Every doctor who registered in India before September 2020 holds a qualification recognised, and a name entered on a register maintained, under one statute, and practises under another. The MCI vs NMC question is therefore not antiquarian. It decides who may open a medical college, who fixes what that college may charge, who can strike a doctor off the register, and whose examination stands between a graduate and a licence. Two bodies have held those powers in succession, built on opposite theories of where trust in a regulator should come from, and the argument between their defenders is usually conducted as a quarrel about character: the old council was corrupt, the new commission is controlled. This article refuses that framing. It tests the replacement the way the series tests every institutional replacement, by asking whether each change made in 2019 maps onto a failure of the predecessor that somebody had documented, in a court record, a committee report, or a statute book, before the change was made.

The comparison sits inside a larger body of law, and the reader who wants the full map of statutes governing hospitals, drugs, public health and the profession should begin with the framework treatment of health legislation in India before returning here for the head-to-head. The anatomy of the successor statute itself, its boards, its registers and its offences, belongs to the article on the National Medical Commission Act 2019, whose record of Act numbers, commencement dates and enacted provisions this comparison follows and does not reopen. What this article owns is the verdict, and the verdict is derived, not asserted. Seven dimensions decide the question. For each, the comparison table at the centre of this article records whether the change addressed a documented failure of the Medical Council of India, addressed a failure that was asserted but not documented, or changed something no identified failure had called in question. Counting that column is the verdict. A reader in a hurry may go straight to the table and the count; a reader who wants to know whether the count is fair has to walk through the record first, because every cell of the verdict column is a claim about evidence.

Two regulators built on opposite theories of trust

The Medical Council of India was the creature of the Indian Medical Council Act, 1956, Act 102 of 1956, which reconstituted a council first created under the colonial Act of 1933 and gave it the maintenance of uniform standards of medical education, the recognition of medical qualifications, and the keeping of the Indian Medical Register. Its design expressed a theory: a profession is best regulated by those the profession itself chooses, because only practitioners can judge practitioners, and because a regulator elected by the regulated carries a legitimacy that no appointed body can borrow. Section 3 of the 1956 Act built that theory into a very large assembly. One member came from each State other than a Union territory, nominated by the Central Government in consultation with the State Government. One member came from each university with a medical faculty, elected from among the faculty by the university senate or court. One member came from each State maintaining a State Medical Register, elected by the registered practitioners of that State from among themselves. Seven more members were elected by registered practitioners across the country, and eight were nominated by the Central Government. The president and vice-president were elected by the members from among themselves. As the number of universities with medical faculties grew, so did the council, until it ran to well over a hundred members, the substantial majority of whom owed their seats to some form of election. It met infrequently, worked through an executive committee, and concentrated every regulatory function in one pair of hands: it wrote the curriculum and the standards, it recommended whether colleges should be permitted and recognised, it maintained the all-India register, and it superintended professional ethics, while the State Medical Councils, creatures of state legislation, handled first-instance registration and discipline on the ground.

The National Medical Commission is the creature of the National Medical Commission Act, 2019, Act 30 of 2019, which received the assent of the President on 8 August 2019 and was brought into force on 25 September 2020, the date on which the 1956 Act stood repealed and the council’s Board of Governors stood dissolved. Its design expresses the opposite theory: a regulator is a technical body, its members should be selected for ability through a search process rather than returned by an electorate with interests in the outcome, and its functions should be separated so that the hand that writes the standard is not the hand that inspects against it or the hand that punishes. Section 4 of the 2019 Act builds a commission of thirty-three: a chairperson, ten ex officio members, and twenty-two part-time members. The ex officio bloc consists of the presidents of the four autonomous boards, the Director General of Health Services, the Director General of the Indian Council of Medical Research, a director of one of the All India Institutes of Medical Sciences nominated by the Central Government, two directors drawn from a named list of national institutes, and a representative of the health ministry not below the rank of Additional Secretary. Of the part-time members, three are experts in fields such as management, law, medical ethics, health research, consumer or patient rights advocacy, science and technology and economics; ten are appointed on rotation from among the nominees that States and Union territories send to the Medical Advisory Council from their health universities; and nine are appointed from among the nominees of State Medical Councils in that same advisory body. Nobody reaches the commission by election from the profession at large. The chairperson and the expert part-time members are appointed by the Central Government on the recommendation of a Search Committee chaired by the Cabinet Secretary, and every member holds office on terms the statute fixes, with no reappointment for the chairperson and the expert members.

