The country’s apex medical education and practice regulator, the National Medical Commission (NMC) on Wednesday put out a set of three draft regulations on the registration of doctors to the National Medical Register, especially after a planned licentiate exam starts. The Indian Express explains what these guidelines are, and how they will change the way medical practice is regulated. What are the draft guidelines? The NMC has released three future-looking draft regulations - License to Practice Medicine, 2022; Registration of Additional Qualifications, 2022; and Temporary Registration of Foreign Medical Practitioner to Practice Medicine in India. These regulations together stipulate the process of registration of doctors in the National Medical Register. At present, all doctors have to register with their respective state medical councils, without which they cannot practice medicine. As per the guidelines. Indian Medical Graduates have to complete their MBBS degree from a recognised college, finish their mandatory 12-month long internship, and pass the yet-to-be-implemented licentiate exam called National Exit Test (NExT) for getting their registration. How will foreign medical graduates be registered? Foreign medical graduates, on the other hand, have to complete their MBBS-equivalent degree from a medical institute “recognised and listed by the NMC” in other countries, be registerable as a medical practitioner in the said country, complete a 12-month internship in India, and pass the same NExT exam. At present, the NMC does not have a list of recognised foreign medical institutes. It does, however, have a set of minimum requirements, such as a 54-month long course or medium of teaching being English, which if an institute follows, their degrees are recognised in India. Secondly, the students are supposed to complete a year-long internship in the country of their study and come back and do another year-long internship. The new guidelines do not specify this. Thirdly, unlike Indian Medical Graduates who get registration after they complete their MBBS, foreign medical graduates have to clear a screening test before they do. The draft also makes provisions for short duration registrations for doctors from other countries to study in India, do fellowships, do clinical research, and voluntary community work. They also have a provision for registering foreign medical experts for practicing medicine (such as live surgeries) at a workshop or seminar in India. The temporary registration can be for a maximum period of 12 months, with the registration expiring either at the end of the programme for which it was granted, or the date on which a valid visa expires. The draft regulations are available on the website of the NMC and comments can be sent to emrb.regn@nmc.org.in till May 5. What is NExT? The National Exit Test is a proposed examination for granting license and registration for practising medicine in India, similar to the USMLE (United States Medical Licensing Examination) for those wishing to practice in the US. At present, students who complete their MBBS and pass the final exam of their university are eligible to get their license without any such licentiate test. The exam will act as a country-wide standardised test for passing MBBS, for granting of license, as well as a qualification test for post-graduation courses instead of the current NEET-PG that students have to sit for after they have completed their MBBS and one-year internship. Another feature of the exam is that it will not only be a theory paper, much like MBBS finals or NEET PG test. It will be held in two parts – one written and one practical exam where the students will be judged on their clinical acumen. Students will have to appear for the first NExT test after completion of MBBS and the second one after completion of the internship. Although NExT was to start from the current year, students who were to appear have already given their MBBS finals and completed their internships, and those who could appear for next year's exam have also given their MBBS exam. NExT is likely to begin 2024 onwards, according to officials in the know. What is the national medical register it seeks to create? At present, a national medical register of all doctors does exist, which is created by collating data from all states. However, the draft regulation seeks to create a dynamic and regularly updated register. As per the draft regulations, the NMC will issue a unique ID to all students who pass the NEET and get admission to recognised medical colleges. The portal will then be thrown open to colleges and institutes to update their student data and put up all verified degrees and certificates. The same ID will be updated when the student does a post-graduation, a super-speciality course, or any other recognised training programme. The draft guidelines also put an onus on the doctors to keep updating their registration with details of additional qualifications, change in employment, contact details, or place of work “as soon as the change occurs”. At present, the registration maintained by states is updated only when doctors re-register themselves every five years. How will a dynamic register help? Currently, all states maintain individual registers and follow different norms for deleting names. Take Delhi, for example, which is a hub for medical students. It does not delete the names of graduates who move to other states before the completion of the five-year duration; they simply give an NOC for registration in the other state. This essentially results in duplication of data. “Many students apply for registration after completing their MBBS in Delhi and then go on to do their internship in other states where they get registered. However, we just issue an NOC but d not delete their names from the Delhi register because many of these students come back to Delhi for higher studies or practice. The name is only deleted when they do not re-register themselves after five years,” said an official from Delhi Medical Council. The five year lag in updating the medical register also means that many doctors who have retired or died continue to be on the register for years. For this reason, when the government has to take stock of the number of doctors in the country, they assume only 80 per cent of those registered are active. With a consolidated national register and unique ID, there will be no duplication of data. The data is also likely to be updated more frequently, resulting in a comprehensive database of doctors in India, including details on all their education and training in one place. This database can then be shared with state governments or other health programmes, which are looking to hire doctors. Newsletter | Click to get the day's best explainers in your inbox
