'You cannot say everybody connected with modern medicine is a doctor'

'We are warning that if you get these 3.5 lakh additional non-medical people with licence, our infant mortality rate and maternal mortality rate will deteriorate'.

The Lok Sabha on Monday passed the National Medical Commission Bill which seeks to effectively repeal the Indian Medical Council Act, 1956.

Doctors across the country, however, are not happy with the bill and have gone on a nationwide strike. They accuse the Narendra Modi government of licensing quacks through this bill that will allegedly provide poor quality doctors, especially to rural India.

For among the provisions is the introduction of 'community health providers', persons 'connected modern scientific medical profession' who can practise medicine at the mid-level, like prescribing medicines independently.

The Indian Medical Association had given a call for 24-hour withdrawal of OPD services on Wednesday.

There are a host of other provisions in the bill which the IMA is opposing as it feels the Modi government is not making a right move in the matter.

Dr R V Asokan, secretary general, IMA spoke to Rediff.com's Syed Firdaus Ashraf about why they are opposing the National Medical Commission Bill that is scheduled to be moved in the Rajya Sabha on Thursday.

"At any point of time, there are about 1.5 lakh unemployed young MBBS graduates. They do not have a place in the system. And these unemployed doctors can be captured for gainful employment wherever the government wants," he says.

Why did you call for a 24-hour strike inconveniencing patients?

It was not a strike. Only OPD (out-patient department) or non-essential services were withdrawn. In case of an emergency, like if a child is ill, they could come to casualty so services were not denied.

Whatever is routine, like an appointment with a doctor, was postponed. So it was not a strike as essential work went on.

The government says it is trying to fix the shortage of doctors in the country through this bill. So why are doctors opposing it?

The Modi government is lying as there is no shortage of doctors in India.

Every year 68,000 medical graduates come out of 506 medical colleges. Out of which only 23,000 go for post-graduation. The rest spend the next 2-3 years in, say, (teaching the students appearing for) NEET (National Eligibility cum Entrance Test).

This is a gross wastage of manpower.

At any point of time, there are about 1.5 lakh unemployed young MBBS graduates. They do not have a place in the system.

And these unemployed doctors can be captured for gainful employment wherever the government wants.

The government has not created any additional post of medical officers. They are simply saying there is a shortage. If you see government data, the vacancies are less and in states like Tamil Nadu, the entire medical service is manned by MBBS doctors.

What is required is proper government jobs for these (doctors). The government offers doctors ad hoc or temporary appointment for 11 months at low wages.

These doctors need decent jobs to join government service. The Tamil Nadu model must be replicated in every state. There is no shortage of doctors in India and the government is lying, as I told you.

They are giving data which is convenient to them.

But…

(Interrupts) We are opposing the licensing of 3.5 lakh unqualified non-medical persons to practise modern medicine (provided for in Section 32 of the bill). They are not medically trained in anatomy, physiology, pathology etc.

They are only trained for specific jobs like pharmacy, testing your eyes or laboratory work.

The government is saying that they are connected with modern medicine. Modern medicine is a huge term. Dentists, nurses, lab technicians, X-Ray technicians, pharmacists all come under modern medicine. You cannot say everybody connected with modern medicine is a doctor.

That is not acceptable to the profession, and it must not be acceptable to you.

The government proposes to provide them with independent licences to practise primary care. A normal delivery is primary care and only cesarean section comes under secondary care.

And secondary care and tertiary care too they can practise under supervision of doctors.

What it means is that private hospitals can now employ these people in Emergency, ICUs (intensive care units) and operation theatres as they will be under doctors. This will be cheap labour (for them).

In states like Chhattisgarh and Assam, the state governments introduced community health workers having a diploma. They have succeeded in drastically improving the healthcare services in those states. So what is wrong in expanding such schemes to the national level?

Please understand, licence to practice with registration in Medical Council is very different from producing community health provider for basic healthcare which is already allowed under the Drugs and Cosmetics Act.

The government can employ community health providers in public health centres and sub-centres. They can provide a National Health Programme and they are empowered already.

There is no need to independently give them licence to practise at will without any supervision.

This will affect infant mortality rate and maternal mortality rate because they will be looked as doctors while they are not.

The message that comes out is that the Modi government wants to follow the Cuban model of community health service that was established after the revolution, and today life expectancy in Cuba is 80 years.

Uganda and Sudan cannot be India's role model in health sector just because community health providers over there are practicing independently.

The best (community health) practitioners are in the United States and United Kingdom, but they work under the strict control (of doctors).

Here we have 68,000 doctors coming out of medical colleges every year, so where is the need to (follow other countries' health models)?

But as per World Health Organisation, the doctor-to-patient ratio should be 1:1,000. In India, it is 1: 1,596.

In states like Kerala the doctor-to-patient ratio is 1:200; in Tamil Nadu it is 1:400.

We have adequate number of doctors. What is needed is an Indian Medical Service where ordinary MBBS doctors can migrate (across states).

Today, if I am registered with the Delhi Medical Council, I cannot practise in Maharashtra. I have to forgo my number in Delhi and then apply in Maharashtra afresh.

Suppose these restrictions are removed and we have an all India (registration) number where I can practise anywhere. This is like free market.

There is a glut of doctors in South India. It is only the question of (facilitating their movement) from high density (areas) to low density ones.

Why don't you suggest this to the Modi government?

We have put all these things on paper and discussed (with them). What is driving the Modi government is something else.

They have a very short-term, myopic vision. The Modi government has no health vision for India. They invest very little in healthcare.

If they have to absorb, say, one lakh MBBS doctors, the amount they have to invest will be 2.5 per cent of the GDP, which they don't have.

Their allocation (to healthcare) this year is 1.1 per cent of the GDP.

Our premier medical journal wrote that 'Mr Prime Minister, your countrymen will die on streets'. We are now warning that if you get these 3.5 lakh additional non-medical people with licence, our infant mortality rate and maternal mortality rate will deteriorate.

In the US, health is an important subject in the political discourse but not in India.

One last question, why is the government saying that the Medical Council of India is mired in corruption?

In the period of 2001 to 2019, for only three-and-a-half years an elected medical council of doctors was there.

For the rest 14.5 years, the MCI was under a board of governors and then oversight committee.

Again it is under the board of governors and you can verify this. So, for more than 14 years it was under government control and worked independently for only 3.6 years.

How much corruption should be apportioned to these 14.5 years of illegitimate rule?