Medical practitioners voice concerns over the new registration system, questioning its legality and impact on state medical councils.
The medical fraternity expresses discontent with the National Medical Commission's new doctor registration system. (Sumit Jha/South First)
A recent gazette notification titled “Registration of Medical Practitioners and Licence to Practice Medicine Regulations, 2023” issued by the National Medical Commission (NMC) has introduced a new system for the registration of medical practitioners in the country.
All registered medical practitioners will now be included in a common National Medical Register, each assigned a Unique Identification Number.
However, the medical fraternity is not happy about this overall revamp in the process of registration of doctors.
The national register will consolidate the entries of registered medical practitioners from the state registers maintained by various State Medical Councils.
This comprehensive register will be publicly accessible on the official NMC website and will provide relevant information about each medical practitioner, such as registration number, name, father’s name, date of registration, place of employment (hospital/institute), medical qualifications including additional certifications, specialisation, year of graduation, university, and institute/university from which the qualification was obtained.
The NMC has also established procedures for the registration of additional qualifications, licence renewal, licence transfer, registration removal and restoration, transitory provisions, and denial of a licence to practise, among other matters.
“The licence to practise medicine issued to a registered medical practitioner shall be valid for a period of five years, after which the medical practitioner shall have to renew the licensing by making an application to the state medical council,” reads the new regulation.
It added that any medical practitioner registered with a State Medical Council, seeking to practise medicine in another state may apply to the concerned state through the web portal of the Ethics and Medical Registration Board (EMRB).
“On submission of an application for the transfer of one’s licence to practise, an intimation shall be received by the State Medical Council where the medical practitioner is registered for practice and the State Medical Council, within a period of 30 days, shall approve the application for the transfer of the licence to practise,” said the new regulation.
The Indian Medical Association (IMA) has said that the new regulation is “plagued by inconsistencies, inadequacies, and contradictions”, is “unsustainable in the eyes of the law”, and also tests legal and constitutional grounds.
The regulation suggests that the EMRB will be responsible for generating a unique ID number and granting licences to practise medicine to practitioners in their respective state/union territory.
This means that the central authority of the EMRB will become the primary registering authority for medical practitioners, superseding the current system where state medical councils hold this responsibility.
The IMA highlights a significant issue with this proposal.
“Each State Medical Council is established under state enactments, which have been duly adopted by the respective state legislatures. These enactments define and specify the functions, authority, and jurisdiction of the State Medical Councils,” said the IMA in their observation accessed by South First.
Therefore, the IMA argues that a subordinate legislation, such as a regulation, cannot abolish the authority vested in the hands of State Medical Councils by the state legislative enactments. The State Medical Councils have the legal mandate to register and maintain the state medical register for registered medical practitioners within their respective states.
The IMA emphasises that a regulation of this nature cannot override the authority of State Medical Councils, which have been established through proper legislative procedures. The State Medical Councils’ role in registering and maintaining the state medical register is essential and cannot be disregarded by a subordinate legislation like a regulation.
“The power to register lies with the State Medical Councils, which were established by the state Legislative Assembly through specific laws. Can a regulation by the NMC override the State Medical Councils’ power to independently register practitioners? State Medical Councils operate under the jurisdiction of the state legislature and their legislation mandates registration with the respective councils,” said IMA president-elect Dr RV Asokan to South First.
He added that the new regulation is not a “law” or “Act” passed by Parliament, but rather a mere “regulation”.
“Can this regulation nullify the authority of the State Medical Councils to register practitioners? For instance, if the Tamil Nadu Medical Council decides not to comply with the NMC’s registration requirements, citing the state legislature’s directive, would we not be heading towards a confrontation between the state and the Centre?” asked Dr Asokan.
The regulation states that the processing fee for generating the unique ID shall be payable to the secretary of the NMC. It further specifies that this unique ID will entitle the doctor to practise anywhere in India, not limited to the authority and jurisdiction of the State Medical Council.
The IMA raises concerns regarding this provision, stating that it not only undermines the authority and jurisdiction of the State Medical Councils but also deprives them of their sole source of revenue.
This could potentially render the State Medical Councils redundant and financially bankrupt.
According to the new NMC regulation, an eligible individual can choose any state to practise medicine. Once the licence is granted, the certificate of licence will be issued, containing a registration number.
This registration number will be formulated in a way that it combines a Unique Identification Number with a specific code — a prefix representing the concerned state or Union Territory. This ensures that each registered medical practitioner is assigned a unique ID number linked to their state of practice.
“Let’s say I want to relocate from Kerala to Karnataka. I would need a No Objection Certificate (NOC) from Kerala and then proceed to Karnataka, despite the fact that this regulation has been made to practise anywhere in India,” said Dr Asokan.
He added that this creates a chaotic situation due to bureaucratic complications when shifting.
“For instance, I am from Kerala and if I secure a postgraduate seat in Bengaluru and wish to move there, I have to transfer my registration to Bengaluru. After two years, when I return to my hometown in Kerala to practise, I have to change my registration again.
“If I pursue a super-speciality, I may go to Delhi and once again go through the registration process. Furthermore, if I decide to seek employment elsewhere, I will be required to register there once more. All this happens within five years,” explained Dr Asokan.
He added that the current system places immense burdens on medical graduates due to the inefficiency of the State Medical Councils. This situation is highly unfavorable for the medical professional. He said that, currently, doctors are required to be registered with the state medical council and this information is shared with the National Medical Commission.
He then asked why there is a need to register with the NMC if the State Medical Councils are already providing the necessary data.
“If the NMC requires practitioners to register with them first, there should be some benefits or privileges associated with it. For example, practitioners should have the advantage of being able to practise in any state or region within the country without facing additional registration requirements,” said Dr Asokan.
Dr Asokan said that the purpose behind this proposed change is unclear.
“We lack information about the intentions or objectives behind implementing this reversal of registration processes. This ambiguity raises concerns,” said Dr Asokan.
He pointed out that the government’s overall direction seems to be aimed at centralisation.
“However, in a vast country like India, this approach may result in inefficiency and delays. It does not serve the purpose well, as the NMC ultimately transfers the registration back to the respective state. The current registration process is already efficient and no doctor can hold multiple registrations,” said Dr Asokan.
“Consider the situation of doctors living near state borders like Tamil Nadu and Kerala. If some emergency happens in Tamil Nadu and I am the nearest doctor, won’t I be allowed to see the emergency case in Tamil Nadu and go their and treat the patients? Creating strict boundaries and restrictions is not ideal in such cases,” said Dr Asokan.
Dr Asokan added that the issue lies in the legal validity of these regulations. The disciplinary proceedings of health currently fall under the jurisdiction of the state. Clinical practice is regulated by the state and only in case of complaints does the state medical council take action. The appellate authority for disciplinary matters lies with the National Medical Commission. However, the procedural aspects remain with the state.
“The purpose of these regulations remains uncertain. It appears to be a purposeless regulation that creates confusion, similar to the demonetisation exercise in the past,” said Dr Asokan.
He added that this presents a clear legal challenge and it is likely that the matter will be taken to the Supreme Court for review.
“Discussions are underway, and appropriate forums will be approached, including the state government and state medical councils. The federal structure seems to be facing a challenge and it is important to ensure that the state governments are aware of the situation,” he added.
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