World Rural Health Conference
Home Print this page Email this page Small font size Default font size Increase font size
Users Online: 538
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents 
EDITORIAL
Year : 2020  |  Volume : 9  |  Issue : 2  |  Page : 453-455  

Call for mandatory representation of practicing family physicians on the National Medical Commission (NMC): Leaving behind the monopolistic barriers in medical education regulation


President Academy of Family Physicians of India, Chief Editor Journal of Family Medicine and Primary Care, 049 Crema Tower, Mahagun Mascot Crossing Republik, Ghaziabad, Uttar Pradesh, India

Date of Submission18-Feb-2020
Date of Acceptance18-Feb-2020
Date of Web Publication28-Feb-2020

Correspondence Address:
Dr. Raman Kumar
President Academy of Family Physicians of India, Chief Editor Journal of Family Medicine and Primary Care, 049 Crema Tower, Mahagun Mascot Crossing Republik, Ghaziabad - 202 016, Uttar Pradesh
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jfmpc.jfmpc_279_20

Rights and Permissions
  Abstract 


The National Medical Commission is being constituted through an act of parliament, the NMC Act 2019. This new medical education regulator will take over the role of the Medical Council of India which is being currently run on adhoc basis through a board of governors (BOG). As per the provision of the NMC Act 2019 under section 24 (1) (c), the Under Graduate Medical Education Board is mandated to to develop competency based dynamic curriculum for addressing the needs of primary health services, community medicine and family medicine to ensure healthcare in such areas. Similarly under section 25. (1) (j) the Post Graduate Medical Education Board is mandated to promote and facilitate postgraduate courses in family medicine. It is important to note that the recently announced (2019) and highly publicized new MBBS curriculum the word “family medicine' has not been even mentioned in the 600 pages document. Through repeated engagements in the form of RTIs, and written representations, it appears that the experts of the Medical Council of India in the past have either deliberately blocked the development of family medicine in India or do not have the basic scholarship within this domain, despite clear direction from NHP and parliamentary standing committee. This has largely happened because there was never any representation of practicing family physicians in the Medical Council of India. The presence of practicing family physicians on the National Medical Commission should be mandatory.

Keywords: Family medicine, Family physicians, MBBS new curriculum, Medical Council of India, Medical education reforms, National Medical Commission


How to cite this article:
Kumar R. Call for mandatory representation of practicing family physicians on the National Medical Commission (NMC): Leaving behind the monopolistic barriers in medical education regulation. J Family Med Prim Care 2020;9:453-5

How to cite this URL:
Kumar R. Call for mandatory representation of practicing family physicians on the National Medical Commission (NMC): Leaving behind the monopolistic barriers in medical education regulation. J Family Med Prim Care [serial online] 2020 [cited 2020 Mar 29];9:453-5. Available from: http://www.jfmpc.com/text.asp?2020/9/2/453/279296




  Introduction: National Medical Commission Act 2019 Top


The National Medical Commission is being constituted through an act of parliament, the NMC Act 2019. This new medical education regulator will take over the role of the Medical Council of India which is being currently run on adhoc basis through a board of governors (BOG).[1] Earlier the 92nd report of the parliamentary standing committee on the functioning of the Medical Council of India noted that due to massive failures of the MCI and lack of initiatives on the part of the Government in unleashing reforms, there is total system failure due to which the medical education system is fast sliding downwards and quality has been hugely side-lined in the context of increasing commercialization of medical education and practice. The situation has gone far beyond the point where incremental tweaking of the existing system or piecemeal approach can give the contemplated dividends.


  Exclusion of Family Physicians and Family Medicine in Past Top


The 92nd parliamentary standing committee on health and family welfare report also noted that the medical education system is designed in a way that the concept of family physicians has been ignored. The committee recommends that the Government of India in coordination with State Governments should establish robust post graduate programs in Family Medicine and facilitate introduction of Family Medicine discipline in all medical colleges. This will not only minimize the need for frequent referrals to specialists and decrease the load on tertiary care, but also provide continuous healthcare for the individuals and families.[2]


  Family Medicine Disappeared from the New Mbbs Curriculum 2019 Top


It is important to note that the recently announced (2019) and highly publicized new MBBS curriculum the word “family medicine' has not been even mentioned in the 600 pages document. It is to be noted that many specialist colleagues sitting in the MCI opine that there is no demand for family medicine in the public and private sectors. This statement is one of the most biased statements. As a matter of fact, the experts of the Medical Council of India have continuously blocked “Family Medicine” through various regulations of the MCI Act. They have monopolized the medical education system in favour of their own specialist vocations. This is reflected by following (a) no independent and mandatory department of family medicine (b) MBBS curriculum doesn't even mention the word (c) Family physicians are ineligible to become faculty (d) Family practice clinics are barred from becoming training locations (e) no representation of family physicians in curriculum committee (f) No representation to family physicians in the governance of MCI.

