President's Message

Presidential address

 “We will make the difference”

I am taking over the reins of highest office of Indian Medical Association in an unprecedented situation, where the identity and rights of the profession is in a precarious situation with   formidable array of issues confronting the medical profession of the country. These issues challenge the political identity of the profession. If the powerful forces behind these moves are allowed to have their way, an independent self regulating medical profession with an exclusive identity will be extinct before long.

Medical Council of India:

The first of these issues is the attempt by the Government of India to create a high arching body in place of Medical Council of India. This body will include other unrelated disciplines like engineering and management. It is not clear how this would help in shaping future doctors of India. Destroying the  unique identity of medical profession will have unknown consequences on the health of the nation. There is every reason for IMA to be concerned. IMA warns the Government to stop this  attempt on track and take the nation into confidence. The Government has no mandate to alter institutions in a way that could interfere with the constitutional guarantee to life.

The Medical Council of India is the independent regulator for modern medicine doctors in India. Its statutory purpose is to protect , promote and maintain the health and safety of the public by ensuring proper standards in the practice of medicine. Interest of the public is served by an independent, accountable MCI. MCI has done yeoman service to the country and has nurtured the medical profession. Indian doctors have achieved international recognition for their professional competence and conduct. Existing provisions of the Indian Medical council Act 1956 confer enough powers on Government of India in the affairs of MCI. It nominates 37 members directly and in consultation with state Governments . No one can establish a medical college or open a new course or increase admission capacity without explicit permission from Government of India. Central Government directly controls the post graduate medical education by nominating six out of nine members. By subjugating the MCI on which it already has adequate powers, the Government have converted it into another Government  department. The Government in its wisdom have made its directives binding on MCI. There  is no justification in robbing MCI of its autonomous character.

The ordinance of 2010 brought in the board of Governors suspending  a federal and democratic MCI.   How can a pack of Government nominated persons discharge the duty of a federal and democratic MCI? In this  arbitrary exercise of power the Government have exhibited contempt of propriety and democracy. IMA dares to challenge the Government in the name of people of India. We will fight this injustice to the end. IMA is the guardian of medical profession and the will of the medical fraternity of the country shall prevail.

Further in the very  ordinance Government of India has taken powers for itself for issuance of directions which will be binding to the medical council of India on matters of public interest and what would constitute public  interest, the authority for interpreting the same would be vested solely with the Government of India. It can be recalled the similar bill brought in by Government of India in 2005 was rejected by the standing committee of Parliament on the ground that any regulatory body should be devoid of Government control or else it would lose its independent regulatory mechanism.

IMA

a)  condemns the dissolution of MCI

b) demands that the nominated Board of Governors of MCI should be replaced by a   democratically constituted MCI restoring its independence. 

c)  demands retaining of MCI in its present character and form.  

Although one could argue that the accountability of MCI has to increase it does not mean that autonomy and independence in working be replaced by the Government interference in day to day working.

Bachelor of Rural Health care (BRMS/BRHC):

The second issue of national importance is the back door attempt to impose a 3 ½  year modern medicine course on the nation under the guise of rural health. Government of India is going ahead with establishment of medical schools to churn out half baked BRHC graduates. While modern medicine is experiencing a knowledge  explosion and  when even a 5 ½ years MBBS course is insufficient to provide basic information to would be doctors, Government of India thinks of a 3 ½  year medical course in its wisdom. It is a mortal blow to modern medicine and the nation. How can reducing the duration of training be the remedy to the maladies plaguing rural health? Compromised education and training in institutions where infrastructure and faculties have been compromised will compromise the health of villagers. And why should the villagers be accorded substandard care? An army of half baked doctors with 3 ½ years curriculum exclusively for villagers is a gross injustice. If this is not discrimination what else is? If this is not violation of the constitution  what else is? Is it not promoting and legalizing quackery ?

MCI abolished all licentiate courses before half a century. Now MCI and Government of India   collude to throw back India  into dark ages with substandard doctors and healthcare. Government of India  statistics shows that the shortage of doctors in PHCs across the nation is less than 10% whereas there is a huge manpower shortage in health workers, pharmacists and laboratory technicians. Instead of addressing this pressing issue the Government of India, like an ostrich creates  300 medical schools to produce half baked doctors. IMA attributes ulterior motives in what the Central Government is doing.

There is a gross shortage of specialists in the community health centers across the country. The Government has done nothing to overcome this crucial gap in healthcare delivery system. IMA urges the Government to stop this crime against  the nation and humanity even at this late stage. We request the   Government  to consider other options to produce regular MBBS graduates with rural medical colleges with rural quota or 1 year compulsory rural  service to MBBS medical graduate instead. Consider incentives like preference in post graduate selection and special rural salary structure.

