# National Medical Commission

The National Medical Commission (NMC) is a statutory body in India that regulates medical education, medical professionals, institutes, and research. Established on 25 September 2020, it replaced the Medical Council of India. The Commission grants recognition of medical qualifications, gives accreditation to medical schools, grants registration to medical practitioners, and monitors medical practice and assesses the medical infrastructure in India.
It was earlier established for 6 months by an ordinance in January 2019 and later became a permanent law passed by Parliament of India and later approved by President of India on 8 August 2019.

## History

The NITI Aayog recommended the replacement of Medical Council of India (MCI) with National Medical Commission (NMC). The NMC bill was passed by parliament and approved by President on 8 August 2019.
National Medical Commission ordinance was brought in to replace Medical Council of India in early 2019 through an ordinance issued in January 2019, by the President of India.
The Supreme Court had allowed the Central Government to replace the medical council and with the help of five specialised doctors monitor the medical education system in India, from July 2017.
The planning commission recommended the replacement of Medical Council of India (MCI) with National Medical Commission (NMC). The decision was approved by most states and after its approval by the Prime Minister Narendra Modi it was to be proposed as final bill in the parliamentary sessions by the Minister of health and family welfare Dr. Harsh Vardhan. It was passed by both houses of Parliament in 2019. President of India approved the National Medical Commission Bill 2019 on 8 August 2019 and it became a law.

## Guidelines for foreign medical graduates

In 2021, the NMC revised its guidelines for foreign medical graduates (FMGs) seeking to obtain a license to practice medicine in the country. The guidelines introduced changes and updates, including the expansion of recognition of medical qualifications from certain countries and the requirement for FMGs to pass the Screening Test for Foreign Medical Graduates (FMGE).
To be recognised as qualified to practice medicine in India, FMGs must be in possession of a valid medical qualification from a recognised medical institution and to have passed the FMGE, a mandatory examination that measures the knowledge and skills of FMGs in various areas of medicine.
The process for obtaining a license to practice medicine in India under the new guidelines involves several steps, including applying for recognition of the medical qualification with the NMC, registering with the Medical Council of India (MCI), and applying to take the FMGE. Upon passing the FMGE, FMGs can then apply for a license to practice medicine in India with the NMC.

## Organisation of Commission
### Medical Advisory Council (MAC)

Functions of Medical Advisory Council:
* "The Council shall be the primary platform through which the States and Union territories may put forth their views and concerns before the Commission and help in shaping the overall agenda, policy and action relating to medical education and training."
* "The Council shall advise the Commission on measures to determine and maintain, and to co-ordinate maintenance of, the minimum standards in all matters relating to medical education, training and research."
* "The Council shall advise the Commission on measures to enhance equitable access to medical education."

### Boards

The commission consists of four autonomous boards:
* Under-Graduate Medical Education Board (UGMEB),
* Post-Graduate Medical Education Board (PGMEB),
* Medical Assessment and Rating Board and
* Ethics and Medical Registration Board

## Composition

The NMC consists of 33 members, including:
a) a Chairperson (medical professionals only)
b) 10 ex officio Members:
* The President of the Under-Graduate Medical Education Board.
* The President of the Post-Graduate Medical Education Board.
* The President of the Medical Assessment and Rating Board.
* The President of the Ethics and Medical Registration Board.
* The Director General of Health Services, Directorate General of Health Services, New Delhi.
* The Director General, Indian Council of Medical Research.
* Director of any of the All India Institutes of Medical Sciences.
* Two persons from amongst the Directors of Postgraduate Institute of Medical Education and Research, Jawaharlal Institute of Postgraduate Medical Education and Research, Tata Memorial Hospital, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, and All India Institute of Hygiene and Public Health.
* One person to represent the Ministry of Health and Family Welfare.
c) 22 Part-time Members:
* Three Members appointed from amongst persons who have special knowledge and professional experience in such areas including management, law, medical ethics, health research, consumer or patient rights advocacy, science and technology and economics.
* Ten members appointed on rotational basis from amongst the nominees of the states/union territories in the Medical Advisory Council.
* Nine members appointed from amongst the nominees of the States and Union territories in the Medical Advisory Council.
Of these at least 60% of the members must be medical practitioners.

## Controversies Surrounding NMC Decisions

The National Medical Commission (NMC), India's apex medical education regulator, has faced numerous controversies and internal conflicts that have raised questions about its effectiveness and governance.