Historically the actions and activities of the people sitting in the medical council of India have been contrary to the stated policies of the government of India in regards to the discipline of family physicians. Family medicine is the most needed specialty, academic discipline and knowledge domain for developing country like India with a high population and high levels of morbidities.


  Family Medicine in the Government of India Policies Top


Several policy documents of the Government of India have repeatedly recommended establishment of family medicine training programs in India. In 1983, “The Medical Education Review Committee” setup by Ministry of Health and Family Welfare GOI, under the chairmanship of Dr Shantilal Mehta recommended that 'the undergraduate (MBBS) medical students should be posted; in a general practice outpatient unit in order to be exposed to multidimensional nature of health problems, their origins. The committee also recommends that this specialty should be further developed so that an increasing number of students pursue higher study in the area.

National Health Policy 2002 stated that in any developing country with in inadequate availability of health services, the requirement of expertise in the area of “Public Health” and “Family Medicine” is markedly more than the expertise required for other clinical specialties. The National Health Policy (NHP) 2017 specifically mentions family medicine speciality and mandates popularization of programs like MD in family medicine. NPH 2017 recommends a large number of distance and continuing education options for general practitioners in both the private and the public sectors, which would upgrade their skills to manage the large majority of cases at local level, thus avoiding unnecessary referrals. The National Health Policy 2017 has emphasized the need to popularize MD Family Medicine and up-skill MBBS doctors through continuous professional development programs.


  NMC Act 2019 Mandates Family Medicine: it Is an Act Not, not Just Policy Top


As per the provision of the NMC Act 2019 under section 24 (1) (c), the Under Graduate Medical Education Board is mandated to to develop competency based dynamic curriculum for addressing the needs of primary health services, community medicine and family medicine to ensure healthcare in such areas. Similarly under section 25. (1) (j) the Post Graduate Medical Education Board shall promote and facilitate postgraduate courses in family medicine.


  Barriers to Academic Family Medicine and Primary Care in India Top


The principal barrier for the underdevelopment of family medicine in India is the non-existing family medicine departments. The family medicine department does not exist at medical colleges because it is not mandated under the minimum requirement to start a medical college regulation 1999. The other barriers are tertiary care oriented infrastructure requirements for the family medicine department as described in the PG regulation of MCI 2000. Similarly there is a need to modify minimum qualification for teachers in the department of family medicine under PG regulation of MCI 2000. These are regulatory and legal restrictions that are barriers to implementation of the well articulated national health policies (2002, 2017). It is more important to introduce the concepts of family medicine at UG level to MBBS students than to initiate MD programs. It is unfortunate that currently, we are training more than 70,000 MBBS students at more than 500 hundred medical colleges and all of them are being allowed to be qualified without any exposure to family medicine.


  Call for Representation of Practicing Family Physicians on the National Medical Commission Top


Through repeated engagements in the form of RTIs (right to information applications), and memorandums it appears that the experts of the Medical Council of India have deliberately blocked the development of family medicine in India in spite of clear direction from NHP and parliamentary standing committee. This has largely happened because there was never any representation of practicing family physicians in the Medical Council of India. In the USA there are independent and autonomous boards for each medical discipline and speciality. Similarly there are independent royal colleges in the UK. However in India family physicians, family medicine, general practice and primary care have been left at the mercy of other specialties. This has to change. Family physicians must be given representation on the National Medical Commission.



 
  References Top

1.
The National Medical Commission Act 2019 Accessed from http://egazette.nic.in/WriteReadData/2019/210357.pdf last accessed 1/02/2020.  Back to cited text no. 1
    
2.
92nd Report of Parliamentary Standing Committee on Health and Family Welfare on the Functioning of Medical Council of India Accessed from http://164.100.47.5/newcommittee/reports/EnglishCommittees/Committee%20on%20Health%20and%20Family%20Welfare/92.pdf Last access 1.02.2020.  Back to cited text no. 2
    




 

Top
   
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
   Abstract
   Introduction: Na...
   Exclusion of Fam...
   Family Medicine ...
   Family Medicine ...
   Barriers to Acad...
   Call for Represe...
   NMC Act 2019 Man...
   References

 Article Access Statistics
    Viewed649    
    Printed17    
    Emailed0    
    PDF Downloaded97    
    Comments [Add]    

Recommend this journal