With the aim of ensuring smooth compliance with its functions and to maintain high quality and standards, the National Medical Commission (NMC) has published Maintenance of Standards of Medical Education Regulations, 2023, or MSMER-2023. 

The draft was introduced in the public domain by the director of the UG Medical Education Board of NMC, Shambhu Sharan Kumar, on June 23, 2023. The NMC has introduced a penalty of up to Rs 1 crore for medical colleges that do not comply with medical education norms. Medical institutions must provide an annual disclosure report to the respective board. Failure to adhere to the norms may result in penalties, further inquiries and even criminal proceedings. The move is intended to improve compliance with standards in medical education, particularly in colleges facing faculty shortages.

Additionally, doctors, departments or institute heads could face penalties up to Rs 5 lakh for submitting false documents.

Under the new regulations, all medical colleges are mandated to furnish an Annual Disclosure Report before the Commission. Also, the respective Board (PGMEB or UGMEB) will undertake evaluation of the Annual Disclosure Report for verifying whether the medical college fulfils the required conditions prescribed by NMC. 

These include—verification of physical infrastructure, availability of required number of qualified faculty for actual teaching and research and to undertake necessary student learning activities on a regular and continued basis, availability of adequate clinical material in terms of number of patients of different specialties, variety of patients to fulfill all round training of students, number of procedures, surgeries, laboratory investigations, radiological investigations and other relevant investigations, assessment of the teaching methodology adopted, methods and modes of assessment, grading of the students; review of feedback from students and other parameters related to standards of medical education that may be added from time to time by the respective boards or as per the NMC notification.

The NMC may also withhold and withdraw accreditation for a period up to five academic years. Any attempt to pressurise the UGMEB, PGMEB or NMC through individuals or agency will lead to immediate halt of the processing of all applications by the medical institution, the draft said.

The central government has also introduced a command centre to keep a tab on faculty members, their attendance and patients at outpatient clinics as well as those undergoing surgeries. This centre uses a network of CCTV cameras that each medical college has to install at key points such as OPD entrance, hospital information management system and Aadhaar-based biometric attendance system for the staff.

The regulator has introduced such a monetary penalty for the first time. The move is likely to ensure better compliance with norms as several government and private colleges have been facing faculty shortage. Several government-run colleges, established over the last few years, also do not comply with these norms.

Earlier in June 2023, with the publication of the new Graduate Medical Education Regulations (GMER) 2023 in the official Gazette, medical institutes violating the norms of MBBS admission had to face strict penalties. They were liable to pay a huge fine ranging from Rs 1 crore to Rs 2 crore per seat.

In the earlier draft of GMER 2023 regulations, the UGMEB of NMC had mentioned that medical colleges would have to pay Rs 50 lakh to Rs 1 crore per seat as a penalty for violating the norms of MBBS admission. But in the final GMER, 2023, that was published in the official Gazette on June 2, 2023, the penalty was set to be doubled from the earlier draft.

Specifying that all the students getting admitted to UG medical courses need to clear the NEET-UG examination, the NMC specified in the draft that “no medical institute shall admit any candidate to the graduate course in contravention of these regulations”. The UG Medical Education Board reiterated that it was mandatory for the students to score the minimum eligible score at the NEET-UG exam to pursue graduate medical education either in India or elsewhere.

Further, addressing the issue of backdoor entry in medical admission and in an attempt to put a stop to it, the Commission specified in the draft: “Provided the medical institution granting admission to any student in contravention of these Regulations, shall be liable to be fined for Rupees 50 lakh per seat for the first-time and for the second time of non-compliance, Rupees one Crore per seat and for any subsequent non-compliance or continued contravention the medical institution shall be barred from granting admissions to any students from the next academic year.”

In fact, the flouting of norms by medical colleges is an old issue and has been going on for years all over India. It was in May 2023 that 40 medical colleges all over India were found not complying with NMC norms. Also, about 100 more medical colleges in Tamil Nadu, Gujarat, Assam, Punjab, Andhra Pradesh, Puducherry and West Bengal were on the verge of facing similar action.

Inspections by the NMC found lapses in CCTV cameras, Aadhaar-linked biometric attendance procedures and faculty rolls. According to government data, there was 69% increase in the number of medical colleges since 2014—from 387 before 2014 to 654 as of now, Minister of State for Health Bharati Pravin Pawar had told the Rajya Sabha in February. Even the number of MBBS seats had increased by 94%—from 51,348 before 2014 to 99,763 as of now. 

In August 2022, several private medical colleges in Vijayawada were found flouting norms in fee collection from students. After the state government revised the fee structure downwards for PG medical courses, some managements found nefarious ways to recoup this amount from the students. Such incidents have also been found in other private medical colleges in India. 

—By Abhilash Kumar Singh and India Legal Bureau

The NMC Act will bring in much-needed reforms in the medical education sector by ensuring probity, bringing down costs, simplifying procedures and enhancing the number of medical seats in India.

By Dr KK Aggarwal

The National Medical Commission (NMC) has come into force from September 25, 2020, thereby repealing the nearly 64-year-old Indian Medical Council Act, 1956. All its bodies such as the Medical Council of India and Board of Governors, which superseded the MCI on September 26, 2018, have also been dissolved.

