight against it? We would have welcomed it.

We are not bothered about medical professionals; we are bothered about the citizens and the future generation of (medical) students.

If you (doctors who have studied alternative medicine) could practice allopathic medicine by just doing this 'bridge course' then why do you think anybody will enrol for MBBS courses?

Ultimately, it (enacting the NMC law) is a loss to the nation.

Now that the NMC Bill has been referred to a Select Committee of Parliament, do you hope any positives will come out of this exercise?

We were afraid of the brute majority of the ruling party in Lok Sabha because of which it can pass anything and everything they want. That is the big problem now.

The Select Committee will at least have members of the other (political) parties and there will be deliberations on the contentious issues of the NMC Bill.

These issues will be questioned, discussed and take all sides into consideration before making its own recommendations.

But what purpose will it serve, since, as you have said, this government has a brute majority in the Lok Sabha?

At least, if the Select Committee makes some recommendations, then the Bill will have to be tabled (in the Lok Sabha) with these recommendations. They cannot table the original bill.

Will these recommendations be binding on the government of the day?

Yes, if they have to get it passed or they will not table the (NMC) Bill with its recommendations at all.

This will be like many other Bills that go to the Select Committee where recommendations are made and if they are not as per the government's liking they just bury that Bill.

Do you think the NMC Bill will also meet the same fate?

We all want progress. We are not saying the whole NMC Bill is bad. Only some of the provisions of this Bill are bad.

Was the Medical Council of India consulted while drafting this Bill?

We've had discussions for almost an year with the central government and highlighted all these contentious issues during our discussions.

Unfortunately, the government completely ignored our suggestions and tabled the Bill in its original format in the Lok Sabha.

It was not an overnight decision to go on a strike (the nationwide strike by Indian Medical Association doctors lasted 12 hours after which it was called of when the NMC Bill was referred to a Select Committee of Parliament).

What logic makes the government ignore suggestions that are for public good?

Do you think the many things that the government does have any logic? They do it because they want to do it.

Photograph: Sahil Salvi