Between those two designs lies the whole dispute. The elected council trusted the profession and was, on the record assembled below, captured by pieces of it. The nominated commission distrusts election itself and answers instead to the government that appoints it, a government to whose written policy directions Section 45 of the 2019 Act expressly binds it. Neither theory is absurd. Professions in many democracies regulate themselves through elected or profession-heavy bodies without scandal, and appointed regulators in many fields do honest technical work without becoming ministries. The question the evidence has to answer is narrower than the rhetoric: what, exactly, had gone wrong with the Indian council, in documents anyone could read, and does the 2019 statute fix those things, or does it fix those things and also do something else?

The failed repairs: what was tried before replacement

Replacement was not the first resort, and the comparison is fairer for remembering the attempts that preceded it, because each failed attempt narrowed the options a legislature faced in 2019. The most ambitious was the National Commission for Human Resources in Health Bill, the product of the reform thinking that followed the National Knowledge Commission and the Yashpal Committee, which proposed to lift health professional education into an overarching commission and leave the professional councils with registration and ethics. The Parliamentary Standing Committee returned that Bill in 2013 with observations that it violated federal principles and threatened excessive bureaucratisation and centralisation, and it died. The pattern repeated at lower altitude: amendment bills to repair the 1956 Act from inside, adjusting composition or adding a power, were introduced in Parliament across the decade and lapsed, and the profession’s associations, which had the political weight to force a repair bill through had they wanted one, directed that weight at defeating replacement instead. A health ministry that could not remove a member, could not direct policy, and could not get a repair bill enacted was left holding two instruments, the ordinance and the supersession clause, both of which it used. The lesson for the comparison is uncomfortable for both camps. For the government, the decade of failed repair means the 2019 Act was not a considered first choice but the survivor of a process of elimination, which explains its bundling: a legislature that finally gets one vehicle loads it with everything. For the profession, the decade means the elected council had ten years of warning, two supersessions, an oversight committee and a parliamentary indictment in which to reform itself from within, and produced no self-reform that any committee recorded. When the verdict section weighs the appointment clause against the evidence, it weighs it against this background too: the alternative to appointment on offer in 2019 was not a reformed election but the unreformed one.

The record that ended the Medical Council of India

The end began with an arrest. On 22 April 2010 the Central Bureau of Investigation arrested Dr Ketan Desai, the president of the Medical Council of India, in a trap case under the Prevention of Corruption Act, alleging that a bribe of two crore rupees had been arranged in return for recognition of the Gyan Sagar Medical College in Punjab, an institution the council’s own processes had found deficient. The college’s representatives and an alleged middleman were arrested with him. A Delhi court refusing bail recorded the bureau’s case at its height: that nobody had dared complain against the president because of the influence he had built, and that complaints reached the bureau only after his arrest, eventually numbering in the hundreds. The Indian Medical Association, in a white paper on Desai, contested the popular version of the trap and pointed to the seizure memos to argue that the cash narrative was concocted; the profession’s own body, that is, disputed the founding story of the reform even while the story was being used to justify it. For the institutional question, the contested details matter less than the uncontested ones: the president of the regulator was arrested on corruption charges arising out of the recognition function, the charges were prosecuted, and a system that had no mechanism to remove or suspend its own head in such an event simply had to be switched off from outside.

It was switched off within weeks. By the Indian Medical Council (Amendment) Ordinance of 2010, notified on 15 May 2010 and later enacted, the council stood superseded, its president, vice-president and members vacated office with no claim to compensation, and a Board of Governors took over its functions; the amendment also wrote Section 3A into the 1956 Act, giving the Central Government a standing power to supersede the council and constitute such a board. The first board had six members and was chaired by Dr S. K. Sarin, a hepatologist of national standing. It was meant to hold the fort for a year while a replacement was designed. The replacement was not designed in a year, or in two: the board’s term was extended, and the elected council was reconstituted only in 2013. That interregnum matters to the comparison for a reason neither side advertises. The Board of Governors, an appointed body of eminent doctors, itself proposed several of the instruments later credited to the 2019 reform, including a common entrance examination and a post-MBBS exit test as a condition of practice. Appointment and election, it turns out, do not divide the reformers from the obstructionists as cleanly as the later debate suggested.

The second act of the record is a report. The Group of Experts headed by Professor Ranjit Roy Chaudhury, constituted by the Central Government to study the 1956 Act and recommend how the council might be made modern and suited to prevailing conditions, reported in favour of structural reconfiguration: a National Medical Commission created by a new Act, standing over segregated verticals for undergraduate education, postgraduate education, accreditation of institutions and registration of doctors. Separately and more damagingly, the Department-related Parliamentary Standing Committee on Health and Family Welfare presented its Ninety-second Report, on the functioning of the Medical Council of India, to the Rajya Sabha on 8 March 2016. A parliamentary committee is not a prosecutor, and its findings are not convictions; but it took evidence, it heard the council, and what it recorded has never been answered on its own terms.

