15 Reasons Why IMA is Opposing NMC Regulations on licencing and registration of doctors

New Delhi: The recently released regulations on registration and licencing of medical practitioners have received mixed reactions from the medical fraternity. While on the one hand, doctors have welcomed the concept of a centralized National Medical Register providing an actual count of doctors across the country, they are still confused about certain clauses of the recent notification by the National Medical Commission (NMC).

Medical Dialogues had earlier reported that in the "Registration of Medical Practitioners and Licence to Practice Medicine Regulations", NMC announced its decision of having a National Medical Register for all registered medical practitioners. The Commission had also mentioned how the doctors in India will now have a Unique Identification (UID) Number, which shall be generated centrally by the NMC Ethics Board.

However, recently writing to the Secretary of NMC, Dr. Sandhya Bhullar, the doctors under the Indian Medical Association (IMA) called out the "contradictions, inadequacies and infirmities" in the regulations and claimed that these shortcomings have rendered the "entire Regulations in an utterly confusing and dis-figured form which does not augur well for a subordination legislation in the official legislation of the Gazette of India by the National Medical Council as a Parliamentary Enacted Body, specially in the context of its resultant legal invalidity."

Objecting to the new rules for licencing and registration of doctors, IMA has expressed its interest to discuss the matter with the NMC Secretary and submit suggestions for the same. "Hope you will be open for remedial measures," the association mentioned in the letter.

Here are some of the reasons why IMA is objecting to the NMC Regulations:

Change in Nomenclature: 

IMA has pointed out that even though the NMC Draft that was put on the public domain was titled Draft Regulation on License to Practice Medicine 2022 and Registration of additional medical qualifications and temporary Registration of the Foreign Practitioner to Practice Medicine in India -2022, now the nomenclature has changed in the Gazetted notification.

"The Regulation is now titled as “Registration of Medical Practitioners and License to Practice Medicine Regulations, 2023” which is a deviation from the original nomenclature that was put into public domain in the form of draft regulations," IMA mentioned.

Confusion over Clauses under which power has been confirmed: 

In its letter directed to the NMC Secretary, the Indian Medical Association has addressed the confusions over the clauses under which power has been confirmed. Referring to the regulations, the Indian Medical Association pointed out that the preamble mentions that the operational regulation is notified in the exercise of powers conferred by Clause (Z j), (Z k) and (Zl) of Sub-Section 2 of Section 57 of the NMC Act 2019.

However, the association pointed out that in operation it brings within its fold the grant of limited license to practice medicine provided for under Sub-Section 1 of Section 32 of the NMC Act 2019 which is squarely provided for coverage for issuance of a regulation under Section (Zn) of Sub Section 2 of Section of 57 of NMC Act 2019 which is not mentioned in the preamble, which by itself is a palpable fallacy.

Regulations Silent on Protocol for Disciplinary Action: 

Normally, in the case of State Medical Councils, when a registered medical practitioner is found guilty of professional misconduct, some disciplinary actions are taken against him/her. However, the regulations is silent on what will happen to the National Medical Register, in case such a doctor registered with the National Register is found guilty of professional misconduct.

In this context, IMA mentioned in the letter, "Further, the ambit in terms of issuance of regulation in regard to the manner of regulating professional conduct and promoting medical ethics under clause b of Sub Section 1 of Section 27 of the NMC Act as provided for under Sub section (Zd) of Subsection 2 of Section 57 of NMC Act and the question of prescribing the manner of taking disciplinary action by the State Medical Council for professional or ethical misconduct of registered medical practitioners of professional or procedure for receiving complaints and grievances by Ethics and Medical Registration Board under Sub Section 2 of Section 30 of the NMC Act 2019 for which regulation is to be notified in terms of (Zh) of Sub Section 2 of Section 57 of the NMC Act is not covered in the ambit of present notified regulation meaning thereby that it would be regulated through issuance of a separate regulation to give an operational effect to the same."

Who is a Registered Medical Practitioner? - Missing Definition: 

IMA noted that the Commission has proposed the National Medical Register for the Registered Medical Practitioners across the country without defining who the Registered Medical Practitioner is.

"Under Section 2 Definitions are brought out and vide a proviso it is brought out that “words and expressions used in these regulations and not defined herein but defined in the NMC Act shall have the same meaning assigned to them in the Act”. However, the word ’Registered Medical Practitioner’ for whom the entire regulations is brought out is not defined under Section 2 of the Regulation and is also not defined under Section 2 of the NMC Act 2019 as well whereby the vary purpose for which the regulation is brought out is missing in terms of as defined definition which can be said to be nothing more or less than an apology in terms of the grossest possible omission in the Regulation," IMA noted.

