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MCI: reforming the unreformed


In news: A recent report by the NITI Aayog, authored by a committee chaired by its vice-chairperson, Arvind Panagariya, has proposed a sweeping overhaul of medical education in India. The committee's remit was to suggest an overhaul of the Indian Medical Council Act, which dates back to 1956.

  • The Medical Council of India(MCI) is a statutory body for establishing uniform and high standards of medical education in India. The Council grants recognition of medical qualifications, gives accreditation to medical schools, grants registration to medical practitioners, and monitors medical practice in India.



  • It is under the aegis of Indian Medical Council Act 1956, with subsequent amendments and ordinances, that the Medical Council of India (MCI) governs medical education in India.

Reforms in the sector

Looking for a big bang reform in an important sector that remains unreformed, there is important reforms proposed under the new Bill that the Panagariya committee has drafted and appended to its report.

  • The most arresting and important governance-related element of the proposed reform is the scrapping of the MCI and its replacement by a new body, the National Medical Commission (NMC).

  1. Members of the MCI are elected. While the current system of election to the MCI was based on noble intentions, the effect has been to keep serious medical educationists out of the body.

  2. The NMC, on the other hand, would have its members selected by a high-powered committee of unimpeachable integrity, to be chaired by the cabinet secretary.

  • The evaluation of medical colleges, which at present is conducted based on inputs, will switch over to an output-based evaluation.

  1. This will eliminate the possibility of corruption, which has flourished under an opaque input-based system in which the MCI could threaten closure of a medical college

  2. The proposed new legislation will mandate both entrance and exit exams for medical professionals. Anyone practicing medicine in India will have to pass the exit exam. This would bring India in line with the norms of medical certification in other major countries.

  3. With a mandatory exit exam before anyone is allowed to practice medicine, medical colleges will have to perform. A college which charges exorbitant fees and whose students fail the exit exam will soon be out of business.

  • The regulation of fees for medical education:

  1. The Panagariya committee's proposal, private medical colleges will be free to set their own fees in a transparent manner. Further, all colleges will need to announce and post upfront their structure of fees.

  2. For-profit medical colleges will be permitted.

  • System of Equity with Efficiency:

To take note of the concerns of states, and to work towards a system characterized by equity, not just efficiency, states will be allowed to regulate the fees that up to 40% of students are charged, with colleges free to charge the tuition fees of their choice for the remaining 60%.This amounts to what economists would call a cross-subsidy from the latter to the former group of students.

Criticism of the report

  • The Panagariya committee's proposal for for-profit colleges will increase various capitation and other hidden fees charged by the colleges that will considerably jack up a student's costs over and above the official, regulated tuition fees.
  • This can lead to a completely non-transparent system which has served no one well.

Way ahead

  • Our current status is that India's system of medical education features ostensibly non-profit medical colleges, while profiteering by unscrupulous colleges which are subject to opaque and capricious regulation has continued unabated.

  • The Panagariya committee has courageously established the principle that, in medical education as in other sectors, profit is not a dirty word.

  • It is far better for society to have well regulated for-profit medical colleges with transparent and upfront fees and with a scrupulous system of entrance and exit exams that will keep them honest, than our current system in which no one is genuinely accountable, standards are poor, and it is both medical professionals-and ultimately patients-who suffer.

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