What exactly did the Ninety-second Report find in 2016?

The committee recorded the council president’s own admission that corruption existed in the sanctioning of medical colleges and in decisions on seats, and concluded that the council had become captive to private commercial interests rather than a guardian of the public interest. Its prescription was a complete restructuring of the regulatory system under a new comprehensive law.

It found the elected composition biased towards the corporate and private sector, an exclusive club that represented neither professional excellence nor professional ethos, and it found the quality of education assessed almost entirely by counting infrastructure and staff, with no evaluation of teaching, learning outcomes or the competence of the graduate produced.

The report’s individual findings deserve the weight the reform case gives them, and one of them deserves more weight than the profession’s defenders usually allow. The finding on assessment is the hinge of the whole comparison. The first objective written into the 1956 settlement was the maintenance of uniform standards of medical education, and the committee found that the council measured that standard by physical inputs: beds, buildings, faculty lists on paper. It did not evaluate what was taught, how it was examined, or what the finished doctor could do. A regulator whose only instruments are input counts invites exactly the fraud the record showed, because an institution can rent the inputs for inspection day. Ghost faculty, patients hired for the visit, equipment borrowed for the week: these were not inventions of the reformers’ pamphlets, they were the standard allegations of the period, and the committee’s structural point explains why they were so hard to defeat. Where assessment is a headcount, compliance is a performance staged for the counter.

The judiciary then supplied the third act. In May 2016 a Constitution Bench of the Supreme Court, deciding the Modern Dental College case on the State’s power to regulate admissions and fees in private professional colleges, also addressed the regulator’s collapse of credibility: an Oversight Committee, headed by Justice R. M. Lodha, a former Chief Justice of India, was set in place to oversee the council’s statutory functions until new legislation arrived. The council worked thereafter under supervision, which is a remarkable condition for a statutory regulator, and the arrangement still failed. A second Oversight Committee, appointed in 2017 and staffed substantially by the doctors who would later form the Board of Governors, reported non-cooperation and non-compliance by the council, and resigned in July 2018.

What did the Supreme Court’s oversight committees do, and why did the second one resign?

The first committee, headed by former Chief Justice R. M. Lodha, was created on the Supreme Court’s direction in 2016 to oversee all statutory functions of the council until Parliament legislated, approving or vetoing its working from above. The second committee, appointed in 2017, resigned in July 2018.

It recorded that the council had been non-compliant and non-cooperative throughout and had misread court orders in ways that challenged the committee’s authority, leaving supervision without a supervised institution willing to be supervised.

The government’s response to the resignation was the second supersession. By the Indian Medical Council (Amendment) Ordinance, 2018, promulgated on 26 September 2018, the council was superseded again and a seven-member Board of Governors, chaired by Dr V. K. Paul, Member of NITI Aayog, and including the directors of the All India Institute of Medical Sciences in New Delhi, the Postgraduate Institute at Chandigarh and the National Institute of Mental Health and Neurosciences at Bengaluru, took over the council’s powers. That board governed Indian medical education for two years, until the 2019 Act commenced on 25 September 2020 and the board stood dissolved with the council it had replaced in fact. By then the legislative vehicle existed: a four-member committee headed by the Vice Chairman of NITI Aayog, Dr Arvind Panagariya, had examined the options and framed a draft National Medical Commission Bill in 2016; the Bill of 2017 was introduced in the Lok Sabha on 29 December 2017, referred to the Standing Committee, which reported on it in March 2018 as its One Hundred and Ninth Report and secured the removal of the proposed bridge course for practitioners of other systems, and lapsed with the House; the Bill of 2019 was introduced on 22 July 2019, passed by both Houses within days, and received assent on 8 August 2019. The council that the ordinance of 2018 had superseded was never revived. It was repealed out of existence, which is a different legal event from supersession, and the difference is the subject of the transition discussion below.

MCI vs NMC across the seven dimensions that decide the question

Seven differences between the two statutes do the real work, and they are not equally connected to the failure record. Composition asks who sits in the regulator. Separation of functions asks whether the same hands write standards, inspect against them and punish breaches. Recognition and assessment ask how a college is judged. Entry to practice asks what stands between a graduate and a licence. Fee regulation asks whether anybody may touch the price of a private seat. The state voice asks how the units of the federation speak inside a national regulator. Government direction asks to whom the regulator must listen. The table states each difference and then gives the verdict this article derives for it. The three verdict labels are used strictly. “Documented” means the predecessor’s failure on that dimension appears in the arrest record, the Ninety-second Report, the oversight history, or the litigation record assembled before 2019. “Perceived” means the failure was asserted in the reform debate and believed by serious people, but the documents establish something adjacent rather than the thing asserted. “Unrelated” means the change answers no failure that the record identifies on that dimension at all.

