Attn Doctors: Using Online Forums, agents to procure patients can lead to 3 months suspension

New Delhi: Using online forums or agents for procuring patients will now be considered a violation of the new Code of Medical Ethics laid down by the National Medical Commission (NMC) and will attract a penalty that can go up to three months of suspension of the license to practice.

The new “National Medical Commission Registered Medical Practitioner (Professional Conduct) Regulations, 2023 which have come into force effective 2nd August 2023 prohibit any kind of solicitation of patients by the RMP. Given the internet revolution and the rise of internet platforms as well as social media where doctors can interact with patients, the guidelines have explicitly included in its clause the prohibition of solicitation of patients via online mediums which charge money or take a split consultation fee for referring the patients to doctors.

Section 9 of the Code of Conduct prohibits any kinds of commissions and fee splitting and explicitly states that  "RMP shall not use online forums or agents for procuring patients,". Further, the violation of this clause can lead to a suspension of the license to practice for a maximum period of three months, as per the regulations.

Telemedicine Allowed but Procuring Patients Online by Paying Commission etc not Allowed

The regulations have taken stress on distinguishing between telemedicine, social media and online procurement of patients. It is to be noted while Telemedicine is allowed and the regulations devote a separate section to validate and lay down the updated Telemedicine guidelines for doctors, it is the use of online agents, platforms, and websites to procure patients that the regulations are clearly prohibiting.

Physicians need to be aware of the difference between the two and maintain themselves within the boundary line of what is ethical.

In the past few years, with the internet explosion, there has been a rise in "listing websites" or " aggregators", where doctors are listed and various consequent services are being provided. Many doctors use these websites for teleconsultation purposes yet many platforms have also begun indulging in practice by which they divert patients to their listed doctors in return for a fixed charge or percentage of fee from those doctors. Many of these websites have also been angrily termed as "online touts" by members of the medical profession.

Since there was a lack of guidelines on the issue from the NMC till now, these platforms were flourishing. However, as the guidelines have now been defined it remains to be seen, how the medical practitioners are going to use these online platforms or aggregators.

Any kind of fee splitting not allowed

Not just online, the new regulations call for a complete ban on any kind of fee splitting and/or commission practice.

Prohibition of Fee Splitting/Commissions: A RMP shall not directly or indirectly participate in any act of division, transfer, assignment, subordination, rebating, splitting, or refunding of any fee for diagnostic, scanning, medical, surgical, or other treatment. These provisions shall apply with equal force to the referring, recommending, or procuring by a RMP of any patient, specimen, or material for diagnostic purposes or other studies/work. However, nothing in this section shall prohibit payment of salaries by a qualified RMP to another duly qualified person rendering medical care under his/her supervision. RMP shall not use online forums or agents for procuring patients. 

The commission or the "cut" practice is known to be rampant in the medical field. Certain Diagnostic firms engaging in the practice have been known to give as high as 50% of the MRP of the test as a referral fee. Even Super-speciality hospitals have been accused of engaging in the cut practice, with marketing departments working with local doctors and smaller hospitals to divert patients to "high-paying" super-speciality procedures at their hospitals.