Regulation of Medical Education and Profession in India
- Discuss the organization and regulation of Medical Education and Profession in India.
- Enumerate the regulatory authorities governing the Medical and Paramedical Professions. Explain their powers.
- “Indeed, a large number of medical areas are not at all regulated by Indian Legal order.” Explain critically.
Organization of Medical Education and Profession
The medical Profession in India consists of four different types of streams – Allopathy, Ayurvedic, Homeopathic, and Unani. While Allopathy, which is also known as the western medical system, is the most popular, other streams are also widely used. There is govt. approved colleges for all three streams. Admission to the undergraduate and graduate levels of these colleges is through competitive exams. Graduates can also go for higher degrees such as MD, MS, FRCS, and MRCP.
Besides the physicians, there are various kinds of paramedical staff such as Radiologists, anesthetists, Pathologists, and of course Nursing. There are diploma and degree courses for these professions as well.
Regulatory Authorities
The expansion of the private sector in India has forced the passage of a number of regulations to promote quality of care and protect consumers. This has expanded the role of government in developing and enforcing regulations in three areas of the health sector: drugs, medical practice, and health care facilities. These regulations have been promulgated by both national and state governments.
The Medical Council of India
The most important act that regulates this field is the Medical Council Act 2001, which paved the way for the formation of The Medical Council of India as well as State Medical Councils. The Medical Council of India was established in 1934 under the Indian Medical Council Act, 1933, now repealed, with the main function of establishing uniform standards of higher qualifications in medicine and recognition of medical qualifications in India and abroad. The number of medical colleges increased steadily during the years after Independence. It was felt that the provisions of the Indian Medical Council Act were not adequate to meet the challenges posed by the very fast development and the progress of medical education in the country. As a result, in 1956, the old Act was repealed and a new one was enacted. This was further modified in 1964, 1993, and 2001. The objectives of the Council are as follows.
- Maintenance of uniform standards of medical education, both undergraduate and postgraduate.
- Recommendation for recognition/de-recognition of medical qualifications of medical institutions of India or foreign countries.
- Permanent registration/provisional registration of doctors with recognized medical qualifications,
- Reciprocity with foreign countries in the matter of mutual recognition of medical qualifications.
Besides the formation of The Medical Council of India, the Medical Council Act, of 2001 also allows the Central Govt. to make important regulations in the medical profession. These are:
Graduate Medical Education Regulations, 1997: These regulations define the general consideration and teaching approach of Medical Students. The Graduate medical curriculum is oriented toward training students to undertake the responsibilities of a physician of first contact who is capable of looking after the preventive, promotive, curative & rehabilitative aspects of medicine. It also describes the eligibility and process for admission into medical colleges in India.
P.G. Medical Education Regulations, 2000: The goal of postgraduate medical education shall be to produce competent specialists and/or Medical teachers,
1. who shall recognize the health needs of the community, and carry out professional obligations ethically and in keeping with the objectives of the national health policy
2. who shall have mastered most of the competencies, pertaining to the specialty, that are required to be practiced at the secondary and the tertiary levels of the health care delivery system;
3. who shall be aware of the contemporary advance and developments in the discipline concerned;
4. who shall have acquired a spirit of scientific inquiry and is oriented to the principles of research methodology and epidemiology; and
5. who shall have acquired the basic skills in teaching the medical and paramedical professionals;
It also defines the nomenclature and major components of the post-graduate curriculum.
Minimum Qualifications for Teachers in Medical Institutions Regulations, 1998: These regulations define the minimum qualification for teachers in medical institutions. All Medical teachers must possess a basic University or equivalent qualification included in any one of the Schedules to the Indian Medical Council Act, 1956 (102 of 1956). They must also be registered in a State Medical Register or Indian Medical Register.
Indian Medical Council (Professional conduct, Etiquette and Ethics) Regulations, 2002: This is by far the most important regulation that governs the conduct of medical professionals. It specifies the duties and responsibilities of physicians in general. It formulates the guidelines for good medical practice such as – maintenance of patient records, display of registration numbers, and payment for services.
Eligibility Certificate Regulations, 2002 : These regulations establish the Eligibility Requirement for taking admission in an undergraduate medical course in a Foreign Medical Institution.
Screening Test Regulations, 2002 : An Indian citizen possessing a primary medical qualification awarded by any medical institution outside India who is desirous of getting provisional or permanent registration with the Medical Council of India or any State Medical Council on or after 15.03.2002 shall have to qualify a screening test conducted by the prescribed authority for that purpose
The State Council maintains the register of medical professionals in the state.
The Pharmacy Council of India
It is the job of the Pharmacist to correctly dispense medicines prescribed by the doctor. This field is governed by The Pharmacy Act, of 1948. The act constitutes the Pharmacy Council of India and as well as State Pharmacy Councils, which in turn formulate and execute the policies governing this profession. The State councils maintain the register of pharmacists in the state.
Indian Nursing Council
Nurses are one of the key elements of the medical fraternity. This profession is governed by Indian Nursing Council Act, 1947, which constitutes Indian Nursing Council. Indian Nursing Council is responsible to ensure a uniform standard of Nursing in India. To be a nurse, one has to pass Higher Secondary Examination and get admitted to a nursing college for four years, and obtain a degree in Nursing.
Testing Laboratories and Experimental Institutions
Testing laboratories are required for doing analysis of various kinds of samples such as blood, urine, and stool. They also do procedures such as XRay, CT Scan, MRI, ECG, etc. Most of these procedures are done by paramedics and the results are certified by a pathologist.
Similarly, for launching new drugs, testing and clinical trials need to be performed. Such tasks are governed by Drugs and Cosmetics Act, 1940.