Dimension	The council under the 1956 Act	The commission under the 2019 Act	Verdict
Composition	Well over a hundred members; the substantial majority elected by practitioners and university faculties; president elected from within	Thirty-three members; chairperson, ex officio members and part-time members appointed; no seat filled by election from the profession	Perceived
Separation of functions	Standards, recognition, assessment, register and ethics concentrated in one council and its executive committee	Functions distributed across four autonomous boards under a coordinating commission	Documented
Recognition and assessment	Physical inspections by council inspectors and visitors; input counts; sanction effectively binary, permission or refusal, recognition or withdrawal	Assessment and rating by a dedicated board; third-party inspection permitted; ratings published; graduated sanctions including monetary penalties and intake reduction	Documented
Entry to practice	University degree plus registration; a screening test only for foreign graduates; no national licentiate examination	One statutory entrance test and a common final-year exit test designed to carry licensing, postgraduate merit and foreign-graduate screening	Documented
Fee regulation	No statutory fee power in the council; fee fixation arrived through court-ordered state committees	Commission empowered to frame fee guidelines for fifty per cent of seats in private institutions and deemed universities	Documented
The state voice	States present through elected practitioner members, university members and nominees inside the deciding body	States speak through an advisory council that cannot decide, and through rotating nominees among the part-time members	Unrelated
Government direction	No power in the Centre to direct the council on policy or to remove its members; the only levers were amendment and supersession	Commission and boards bound by the Centre’s written directions on questions of policy, the Centre deciding finally what is policy; members removable by the Centre; the commission itself supersedeable	Unrelated

Composition first, because it is the dimension on which the public argument concentrates and the dimension on which the documents are most often misread. The reform debate treated election as the disease. The NITI Aayog committee of 2016 said the quiet part plainly: with most members elected, the regulated chose the regulators, and the conflict of interest was structural rather than personal. The Ninety-second Report attacked the composition too, calling it an exclusive club unrepresentative of excellence or ethos and noting that more than half the members came from the corporate and private sector. But read closely, the committee’s documents prove a different proposition from the one the remedy assumes. They prove that this electorate, in this institutional setting, with no removal power anywhere in the system, no asset disclosure, no cooling-off rule and a recognition function worth crores to its applicants, produced capture. They do not prove that election as such produces capture, and the comparative evidence cuts the other way: professional self-regulation through elected bodies functions in other democracies, and India’s own appointed bodies have their own capture histories. What the record documented was a specific machine for corruption, in which a valuable discretionary decision, college recognition, was held by a body accountable to an electorate of interested parties and to nobody else. The 2019 Act smashed the machine. It also abolished the electorate, which was not the part of the machine the documents indicted. Hence the verdict of “perceived”: the failure of election was perceived, and honestly perceived, but what was documented was capture without accountability, a failure that disclosure rules, removal powers and conflict screening, all of which the Act also contains, address directly.

Separation of functions is the cleanest cell in the table. The Roy Chaudhury Group of Experts recommended segregated verticals in 2015. The Ninety-second Report recommended the same architecture in 2016, proposing separate boards for education standards, for accreditation and assessment, for registration and licensing, and for ethics. The enacted statute follows that blueprint almost exactly. Under Section 16 of the 2019 Act, four autonomous boards operate under the commission’s supervision: the Under-Graduate Medical Education Board, which sets standards and curriculum for the MBBS; the Post-Graduate Medical Education Board, doing the same for postgraduate education; the Medical Assessment and Rating Board, which permits new colleges and judges existing ones; and the Ethics and Medical Registration Board, which keeps the National Register and polices professional conduct through the State Medical Councils. Each board has a president and four members appointed by the Central Government. Under the 1956 Act, by contrast, the council’s executive committee and its postgraduate committee between them covered the same ground without structural separation, so that the body which decided what a college must have was the body that visited to count it and the body that answered for the count. Separation is standard regulatory design across sectors for a reason that has nothing to do with medicine: it converts one unreviewable discretion into several decisions, each visible to the others. The commission also sits in appeal over its boards under Section 10, which gives an aggrieved college or doctor an internal appellate tier that the old structure, in which the council was accuser, judge and reviewer of its own recognition decisions, never supplied.

