Maharashtra Medical Council - Need for Self-Regulation of Health Care: A Case Study with Details for Replication
Self-regulation of the medical field became necessary with specialisation of medicine in the modern world. As a result, several models of self-regulatory bodies emerged over time. The structure and functions of these bodies differ from country to country, but in general, the chief objectives of self-regulation remain licensing of practitioners, continuing professional development and taking disciplinary action in case of malpractice. Initially, self-regulation was conceived as an autonomous professional institution, but over time with new ethical challenges and misuse of medical power, the representation of the state in a self-regulatory body was ensured. As an example of an established best practice in medical regulation, a case-study of the General Medical Council (UK) is presented in the report. The present study is a documentation of the innovative practices of the Maharashtra Medical Council (MMC), the professional self-regulatory body for practitioners of modern medicine in the state of Maharashtra in India. It was set up under the Maharashtra Medical Council Act, 1965.
In 1993, the MMC came under the allegation of electoral malpractice and a case was filed against it in the Bombay High Court. The case was finally resolved after the 1999 election, the results of which were annulled as corrupt practices as observed again by the Court. According to the Court directive, the practice of postal ballot was replaced by direct secret ballot and elections were held by this method in April 2009, after the Council had been disbanded for more than a decade. In the new system, polls are held at each district headquarters and voting is done in-person under the supervision of the district collector. The Council subsequently formed, comprising of 18 members with equal representation of the government and professional body, became functional in May 2011.
Since it became functional, the Council has initiated new practices to increase its efficiency and impact. It has made renewal of registration compulsory for doctors and digitized the process to ensure the convenience of doctors. It has resumed the task of receiving complaints and is taking steps to increase the speed of redressal. It has also taken suo-moto actions against erring practitioners in the state, most notably against those suspected of violating the PCPNDT (Prevention) Act. Respondents of this study felt that this has contributed in making the election process more credible and fair. The MMC has also mandated at least 30 hours of continuous medical education for doctors every five years. This practice has been introduced based on the central government notification, with the aim of regularly updating doctors’ scientific knowledge and ensuring a high quality of medical education throughout the state.
While these are signs of progress, there are many challenges that lie ahead on the road to successful self-regulation. With regard to electoral reforms, the authors of the report suggest that the MMC should increase the number of its polling centres and also ensure its proper distribution of polling booths at the time of elections. The process of attending to complaints also needs to be revamped as currently it suffers from an overall lack of transparency. The CME events need to cover varied specialties and the system of awarding the point needs to be standardized across India so that the credit hours are accepted across states. However, there is a general agreement among the respondents, that despite all these challenges, the MMC – after two years of its reconstitution, has been proactive and prompt in taking steps to reform itself. Based on a preliminary comparative evaluation, this Report suggests that many other state medical councils can adopt practices initiated by the MMC, especially those regarding the format of elections, renewal of registration and actions against the erring doctors.