Roles of State Medical Council Questioned:

Section 4(i) and Sub-Section (iii) of the regulations specify that NMC will be the primary registering authority for those medical graduates who clear the National Exit Test (NExT) and become entitled to registration in the National Medical Register.

However, IMA has claimed that it violates the governing principle on the basis of which the State Medical Councils are created through State Legislative Enactments with original authority for registration of the Registered Medical Practitioners in the given States is not open for any trespass, prejudice, marginalization of any type by a regulation which in its very nature is a subordinate legislation.

"As such, the dichotomy renders the regulation questionable on this very count itself," IMA has pointed out in the letter.

Further, the association has mentioned that according to Section 4(iii), after registering with the NMC National Medical register, a RMP can practice anywhere in India. Referring to this, IMA has pointed out, "...therefore in terms of the same, the need for their registration in State Medical Council turns out to be redundant."

"In the teeth of this very clause, the entire operational mechanism incorporated in the regulation for transfer of registration turns out to be inconsistent by its nature and intended operation," the association further mentioned.

Also Read: Finally, NMC Announces A Common National Medical Register for All Doctors

Processing Fee for generation of UID: 

While Section 4(iii) specifies that doctors will get a Unique Identification (UID) number from the NMC Ethics Board, according to Section 4 (iv) Regulations, the processing fee for the generation of UID shall be payable in favour of the Secretary NMC.

Questioning this, IMA has claimed in the letter that the regulations are not only making the State Medical Council invalid, but NMC is also taking the only source of revenue receipt from the State bodies.

The letter mentioned, "...then not only in the authority and jurisdiction of State Medical Council stands mauled but also the lone source of revenue receipt is pocketed by the NMC making them lifelong redundant and bankrupt as well."

Where is the Web Portal to apply for Grant of Licence? 

According to Section 6(a) of the NMC Regulations, in order to get a licence to practice in India, the medical practitioners will have to make an application through a web portal of the Ethics and Medical Registration Board. However, referring to this, IMA pointed out that no such web portal is notified as of now.

What is the procedure for transfer of licence for doctors registered in more than one State? 

The recent regulations have created confusion amongst doctors as they are unsure if the new rules will allow them to practice in more than one States at the same time.

Section 6(b) of the regulations states that the eligible persons applying for the grant of licence to practice medicine, "...may opt any State/States to practice medicine and the application so made through the web portal shall be referred to the concerned State/ States Medical Council."

Referring to this, IMA has pointed out that while it indicates that an applicant can seek registration in more than one State through one application, the regulations do not provide any mechanism for any type for the purposes of providing the same.

"Nonetheless, in case Registration is awardable in more than 1 State through a common application, the modality of transfer of registration of such an applicant existingly registered in more than 1 State originally is not provided for," IMA mentioned in the letter.

Limited time period granted to State Medical Councils to consider applications for registration: 

Referring to Section 6(c) of the regulations, IMA has pointed out that the State Medical Councils have been granted with a time period of 30 days to consider the application for registration.

However, according to IMA, the 30 days time period with due verification as warranted is "much lesser a time limit for all the desired dispensation specially with reference to checking the authentication of all the documents including certificates, specially internship completion certificates and confirmations in regard to the vetting of the documents from the respective Embassies in case of Foreign Medical Graduates including confirmation of the documents submitted by them from the Foreign Universities."

Contradictions in rules to practice Medicine in Multiple States: 

While the NMC guidelines state clearly on the process on transfer of license, they remain silent on the issue of multiple state licenses. It is clear that the UID will remain the same but if a doctor is practicing in multiple states, it is not clear how many prefixes will be attached/altered in cases of doctors who wish to practice in multiple states.

Meanwhile, IMA has pointed out that Section 7 (iv) of the Regulations allows the Registered Medical Practitioner with additional qualification to practice anywhere in India. 

"A licenced Practitioner with registered Additional Qualifications shall be allowed to practice in the field of specialization/super-specializationcommensurate with additional knowledge and skill obtained, as applicable to the additional qualification anywhere in India with all its privileges as the case may be," mentions the concerned regulations.