Recognition and assessment is where the documented failure was most concrete, and the change is correspondingly specific. Under the 1956 Act, a new college or a new course or an increase in seats required the prior permission of the Central Government under Section 10A, granted or refused on the council’s recommendation after inspections conducted under Sections 17 and 18 by inspectors and visitors the council appointed. The process was physical, episodic and theatrical: a team arrived, counted faculty and beds and patients, and reported, and the college’s year turned on the performance of a few days. Critics inside the system counted the inspections a college might undergo across its journey to full recognition in the dozens. The standing committee’s finding that quality meant infrastructure explains the pathology: an input checklist can be satisfied by hiring for the day, which is why the era’s reporting is full of ghost faculty and rented patients, and why recognition decisions, taken behind the checklist, were the precise point at which money could move. The prosecution case against the council’s president was, at its core, a recognition case.

The 2019 Act attacks that point from four directions at once. Permission for a new college, a new course or more seats is granted by the Medical Assessment and Rating Board itself under Section 28, removing the dual control under which the council recommended and the ministry decided and each blamed the other. Assessment and rating is a distinct statutory function under Section 26: the board determines the procedure for assessing and rating institutions against the standards the education boards set, conducts inspections, and, by an express proviso, may hire and authorise a third-party agency or persons to carry out inspections, so that the inspector need not be a member of the guild being inspected. Ratings must be made public on the board’s website at regular intervals, converting assessment from a private file into a published fact that students and patients can use. And the sanction ladder in Section 26 is graduated: warning, monetary penalty, reduction of intake, stoppage of admissions, and a recommendation to the commission for withdrawal of recognition, replacing a regime whose realistic choices were the nuclear one of derecognition, which harmed enrolled students, or nothing. Each of those four changes answers a documented defect: discretion concentrated at a corruptible point, assessment by insiders, secrecy, and a binary sanction that made enforcement too destructive to use. This is the strongest part of the reform, and the profession’s critique has never really engaged it.

Where do a college’s ratings appear, and who can read them?

Section 26 of the 2019 Act obliges the Medical Assessment and Rating Board to make the assessment and ratings of medical institutions available on its website or in the public domain at regular intervals, and empowers it to empanel independent rating agencies to do the assessing.

Any reader can see them: the student choosing a college, the patient choosing a hospital and the researcher comparing institutions all read the same published rating.

Entry to practice is the dimension on which the two statutes differ most in ambition. The 1956 settlement trusted the university. A recognised degree from a recognised institution entitled its holder to enrol on a State Medical Register and practise; the only national screen stood at the border, where Section 13 of the 1956 Act required an Indian citizen holding a foreign medical qualification to pass a screening test, the Foreign Medical Graduate Examination conducted by the National Board of Examinations, before enrolment. There was no licentiate examination for the home-grown graduate, however weak the university that had examined him, and proposals for one surfaced and sank repeatedly: the first Board of Governors proposed a post-MBBS exit test in 2010 and 2011, and the idea returned in bill after bill without enactment. The standing committee’s finding that the system had failed to produce a competent basic doctor, and that quality was never tested at the output end, is the documented failure this dimension answers. The 2019 Act answers it with two examinations. Section 14 writes the National Eligibility-cum-Entrance Test into the statute as the uniform entrance examination for undergraduate admission, with common counselling, absorbing the separate entrances of the All India Institutes and other statutory institutions from the academic year 2020-21; NEET itself had arrived earlier, through the council’s own regulations in the last years of the old regime, a constitutional detour through the courts, and an amendment of the 1956 Act in 2019, so the successor statute inherited rather than invented it. Section 15 then creates the National Exit Test, and it is examined separately below, because its text and its fate have parted company.

Fees are the dimension where the old statute’s silence did the damage. The Indian Medical Council Act, 1956 gave the council no power over what a private college charged, and into that silence stepped, first, the capitation fee, the unrecorded payment for a seat that became the financial engine of private medical education and the original source of much of the money that later corrupted the recognition process. The courts filled part of the gap: in Islamic Academy of Education in 2003 the Supreme Court directed each State to constitute a fee fixation committee headed by a retired High Court judge, and in P. A. Inamdar in 2005 a seven-judge bench confirmed the committee model while holding that unaided institutions retained autonomy subject to a bar on profiteering and capitation. Fee control under the old regime was therefore real but judicial, state by state, committee by committee, and wholly disconnected from the national regulator. The Ninety-second Report recommended that fee regulation be brought within the regulatory mandate. Section 10(1)(i) of the 2019 Act does exactly that, in part: the commission frames guidelines for the determination of fees and all other charges in respect of fifty per cent of seats in private medical institutions and deemed universities. In February 2022 the commission issued its fee guidelines, directing that the fee for that half of seats be aligned to the fee charged in government medical colleges of the State. The other half of seats remains outside the guideline power, a compromise written into the statute itself, which the profession’s critics call a licensed profiteering zone and the government defends as the price of private capacity. Either way the cell is “documented”: the failure was recorded by committees and courts for decades, and the remedy, though partial, is aimed at it.