### Internal Conflicts and Management Issues

The NMC has been grappling with internal discord among its four autonomous boards—Undergraduate Medical Education Board (UGMEB), Postgraduate Medical Education Board (PGMEB), Ethical Medical Review Board (EMRB), and Medical Assessment and Rating Board (MARB). These conflicts have resulted in inconsistent decisions, leading to the frequent withdrawal of public notices. Reports have highlighted issues such as conflicting penalties and approvals for medical institutions, delays in decision-making, and poor internal consultations, which have been flagged to the Union Health Ministry. This turmoil has been exacerbated by high-profile controversies, including the NEET paper leak and concerns about declining standards in medical education. Critics argue that the NMC has failed to regulate effectively, with calls for increased oversight from the NMC secretariat.

### Removal of Critical Departments

The National Medical Commission (NMC) was established in January 2019 by way of an ordinance, which later achieved permanency in the form of a law, after being passed by the Indian Parliament and approved by the President of India on August 8, 2019. It replaced the earlier Medical Council of India. This act aims to enhance medical education accessibility and quality, ensure a sufficient number of high-quality medical professionals across the nation, promote universal healthcare with a community health perspective, and make medical services accessible to all citizens. It also supports national health goals, encourages medical professionals to integrate the latest research, maintains ethical standards, and provides a flexible structure to adapt to evolving needs, all while implementing a transparent assessment of medical institutions and a grievance redressal mechanism. Thus, it has the responsibility to recognize new medical colleges across India, approve the National Eligibility cum Entrance Test (NEET) syllabus, set national medical undergraduate curriculum standards, assess medical infrastructure, and maintain oversight of medical practice in India. On June 26, 2023, the NMC issued a circular soliciting comments and suggestions on the draft regulations for the Minimum Standard Requirements (MSR) for medical colleges across India. Aligning with the MCI/NMC regulations, the proposed list consisted of 23 departments, including Respiratory Medicine as ‘required departments’ to run the MBBS course, and a 30-day timeframe was allocated for feedback and responses. On August 16, 2023, a gazette notification was published, which highlighted that three departments (Departments of Respiratory Medicine, Emergency Medicine, and Physical Medicine and Rehabilitation) were excluded from the list of required departments for running undergraduate courses, while a new department (Department of Integrative Medical Research) was included. Also department of Yoga was recommended to be set up in every medical college by NMC.
A significant point of contention is the NMC's decision to remove three vital departments—Respiratory Medicine, Emergency Medicine, and Physical Medicine and Rehabilitation—from MBBS curricula and their affiliated hospitals. This controversial move has been challenged through a Public Interest Litigation (PIL) in the Nagpur Bench of the Bombay High Court. The petition contends that the UGMEB's decision undermines the standards of medical education previously established by the NMC’s own Undergraduate Medical Education Regulations (UGMSR) 2020. Furthermore, it argues that this removal diminishes the specialty healthcare services that these departments have historically provided in medical college hospitals.
The department of Respiratory Medicine (earlier called the Department of Tuberculosis, Department of Tuberculosis, and Department of Chest Diseases and TB and Respiratory Diseases) was initially established in medical colleges and tertiary care hospitals to address the significant burden of tuberculosis in India. Over time, it evolved to meet the rising burden of chronic lung diseases such as COPD, asthma, bronchiectasis (often a sequel of tuberculosis), interstitial lung disease, and lung cancer, one of the most prevalent cancers worldwide. Given that respiratory symptoms are the most common reason for patients seeking medical consultation, and chronic respiratory diseases pose a substantial burden on the population, the department of Respiratory Medicine has become essential for the MBBS program. It has provided undergraduate students with the knowledge and skills necessary to manage patients with respiratory diseases. Over the years, this department has not only catered to patient care but has also significantly contributed to the education and skill enhancement of undergraduate medical students. The Indian Chest Society (ICS), which is the largest body representing the specialty of Respiratory Medicine, has strongly opposed the action taken by the NMC and requested the NMC to withdraw its UGMEB 2023 guidelines with immediate effect and reinstate the department of Respiratory Medicine as a ‘required’ department for medical colleges running undergraduate courses across India.

### Curriculum Revisions Following Judicial Scrutiny

The NMC was compelled to revise the Competency-Based Medical Education (CBME) 2024 guidelines after the Madras High Court expressed concerns regarding the inclusion of the term “Gender Identity Disorder” in the MBBS curriculum. This decision highlights the sensitive nature of educational content and the regulatory body’s responsiveness to judicial oversight, reflecting the ongoing debates surrounding medical education and the evolving understanding of gender identity in health contexts.