The Union Health Ministry has recently introduced, rather quietly, an amendment in the National Medical Commission Bill to create a new cadre of non-MBBS 'mid-level medical practitioners' with limited licence to practise specified medicines in primary and preventive healthcare settings and in other settings under the supervision of a medical doctor. Those who qualify as mid-level medical practitioners include non-MBBS medical professionals such as nurses with specific training like tertiary nursing care, pharmacists, physician assistants, optometrists, etc. This new cadre can prescribe specified medicines in settings specified by NMC and in hospital settings such as ICUs under a doctor's supervision. According to the amendment, the nurses may also be allowed to perform some surgical or critical procedures under the supervision of a senior doctor, and in certain circumstances. The ministry's latest move came after the Parliamentary Standing Committee on Health rejected a controversial provision in the NMC Bill which enabled Ayush practitioners to prescribe a listed set of medicines after taking a Bridge Course. Taking a cue from the Committee’s recommendations to consider giving limited drug-prescription rights to nursing practitioners or pharmacists instead of Ayush experts, the ministry drafted a new provision in the Bill to grant limited licence to practise medicine to non-MBBS medical practitioners. The amended provision, which has already received the Cabinet nod, will now be part of the official amendments the government will move to the NMC Bill in the next session of Parliament.

The government's anxiousness to create a new cadre of non-MBBS medical practitioners is quite understandable as it has been trying to address a long standing issue of lack of medical attention in most part of the country, especially in the vast rural areas, arising from the severe shortage of doctors. The gravity of the situation can be fathomed from the country's pathetic doctor-patient ratio which remains a dismal 1:1600 as against the WHO mandated 1:1000. By creating a new non-MBBS medical cadre, the government wanted to fill the gap in the delivery of primary and secondary healthcare services in rural areas and share the workload of senior doctors. The government's move to train mid-level healthcare practitioners was inspired by the practice in China. Besides, many developed countries including the US and Canada have also implemented the system successfully. But, the government's decision has stirred up a Hornet’s nest as the medical fraternity is up in arms against the government move. Vehemently opposing the move, the Indian Medical Association has stated that such a provision will eventually boomerang on the healthcare sector as it would be difficult to define limited practice and specified medicines in the Indian context as flouting of rules is a common practice in the country. The medicos rue that creating an unqualified medical professional is endorsement of quackery. Before finalising the Bill, the government should, therefore, address the concerns expressed by the medicos to make this initiative a win-win situation for everyone. While government can ensure last mile availability of healthcare providers, the doctors can better utilise their expertise in secondary and tertiary care. But, all said and done, there should be proper checks and balances mechanism in place to thwart any misinterpretation of this controversial provision in the Bill.