The guideline power also did not abolish the machinery it overlaid, and the resulting layering is part of the comparison. The state fee committees born of the Islamic Academy direction continued to exist under their state mandates, and the commission’s guidelines entered a field already occupied by committees, state legislation on admissions and fees in several States, and the constitutional protections the Inamdar bench had written around unaided and minority institutions. A private college therefore answers, in the new regime, to a national guideline for half its seats and to the older state apparatus for the rest, an arrangement nobody would have designed from a blank page. The profession reads the layering as proof that the reform distrusted its own instrument. The government reads it as federal gradualism. The comparison records only that the fee question, which under the council was a judicial artefact scattered across thirty-odd committees, became under the commission a statutory function with a national author, and that the change of author, partial and layered as it is, is the kind of change the failure record had actually requested.

The state voice is the first of the two cells marked unrelated, and it shows what the bundling did. Under the 1956 Act the States were inside the room where decisions were taken, three times over: a nominee in consultation with each State Government, an elected member from each State’s registered practitioners, and the university members, most of them from state universities. Those members voted. Under the 2019 Act the States speak in two registers, neither of which is a vote that binds. The Medical Advisory Council, constituted under Section 11 and chaired by the commission’s chairperson, is declared by the Act to be the primary platform through which the States and Union territories may put forth their views and concerns before the commission, and it advises on measures for determining and maintaining minimum standards. Its members include a nominee of each State Government, the vice-chancellors of health universities and representatives of State Medical Councils. From that council’s state nominees, nineteen of the commission’s twenty-two part-time seats are filled on rotation. The federal channel is therefore wide but shallow: many voices, advisory only, on a body whose advice the commission may note and disregard, while the seats the States do hold on the commission itself are part-time, rotating and outnumbered by the ex officio and appointed core. Nothing in the failure record identified the States’ voting presence as a defect. The documented complaints ran the other way, against a regulator indifferent to the distribution of colleges across States and to primary care needs in the poorer ones. Diluting the federal voice answered no documented failure; it answered a preference for a regulator the Centre can convene, staff and steer.

What can the Medical Advisory Council do, and what can it never do?

The council can place the views and concerns of every State and Union territory formally before the National Medical Commission, advise it on the measures needed to determine and maintain minimum standards of medical education, and supply, from among its state and State Medical Council nominees, the nineteen rotating part-time members of the commission.

It cannot decide anything: it passes no regulation, grants no permission and binds the commission to nothing, however unanimous its advice.

Government direction completes the table, and it is the cell the profession’s case is really about. The 1956 Act gave the Central Government no power to direct the council on questions of policy, and no power to remove its president or members, however disgraced. The ministry official who told the story of those years put it in one sentence that the reform literature repeated: the ministry was not empowered to remove or sanction a member of the council even if he had been proved corrupt. The Centre’s levers were two, both blunt: amend the statute, or supersede the whole council, which it did twice by ordinance when the ordinary position became indefensible. The 2019 Act replaces those blunt levers with a full control panel. Section 7 empowers the Central Government to remove the chairperson or any member on stated grounds, including conviction for an offence involving moral turpitude and the acquisition of a prejudicial financial interest, with a hearing required on the grounds that turn on conduct. Section 45 binds the commission and the autonomous boards to such directions on questions of policy as the Central Government gives in writing, with the proviso that the commission be given an opportunity to express its views first, and with the final word on what counts as policy reserved to the Government itself. Section 46 empowers directions to State Governments for carrying out the Act. Section 55 goes further and empowers the Central Government to supersede the commission itself for up to six months, extendable by six more, on grounds that include persistent default in complying with the Government’s directions. A removal power for cause answers the documented failure; the 1956 system’s scandal was precisely an unremovable president. A standing direction power, a final governmental say on what is policy, and a supersession clause triggered by disobedience of directions answer something else: they convert the regulator’s accountability upwards, to the ministry, where the council’s accountability had run downwards, to its electorate. Whatever that conversion is worth, no committee documented a failure of the council that consisted in refusing ministerial policy directions. The cell is unrelated, and it is the cell that will decide how the commission behaves in a crisis, because a regulator that can be directed and dissolved by the government of the day will price that fact into every hard decision it takes.