Pointing out that the doctors with additional qualifications are allowed to practice anywhere and not limited to the State where they are primarily registered with the State Medical Council, IMA has mentioned it to be "hugely paradoxical and is plagued by an absolute contradiction."

At this outset, the association has also referred to the mechanism for transfer of License as provided in Section 9(ii) of the regulations. IMA has pointed out that the mechanism for transfer of License to Practice in another State has been provided at the cost of losing the Right to Practice by the practitioner by the transferring State.

Referring to this, IMA has mentioned, "This is inconsistent with the provision included in Section 6(b) of the Regulation, where the Registration is provided for the Registered Medical Practitioners in State/States. Upon harmonious reading of the 2 provisions in the Regulation, a mechanism for automatic registration between the transferring and transferee State/States needs to be worked out with right vested in the Registered Medical Practitioners to practice in such State/States."

Why Renewal of License without Required Credit Hours? 

IMA has referred to Section 8 of the Regulations addressing the process of renewal of license to practice medicine and pointed out that the provisions are made for renewal of registration in every 5 years without any prescription for the mandatory requirement stipulated credit hours.

In this regard, the association has mentioned that "In absence of the same, it would amount to a blind renewal of registration which would be inconsistent with the provisions on this count in the international parlance and thereby is not only a retrograde step but also would make India a laughing stock in the comity of the nations. As such, renewal of registration in terms of its inseparable linkage with prescribed credit hours is a must to be provided even in terms of legal pronouncements as well made by the judicial forums where the same is upheld in unequivocal terms."

No Provision for reinvestment of "Inactive Registration": 

Section 8(iii) of the regulations state that if no application is received within three months of expiration of the validity of licence, the entries of the name of such doctors in the State Register will be converted as inactive and the concerned medical practitioners shall not be entitled to practice medicine. Further it mentions that the entry of the "inactive" status in the State Register will automatically get reflected in the National Register.

Referring to this, IMA has pointed out that there is no provisions in the regulations for reinvestment of "Inactive Registration". This would mean that Registration declared inactive due to minor inadvertence would end up in permanent removal of the name from the register.

"As such, a procedure for reinstatement for Inactive Registration needs to be provided for to avoid the consequent malady of ending up in invocation of an irreparable inter-alia lifelong damage," IMA mentioned in the letter.

"Suffixed" or "Prefixed" State Code? 

Section 9(iv) of the regulations mention that the Unique Identification (UID) number of the doctors shall remain the same in case of transfer of Licence to Practice and the prefixed Code of the concerned State/Union Territoru shall be substituted with the Code of the new State/Union Territory. On the other hand, Section 6(d) mentions that the UID shall be suffixed with a Code of the concerned State/UT.

Pointing out the anomaly, IMA mentioned, "In Section 9 (iv), the UID in case of a transfer of the Registration No. shall remain the same and the “Prefixed“ code of the concerned State shall be substituted with the “Suffixed” code of the new State which is contradictory because in terms of Section 6 (d), the State Code is to be “Suffixed” whereas in terms of Section 9 (iv) the word used is “Prefixed” State Code which anomaly is beyond the scope of correction. As such, the contradiction mandates prompt correction."

What is the mode for Restoration of Registration? 

The association has also pointed out that even though Section 10 of the regulations provides for the removal and Restoration of Registration, there is no specific mode and manner mentioned for the Restoration of Registration.

Referring to this, IMA has called the regulations not only "half baked but also half cooked."

Objections to rules regarding Transitory Provisions: 

IMA has pointed out that while NMC has given only three months of time to the existing medical practitioners to update in the web portal of NMC Ethics Board, there is no such web-portal available for the same. Referring to this, IMA has called the concerned proviso "meaningless".

Further, the association has pointed out that there are State Medical Councils in the country having their records in a digital format. Referring to this, the association mentioned, "The entire information of such State Medical Registers in one go can be transferred to the National Medical Register without compelling the individual Registered Medical Practitioners included in such electronic format to prefer individual applications for inclusion of their names in the National Medical Register."

"It is stipulated therein under Section 11 of the Regulation that the Registration upon the inclusion in the name of National Medical Register shall be valid for 5 years for the date of such inclusion which also would be perilous for the State Medical Councils, specially from the point of view of their receipt revenue for the purposes of Renewal of Registration which would be causing a heavy prejudice to the financial receipts of the State Medical Councils," it further mentioned.

Also Read: Will doctors be able to practice in multiple states? New Rules on License Transfer leaves medical fraternity confused