 
As a result, the much-awaited NMC will start to function effectively soon to bring reforms in the medical education sector. Last year, the National Medical Commission Act 2019 was passed by both Houses of Parliament.

A gazette notification by the health ministry read: “The Indian Medical Council Act, 1956 (102 of 1956) is hereby repealed with effect from September 25. The BoG appointed under Section 3A of the Indian Medical Council Act, 1956 (102 of 1956) in supersession of the MCI constituted under sub-section (1) of section 3 of the said Act shall stand dissolved.”

Dr Suresh Chandra Sharma, former Head of Department, ENT, All India Institute of Medical Sciences, has been appointed the chairman of NMC for three years, while Dr Rakesh Kumar Vats, ex-Secretary General, Board of Governors, MCI, has been appointed Secretary of NMC for three years. Apart from the Chairman, the NMC will consist of 10 ex-officio members and 22 part-time members appointed by the government.

To ensure transparency, the members will have to declare their assets at the time of joining and demitting office, along with declaring their professional and commercial engagement or involvement. Further, the chairperson/member on ceasing to hold office will not accept any employment for two years in a private medical institution whose matter has been dealt with him either directly or indirectly.

The purpose of the NMC Act, 2019, is to provide for a medical education system that improves access to quality and affordable medical education, ensures availability of adequate and high quality medical professionals in all parts of the country; promotes equitable and universal healthcare that encourages community health perspective and makes the services of medical professionals accessible to all citizens. Further, it promotes national health goals; encourages medical professionals to adopt latest medical research in their work and to contribute to research; has an objective, periodic and transparent assessment of medical institutions and facilitates maintenance of a medical register for India. It also enforces high ethical standards in all aspects of medical services; is flexible to adapt to changing needs and has an effective grievance redressal mechanism. 

The functions of the NMC include: 

• framing policies for regulating medical institutions and medical professionals
• assessing the requirements of healthcare related human resources and infrastructure
• ensuring compliance by the State Medical Councils of the regulations made under the Bill
• framing guidelines for determination of fees for up to 50 percent of the seats in private medical institutions and deemed universities which are regulated under the Bill.

The NMC will frame policies and co-ordinate the activities of four autonomous boards.  Each autonomous board will consist of a president and four members, appointed by the central government. These boards are—Under-Graduate Medical Education Board (UGMEB), Post-Graduate Medical Education Board (PGMEB), Medical Assessment and Rating Board (MARB) and the Ethics and Medical Registration Board (EMRB).

Read Also: All about National Medical Commission Bill, 2019

UGMEB and PGMEB Boards will be responsible for formulating standards, curriculum, guidelines, and granting recognition to medical qualifications at the undergraduate and post-graduate levels respectively. MARB will have the power to levy monetary penalties on medical institutions which fail to maintain the minimum standards as laid down by UGMEB and PGMEB. It will also grant permission for establishing a new medical college, starting any post-graduate course or increasing the number of seats. EMRB will maintain a national register of all licensed medical practitioners and regulate professional conduct. Only those included in the register will be allowed to practice medicine. The Board will also maintain a separate national register for community health providers. 

The NMC may grant a limited license to certain mid-level practitioners who may prescribe specified medicines in primary and preventive healthcare. In any other cases, these practitioners may only prescribe medicines under the supervision of a registered medical practitioner.

There will be a uniform National Eligibility-cum-Entrance Test for admission to under-graduate and post-graduate super-speciality medical education in all medical institutions regulated under the Bill. The NMC will specify the manner of conducting common counselling for admission in all such medical institutions. There will be common final year under-graduate examination called the National Exit Test for students graduating from medical institutions to obtain the license for practice. This Test will also serve as the basis for admission into post-graduate courses at medical institutions.

Under the NMC Act, the final year examination has been converted into a nationwide exit test called NEXT. This single examination will grant—

• a license to practice medicine
• an MBBS degree
• entrance to postgraduate courses.

There is a provision for common counselling for entrance to PG courses also.

Students will be able to get admission to seats in all medical colleges and institutes of national importance like AIIMS, PGI Chandigarh and JIPMER through a single counselling process. The Act does not impose any restriction on the number of attempts at NEXT examination.

An outstanding feature of the NMC Act is that it provides for the regulation of fees and all other charges in 50 percent seats in private colleges as well as deemed to be universities. There was no provision to regulate fees in the Indian Medical Council Act 1956. According to the government, nearly 50 percent of the total MBBS seats in the country are in government colleges, which have nominal fees. Of the remaining seats, 50 percent would be regulated by NMC. This means that almost 75 percent of the total medical seats in the country would be available at reasonable fees.

According to the central government, the NMC Act will reduce the burden on students, ensure probity in medical education, bring down its costs, simplify procedures, help to enhance the number of medical seats in India, ensure quality education and provide wider access to people for quality healthcare.

—The writer is President, Confederation of Medical Associations in Asia and Oceania, and former National President, IMA

Lead Picture: UNI