Admissions and counselling: the gate before the college

Between the regulator and the student stands an admissions machine, and the two regimes ran it differently in ways students felt more directly than any question of composition. Under the 1956 settlement as it stood for most of its life, admission to the MBBS ran through a thicket of entrances: state examinations, institutional examinations, and the deemed universities’ own tests, each with its own calendar and its own opportunities for the capitation economy to price a seat outside the merit list. The single national entrance examination arrived late in the old regime and by an untidy road, first through the council’s own regulations, then through the courts, which struck the notification down in 2013 in the Christian Medical College Vellore case and restored it on review in 2016, and finally through Parliament, which wrote the uniform entrance test into the 1956 Act itself in 2019. Counselling, the stage at which merit is converted into an actual seat, remained divided between a national pool and state pools run by state authorities, with domicile and institutional preference rules that the courts policed for fairness at the margins, upholding the State’s power to regulate admissions in unaided colleges in the Modern Dental College judgment while striking down arrangements that defeated merit.

Section 14 of the 2019 Act completes that trajectory and hardens it. The entrance examination is uniform by statute rather than by regulation, the separate entrances of institutions governed by their own Acts of Parliament are absorbed, and common counselling by designated authorities is written into the section for undergraduate and, in step with Section 15, postgraduate admission. The comparison scores this honestly on both sides. For the student, the unified gate is an unmixed gain in legibility: one examination, one merit list per pool, and a counselling architecture whose rules are set nationally even where the conducting authority is the State’s. For the federation, the same unification is the state-voice question returning by the back door, because control of the entrance and the counselling calendar is control of the effective shape of the state quota, and the friction between the commission and several States over counselling schedules and quota operation in the years after commencement was the advisory council’s weakness made visible in practice. Neither effect belongs to the appointment controversy. Both belong to a centralising logic the statute shares with its entrance provisions, and a verdict that scores the Act down for Section 45 while ignoring the quieter centralisation of Section 14 has not counted the whole statute.

Recognition in the courts: the litigation both regimes inherited

No account of the two regulators is complete without the arena in which much of their real power was exercised, the constitutional courts. Litigation over the recognition and derecognition of medical colleges, over permission for new colleges and new courses and increased seats, over admission timelines and the consequences of deficiency findings, formed the largest single body of case law in Indian medical education law, and it did so under the old regime for structural reasons the reformers cited constantly. A binary sanction, an annual permission cycle tied to an admission calendar that could not slip, a recommendation travelling from the council to a ministry that took the formal decision, and students already admitted into colleges whose status was contested: every element of that design manufactured writ petitions. Courts responded by building a protective jurisprudence around the student, holding in substance across a long line of cases that admissions made and courses pursued could not be destroyed by the institution’s regulatory failures, that deficiencies had to be pointed out with an opportunity to cure within the admission calendar, and that the regulator’s processes had to run on a schedule the academic year could survive. The council chafed under the discipline; the colleges weaponised it; and the spectacle of judges effectively timetabling a regulator’s inspections deepened the public sense, fair or not, that the old machine could not be trusted to run itself.

The 2019 Act tries to legislate the disputes into a corridor before they reach a courtroom. Permission decisions sit with the Medical Assessment and Rating Board under Section 28, and a refusal can be carried first to the commission and then to the Central Government, so that the record a court reviews has been made twice inside the system rather than once. The commission hears appeals against the decisions of its autonomous boards generally under Section 10, and a person aggrieved by a decision of the commission may appeal to the Central Government within thirty days under Section 9(6), a general appellate route the old Act never gave against the council, whose decisions were reachable only by writ. Whether the corridor works is an empirical question the years since commencement have only begun to answer, and the early signs are honestly mixed: the volume of recognition litigation has not collapsed, because the stakes of a permission decision are unchanged and an appeal inside the system is worth exhausting quickly on the way to court. But the comparison should record the design intention accurately, because it marks a real change in legal architecture. Under the 1956 Act the council was a recommender whose advice the ministry owned, and accountability for a bad decision could be passed between the two indefinitely. Under the 2019 Act the decision, the appeal and the second appeal each have a named owner inside or beside the regulator, and the writ court reviews a ladder that was actually climbed. That is a difference in the rule of law within the system, independent of who appoints the climbers, and it belongs on the documented side of the ledger: the litigation chaos of the old regime was not an allegation, it was a docket.

