What failed MCI ?

Dr Sanjay Kumar Bhasin
The Medical Council of India (MCI) was first established in 1934 under the Indian Medical Council Act, 1933, later reconstituted under the Indian Medical Council Act, 1956. It took the shape of a statutory body for establishing uniform and high standards of medical education in India in addition to granting recognition of medical qualifications, accreditation to medical schools, granting registration to medical practitioners, and monitoring medical practice. After 80 years of its establishment and 60 years of it functioning as statutory body to deal with above aspects related to medical education in India a debate has been started by virtue of publication of a report by Parliamentary committee to look into working of MCI, whether MCI has failed in its assigned role. The performance of MCI is dismal as per the report. The Committee observed that MCI repeatedly failed on all its mandates and committee suggested remedy to the problem, few of the grey areas pinpointed are:- (i) MCI failed to create a curriculum for producing doctors as per Indian context especially in the rural health services and poor urban areas; (ii) MCI failed to maintain uniform standards undergraduate and post-graduate education; (iii) No checks on capitation fee & granting private medical institutions  (iv) MCI focused on nitty-gritty of infrastructure and human staff during inspections without substantial evaluation of quality of teaching, training and skills developments; (v) failure to create a transparent system of medical college inspections and grant of recognition or de-recognition;  geographical mal-distribution of medical colleges (vi) failure to oversee and guide the Continuing Medical Education in the country, leaving it in the hands of the commercial private industry; (vii) Code of Ethics not properly operationalised.
From amongst the above observations of MCI and as a senior medical teacher who is in the profession for now more than 30 years, what I feel most glaring for the debacle of MCI and failure of Health & Medical Education System in India are:
Mushrooming of Corp-orate Health Sector:   Corporate hospitals are being set up in increasing numbers with a motive to make huge profits and offer dividends to their shareholders. Private medical treatment is beyond the reach of the low socio-economic status people who form majority in India. Due to unhealthy nexus between pharma-surgical goods companies & the Corporate Hospital owners, the patient pays hugely inflated costs. Corporate big wigs are propagating that primary care (that is already decaying thanks to MCI’s inactions) should be the responsibility of government health sector and Secondary and Tertiary care should be given to the Corporate Health sectors. Last two being the most profit making sectors.
Capitation Fee: Private medical colleges necessitate huge capital investments by each medical student without checks and balances, even taste and merit of the student is ignored. On graduation, there is a need to recover these investments & hence medical students fail to face ethical dilemmas. Under these circumstances the students emerging from almost all medical colleges especially private Medical Colleges are ill-equipped to ask questions themselves or ponder the nature and consequences of their own actions towards patients and their families. MCI vehemently failed in assessing this aspect.
Less Emoluments for Government Doctors: if we talk of  both professional & non professional graduates like MBBS, Mass Communication, MBA etc, it is learned that an MBBS graduate is least paid amongst the all. Worst is the scenario with a postgraduate medical professional (MD/ MS).
Emolument imbalances between Government & corporate doctors set in an unhealthy idea in the mind of a government doctor.
Inducements: Whether healthy or not, they have been introduced and initiated by private labs, pharmaceutical companies as well as surgical goods manufacturers. The intense competition between private labs, pharmaceutical houses as well as radio-diagnostic centers has engendered the pernicious system of fee splitting. Rather they have induced doctors into malpractices for their personal gains. There are no checks on them by the Government or the controlling agencies including MCI. For wealth, prestige and respect in the society (that goes by how rich one is in the society today) doctors gets induced into these unhealthy practices.
Lack of Drug Policy: The Drug Policy of 1986, titled “Measures for Rationalization, Quality Control and Growth of Drugs & Pharmaceuticals industry in India” failed to see light of the day. Failure to implement it led to, mushrooming of propaganda Pharmaceutical houses, Uncontrolled Drug Manufa-cturing units; Lack of Rate & Quality Controls.
Quackery: India has more fake than genuine doctors, is the statement of Chairman of the anti-quackery committee of the Delhi Medical Council. It is surprising that in our country quackery has gone unchecked since long. Although Medical Council of India is not empowered to take action against quacks yet it never recommended ways & means to the government for proper redressal of the issue. It is behind the curtain reality that quacks demands in thousands for referring patients to different specialists.
Private Practice by Government Doctors: Although MCI puts bar on private practice by the medical teachers yet it neither check, nor controls such activities. The private practice by teaching faculty is one of the biggest factors in deteriorating teaching standards in GMC’s, proper patient care and lack of urge amongst teaching faculty of GMC’s to go in for proper research and to keep pace with technology developments. Total ban on private practice by teaching faculty can prevent further deterioration in medical education sector in Government hospitals.
Bureaucratic-political influences/over activism: Politicians and bureaucrats lecture too much to doctors on what they ought to be. Doctors are treated shabbily by the governments, even trod upon like dirt. Lack of recognition of the services of Doctors by the Society including Politicians & Bureaucrats adds to their frustration. Only when Doctors develop connections and acquire money he is accepted by Society.
The Parliamentary committee observed that the onus of failure of medical education system cannot be laid exclusively on the MCI but on both State & Central governments. The committees conclude, “Even at the risk of sounding repetitive, that the need for major institutional changes in the regulatory oversight of the medical profession in the country is so urgent that it cannot be deferred any longer. The Committee is, however, aware that any attempt at overhauling the regulatory framework will face huge challenges from the deeply entrenched vested interests who will try to stall and derail the entire exercise. But if the medical education system has to be saved from total collapse, the Government can no longer look the other way and has to exercise its constitutional authority and take decisive and exemplary action to restructure and revamp India’s regulatory system of medical education and practice. The Committee, therefore, exhorts the Ministry of Health and Family Welfare to implement the recommendations made by it in this report immediately and bring a new comprehensive Bill in Parliament for this purpose at the earliest.” Whether government acts upon the recommendations of the committee or not has yet to be seen but in welfare country like India where socioeconomic and related fabric of Indian society do not afford this sector to be taken over by the private players, definitely some concrete steps needs to be taken in the form of uniform medical education code & its vigorous monitoring, curb on mushrooming of Corporate Medical sector & rate controls, end of quack system & proper drug policy affordable to poor as well as ban on private practice by medical teacher hers with good emoluments to keep pace with their exaggerated needs may save this Nobel profession from  further decaying in the larger interest of patients and doctors.
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