The clinical establishment (Registration and Regulation) act 2010:

In its wisdom the Lok sabha passed this bill to regulate the hospitals of this country without even a semblance of a discussion. This law effectively brings in a license raj. Every clinic and hospital in this country has to renew  its license every three years. While the Government have moved away from license raj in trade and industries it has deemed it fit to bring in Government control in a vital sector. This is the price we have to pay for the dynamic growth we have brought in. By backdoor exercise of power on a state subject the medical profession of the country has been betrayed. There are more than 43 laws governing the healthcare institutions. What is left for the Government to regulate? If the price of being honest citizens is a license raj it is time for a non cooperation movement.

A particularly disconcerting aspect is the definition of an ‘emergency medical condition’ in Section 2(d) of the Act and section 2(o) seeks to legislate regarding what is essentially a medical phenomenon, namely, ‘stabilisation’ of the condition of the patient and mandates that the patient should not be transferred till his/her condition has been ‘stabilised’. But no mention of incurring cost or infrastructure of the establishment has been made. The entire autonomy of functioning of the private healthcare sector has been taken away by this act at a time when the private sector shoulders the major responsibility of healthcare in India as per official data. The  act is replete with instances of excessive delegation which would only serve to deter the growth of clinical establishments and prove to be a fetter to their functioning rather than severing any credible and/or laudable purpose. This is likely to result in bureaucratic red- tapism and motivated and colourable exercise of administrative power. In plain words, it is likely to further promote corruption and to subjugate the already overburdened private healthcare delivery system to government control.

IMA demands

a)      a single window for all legislations on a hospital.

b)      confine to registration and collection of statistics .Do away with licensing.

c)       provide for online registration and independent accreditation process.

d)      abolish the national council under this act which effectively undermines the authority of the states.

Security in hospitals:

                Security in hospitals across the country has become an important issue for doctors, healthcare workers and patients alike.  Junior doctors in large institutions and doctors in causalities are especially vulnerable; not to speak of obstetricians who are at the receiving end irrespective of whether they intervene or do not intervene.  Prevention of violence and damage to property Bill 2008 for Hospital and medical professionals protection , at the initiative of IMA have been enacted in many states namely Andhra Pradesh, Maharashtra ,Kerala , MP, Delhi and few more states. . I will request the state branches to take this matter with their Governments to replete this act. I would appeal to the medical profession to constantly improve their communication skills and avoid situations leading to violence.  Nevertheless I demand that authorities be ruthless on antisocial elements indulging in organised violence against doctors and hospitals

Health Insurance:  

Health insurance is fast emerging as  an essential component of health care delivery system.  The issues confronting hospitals especially in the cashless service sector have to be sorted out for the benefit of the patients.  IMA will  play a lead role along with  institutions like IRDA, hospitals  and Nursing Homes associations, Corporate groups like CII and FICCI and other professional and specialist organisations to ease the current  impasse by assisting in Process of accreditation of Hospitals and medical Establishments which should be transparent and uniform  IMA also appeals to the Government of India  to rationalise the tariff under CGHS and the Rasthriya Swasthya Beema Yojana  and expand the coverage

Academic wings of IMA:

My identity in IMA is from  college of general practitioners. IMA CGP and IMA AMS have scaled new heights. With mandatory CME hours round the corner these institutions which have stood the test of time are all the more relevant now. We will pursue  deemed   university  status for AKN Sinha institute. Distance learning courses will get special emphasis in my tenure.

Service Doctors issue:

IMA is aware of the problems faced by the service doctors in their day to day working. Service doctors are hard pressed in performing their duties due to excessive workload, lack of infrastructure and the interference from different quarters still they are the major healthcare providers. IMA is keen and will take all initiatives to improve working conditions, rationalization of their wages, better security for them.

ESI Scheme:

 As IMA’s representative in the core group of ESI,I am a witness to its inclusive growth. It is the largest social security scheme of the world. It has grown into a health care  delivery system for a substantial section of our society and has successfully branched into medical education as well. The working conditions and welfare of doctors providing care in ESI is close to my heart.

Membership:

Politics is all about numbers. If IMA has to stand upto the Government, we need the numbers. Not only we need to represent a larger constituency we need to do it urgently. I would exhort all of you to catch them young. Let all state branches devise special programmes to benefit young doctors. They are our future. They are our strength.

My dear students:

 We are on war  today to save your tomorrow. IMA will stand like a rock through the testing times to guide you. IMA declares the proposed exit test after regular university exams as illegal and unacceptable .On the other hand let the society have a debate on the pros and cons of a common entrance test. Let there be a consensus before a decision like this is taken. On one hand MCI and Government wants to introduce “Exit Test” for the qualified and well trained young medical graduates and on other hand it wants that Indian public to be treated by half baked, improperly trained persons under the BRHC! what a paradox!