Other Regulatory Mechanisms
The other important acts that govern the medical profession are Nursing Home Act, Private Hospitals and Medical Clinics (PHMC) Act, and Consumer Protection Act, 1987. Most of States have also enacted provisions for building and running private hospitals and nursing homes. A physician should observe the provision of the state Acts such as Drugs and Cosmatic Act 1947, Pharmacy Act 1948, Narcotic Drugs and Psychotropic Substance Act 1985, Medical Termination of Pregnancy Act 1971, Transplantation of Human Organ Act 1994, Mental Health Act 1987, Environmental Protection Act 1986, Pre-natal Sex Determination Test Act 1994, Drugs and magic remedies (Objectionable Advertisement) Act 1954, Persons with Disabilties (Equal Opportunities and Full Participation) Act 1995, and Biomedical Waste (Management ad Handling) Rules 1998.
While, these Acts have provided basic guidelines for regulation of certain aspects of the health sector, they have also created new challenges, as consumers have become more involved in monitoring health service delivery. The challenge for the future will be to ensure the quality and efficiency of health services in both the public and private sectors through these regulatory mechanisms while seeking to promote national health objectives
Powers of the MCI
MCI Regulations, 2000, Section 34 specifies powers and Duties of the President of MCI. The President shall subject to the provision of the Act, rules, regulations and Standing Orders of the Council do such acts as he considers necessary for the furtherance of the objectives for which the Council is established. Similarly, Section 35 specifies the powers and duties of the Vice President. If the office of the President is vacant or if the President for any reason is unable to exercise the powers or perform the duties of his office, the Vice-President shall act in his place and shall exercise the power and perform the duties of the President.
Power to take cognizance – State Medical Councils have the power to take cognizance of any offense of misconduct committed by a Registered Medical Practitioner during the practice of his profession only when a written complaint in this respect is received by the council or when the practitioner is convicted in the court of law. The gravity of the offense determines the scale of disciplinary action.
The following are some of the offenses that can entail disciplinary action –
- Association with unqualified persons
- Illegal Advertising
- Adultery
- Illegal Abortion
- Rendering improper services such as using unsterile equipment.
Unethical Acts & Misconducts
Any violation of the code of conduct, unethical act, or misconduct shall lead to the removal of his/her name from the register permanently or temporarily and shall publicize the name of the physician in the local press as well in the publications of different medical associations/societies/bodies.
PUNISHMENT AND DISCIPLINARY ACTION
8.1 It must be clearly understood that the instances of offenses and Professional misconduct which are given above do not constitute and are not intended to constitute a complete list of the infamous acts which calls for disciplinary action, and that by issuing this notice the Medical Council of India and or State Medical Councils are in no way precluded from considering and dealing with any other form of professional misconduct on the part of a registered practitioner. Circumstances may and do arise from time to time in relation to which there may occur questions of professional misconduct which do not come within any of these categories. Every care should be taken that the code is not violated in letter or spirit. In such instances as in all others, the Medical Council of India and/or State Medical Councils have to consider and decide upon the facts brought before the Medical Council of India and/or State Medical Councils.
8.2 It is made clear that any complaint with regard to professional misconduct can be brought before the appropriate Medical Council for Disciplinary action. Upon receipt of any complaint of professional misconduct, the appropriate Medical Council would hold an inquiry and give the opportunity to the registered medical practitioner to be heard in person or by a pleader. If the medical practitioner is found to be guilty of committing professional misconduct, the appropriate Medical Council may award such punishment as deemed necessary or may direct the removal altogether or for a specified period, from the register of the name of the delinquent registered practitioner. Deletion from the Register shall be widely publicized in the local press as well as in the publications of different Medical Associations/ Societies/Bodies.
8.3 In case the punishment of removal from the register is for a limited period, the appropriate Council may also direct that the name so removed shall be restored in the register after the expiry of the period for which the name was ordered to be removed.
8.4 Decision on complaint against delinquent physician shall be taken within a time limit of 6 months.
8.5 During the pendency of the complaint the appropriate Council may restrain the physician from performing the procedure or practice which is under scrutiny.
8.6 Professional incompetence shall be judged by peer groups as per guidelines prescribed by the Medical Council of India.
In spite of several regulations and acts, there are several areas that are not regulated. For example, the new technological frontier has opened immense possibilities in the medical field such as surrogate motherhood, artificial limbs, and stem cell research. However, there is no regulation on these activities. Foreign drug companies routinely perform human trials of their experimental drugs in India especially because there are very strict laws for such tests in their own countries and there are no strict laws in India. Poor people are made guinea pigs because of this.
The recent case of Manji Yamada, the Japanese baby born to a surrogate mother in India, highlights the lack of proper laws for treating infertility.
Activities that are not under the purview of MCI
1. Questions pertaining to drugs, reactions, nonscheduled drugs, etc.
2. Paramedical personnel- Registration, duties, responsibilities of nurses, Pharmacists, Laboratory Technicians, etc.
3. Dental Surgeons – Registration / Practice etc.
4. Matters relating to the Registration and practice of Indian systems of Medicine like Ayurveda, Siddha, Unani, and Homeopathy.
5. Queries pertaining to Diplomats of the National Board of Examinations and other related matters.
6. Screening test – Scheme of Examination including syllabus, dates of examinations, No of Attempts, etc.
7. Matters relating to Nursing Homes and Hospitals.
8. All India Entrance Examinations for Admission to MBBS courses.
9. All India Entrance Examinations for Admission to PG courses.
Keywords: Regulation of Medical Education, Regulation of Medical Education: Notes, Regulation of Medical Education in India, Regulation of Medical Education Definition, Regulation of Medical Education
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