The Central government’s recent move to create a mid-level non-MBBS medical professional cadre with limited rights to practise and prescribe modern medicine is stirring up a storm in the medical fraternity, with the Indian Medical Association (IMA), the largest conglomerate body of doctors in the country, vowing to go against the proposition.

A nationwide protest led by thousands of IMA-affiliated doctors and medical students last year had forced the government to ditch a bridge course proposal that would have enabled Ayush doctors to practise modern medicine.

The Union health ministry, to avoid a repeat of last year’s crisis, tactfully drafted the new provision in the National Medical Commission (NMC) Bill to establish the new cadre. The amended provision is already approved by the Cabinet.

“We will definitely oppose this plan and make people understand its potential repercussions. Those who qualify as mid-level medical practitioners include non-MBBS medical professionals such as a nursing practitioner who has done a course like tertiary care. Para-medical staff here follow the instructions of the doctor, they are not into diagnosis or drug prescription. The move intends to deal with the dearth of doctors in rural areas. But it is like creating two classes of citizens. The poor in rural areas also deserve access to quality healthcare,” IMA Secretary General Dr RN Tandon told Pharmabiz.
 
The Delhi Medical Council and the Delhi Medical Association are also getting ready to make representations to the government against the new measure.

According to the new section of the Bill, “mid-level medical practitioners will get limited licence to practise specified medicines in primary and preventive healthcare settings and in other settings under the supervision of a medical doctor.”  

Dr Tandon says 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. “Flouting rules is common practice here. They can’t even control quackery. Now, this step of creating an unqualified medical professional is endorsement of quackery,” he added.

The Parliamentary Standing Committee on Health, while rejecting the bridge course for Ayush practitioners, had mooted a proposal to give limited drug-prescription rights to nursing practitioners or pharmacists. The government is in favour of this idea and the provision will be part of the official amendments to the NMC Bill when it is tabled in the next session of Parliament.

Along with nursing practitioners, other paramedical staff such as pharmacists, physician assistants and optometrists would also qualify to prescribe allopathic drugs. And there will be two registers — one of licensed MBBS doctors and the other of mid-level medical practitioners. This will be maintained by the Board of Ethics under the NMC, which will replace the Medical Council of India once the law is passed by parliament and cleared by the president.

The bill provisions will also allow nurse practitioners to perform some surgical or critical procedures under the supervision of senior doctors, and in certain circumstances.

According to industry experts, the idea of mid-level medical cadre is not new. It was proposed for the first time by World Health Organisation to tackle the healthcare crisis in African countries. Many developed countries including the US and Canada have implemented the system successfully.

“The whole idea is ridiculous. There is no comparison here with developed nations. We cannot adopt a system because it is successful somewhere else. These countries have proper checks and balances in place that we don’t have,” said Dr Girish Tyagi, registrar of Delhi Medical Council and president-elect of Delhi Medical Association.

Mid-level medical professionals may make it easier for the government to deliver basic healthcare to villages. “The government is looking for shortcuts. Instead of taking concrete steps to develop rural health infrastructure, they are allowing quackery. We will fight against this counterproductive proposition,” Dr Tyagi stated.   

India’s doctor-patient ratio, as far as modern medicine is concerned, remains a dismal 1:1,600 as against the WHO mandated 1:1,000. As of now, only MCI-licensed and registered medical doctors can practise modern medicine and prescribe them.