Health of doctors:

I want all my brethren and their family members to be healthy and stress free. So spend some time for  yourself and your family’s health. Doctors are known to violate all rules of health by over working. Long stressful working hours have burnt out many promising doctors in midlife. Learn to manage your time well with adequate sleep and relaxation. The small fraction of the doctors who still smoke can make a beginning by quitting this unhealthy habit.

State branches:

I would  want IMA state branches to communicate in real time. Let information from  all 1600 branches flow into IMA on daily basis. Let us create a command and control so that the medical fraternity of the country can be alerted in matter of hours. Information  is power. Let it flow in both directions in real time.

Many of our State /Local Branches are involved in many disputes within/amongst  themselves which in many cases has lead to court cases. I appeal to all branches to resolve it and unite shedding their differences as outside forces have started taking advantage of our fight and weakening our  strength and unity

Anti Quackery Movement:

Special thrust and emphasis would be given to  Anti Quackery Movement  We request the state governments to pass Anti Quackery  Bill to save innocent and poor citizens of our country from the  menace of quackery   

Quality in healthcare:

IMA is concerned with quality in our healthcare institutions. IMA would devise its own accreditation system for institutions. Standard of care inside the profession should be  facilitated by  standard protocols(SOPs).

International affairs:

IMA will play its legitimate role in international institutions like WMA, WONCA and SAARC. We will reflect the confidence of new India amongst the international medical community.

Telemedicine:

My vision is to start telemedicine from the IMA headquarter and request all state branches to a participate in it through their offices so that through this networking we are able to reach the remotest area. This will also help in our projects like  Aao Gaon Chalae

 Media  and medical Profession:

I appeal to all my state  branches to develop state media centre in their head quarters building to provide and disseminate right health messages to the public .It will also become a useful source for  providing  qualitative health information.

Public Health:

IMA is the main bridge between clinical medicine and public health.  This link is vital for the concept of private public partnership.  These two disciplines are the two eyes of modern medicine.  Both have unique identities.  Optimum use of national resources would require to cross the chiasm between the private and public sectors.  IMA is ideally suited to foster private public partnership.  IMA has demonstrated its resilience in  carrying out giant projects in TB care,  HIV-AIDS and rural health care.  GFATM project in RNTCP PPM and Aao Gaon Chalen project have revolutionized the concept of PPM. I extend hands of co-operation to the Government to work with IMA in all areas of health including rural healthcare. Let us go beyond National Health programmes.My dream project Aao Gaon Chalae was started with the purpose of providing healthcare at the doorstep of every village and tribes in our country. I request all my state/local branches to take the initiative and adopt one village each . Our dream is to see that every citizen is provided with basic healthcare.

IMA continues to take a proactive role in sex determination issue through its mission of “Save the Girl Chid” .

India is hub of human resource globally and to provide quality human resource IMA strongly feels that younger generation be provided with proper nutrition and be free of  Anaemia .

IMA continues in its efforts on issues of Tobacco, alcohol and drug abuse

My priority is to take a lead in preventing and addressing the Lifestyle diseases like Diabetes/Hypertension/Coronary artery disease   Public Health forum to be crated in every states.

Conclusion:-

IMA should not be seen as a simple association/union but it like a intellective protective body for the identity and  rights of the profession and the individuals. I applaud the role of medical specialty organizations and the academic wings of IMA in their yeoman service in updating the medical professionals through CME and workshops.  I appeal to all specialist organizations whose members are also members of IMA that we should use the IMA platform to raise their problems and issues concerning   individual identity/rights/dignity of the profession and professionals. We should  work with unity and cohesiveness for strong networking.

Many members of medical profession are representatives at various legislative bodies  recognizing their contribution towards the nation IMA would empower them to be our mouth piece to raise various medical issues in their respective platforms.IMA is often seen as socio-academic organization its time for a paradigm shift towards trade union approach to fight for our rights, dignity of the profession, to safe guard the interest of our members and for collective bargaining on the issues of health care.

 IMA offers all the cooperation and assistance to the Government of India and also to state Governments through state branches in not only implementing the national health programmes but also in establishing Medical Colleges and Medical establishments under PPP scheme. We also offer our services in maintaining and enhancing the standard of medical education in the country. IMA is keen to participate in the formulation of the National and state Health policies.

With 92% of mandate behind me and my team I am conscious  of the enormous burden of love and trust  on my shoulders. My endeavor is to take along the whole medical fraternity. We are into testing times for the profession. Stewardship of this noble profession now is crucial for its survival. Unity ,hard work and providence will reach us to destiny. We are not alone in this fight of right against might. I count every Indian on our side. Wish me good luck.

Jai Hind         !                                                                                                           Jai IMA!