Choosing the governors: elections against a search committee

Between the two designs stands a machinery question that the comparison should not skip, because capture does not care about the label on the door; it cares about who selects, who can remove, who must disclose, and who may profit afterwards. The 1956 Act answered those questions weakly. Elections to the council were conducted under rules made by the Central Government, disputes went to the Government for a final decision, and that was nearly the whole of the integrity apparatus. A member’s financial interest in a college whose recognition he influenced was policed, if at all, by the criminal law after the fact. The 2019 Act answers the same questions in unusual detail, and some of its answers are the reform’s most defensible features, all the more so because they would have worked equally well inside an elected body. The Search Committee that recommends the chairperson and the expert members consists of the Cabinet Secretary as chair, three experts of not less than twenty-five years’ standing in medical education, public health education and health research nominated by the Central Government, one expert drawn from among the State Medical Council nominees on the commission, one person of similar standing from management, law, economics or science and technology, and the Union Health Secretary as convenor. It must recommend a panel of at least three names for each vacancy, and it must satisfy itself that a recommended person holds no financial or other interest likely to prejudice the functions of the office.

How does the search committee choose the Commission’s chairperson and expert members?

The Central Government refers each vacancy to the Search Committee, which is chaired by the Cabinet Secretary and includes three senior experts in medical education, public health and health research, one expert drawn from the commission’s State Medical Council nominees, one senior figure from management, law, economics or science and technology, and the Union Health Secretary as convenor.

The committee must clear each candidate of prejudicial financial interests and recommend a panel of at least three names, from which the Government appoints.

The same appointment logic runs one level down, into the boards where the working decisions sit. Each autonomous board consists of a president and four members, appointed by the Central Government, and the boards hold office under the commission’s supervision while exercising functions the statute assigns to them directly, a deliberate middle position between independence and hierarchy: the assessment board can refuse a college without asking the commission, and the commission can reverse the assessment board on appeal. In the old council, the corresponding work was done by committees of the council itself, chaired by members who owed their council seats to the electorates described above and who returned to those electorates for re-election, so that the inspection and recognition chain terminated, at every link, in a person with an electoral interest in the regulated community’s goodwill. The board structure severs that link at the working level even where one doubts the severance at the top, and it deserves separate credit in the comparison for exactly that reason.

The statute then surrounds the appointee with rules the old council never lived under. Section 6 requires the chairperson and every member to declare assets and liabilities on entering and on leaving office, and to declare professional and commercial engagements, with the declarations published on the commission’s website. It bars a departing chairperson or member from accepting, for two years, any employment in a private medical institution whose matters that person dealt with, subject to a governmental power to permit exceptions that critics reasonably describe as a hole in the fence. Terms are single and short: the chairperson and the expert members serve a term not exceeding four years with no extension and no reappointment, and the state-nominated part-time members rotate every two years. Rotation and non-renewability are anti-capture devices of a classic kind: a member who cannot be reappointed has nothing to sell to the appointing authority, and a member who rotates off quickly cannot build a durable market in favours. The honest summary of this dimension machinery is that the 2019 Act contains two distinct anti-corruption programmes. One is transparency and tenure design, which follows the evidence. The other is appointment itself, which follows a theory. The comparison with other appointment-built regulators inside Indian law, traced in the article on the tribunal experiment at the NCLT and NCLAT, shows the same pairing repeated: whenever an elected or professional body is replaced in Indian legislation, the replacement bundles a genuine integrity apparatus with a transfer of appointment power to the executive, and the two are thereafter defended as though they were one reform. They are not, and separating them is the analytical heart of this article. The pattern is not unique to medicine; the shift from election to appointment as the default source of regulatory legitimacy runs across the central institution Acts compared elsewhere in this series, where the governance-by-appointment sentence recurs in statute after statute.

The working rhythm differs as much as the selection method, and rhythm is a governance fact. The old council was an assembly: it met as a general body at long intervals, transacted its real business through an executive committee between meetings, and left long stretches of the regulatory year to a permanent secretariat answerable in practice to the president. A body of well over a hundred cannot deliberate; it can only ratify, and ratification by an interested assembly is the institutional form the capture finding took. Section 9 of the 2019 Act writes the opposite rhythm into law: the commission must meet at least once every quarter, one-half of its total membership including the chairperson is a quorum, and decisions run by majority of those present and voting, with the chairperson holding a casting vote. Thirty-three people meeting quarterly under a published asset regime will still make mistakes, and may make obedient ones, but they cannot plausibly claim that a decision happened somewhere else. The compactness that the profession reads as exclusion is, from the design side, the precondition of answerability, and it is the part of the composition change that does follow from the documented failure, even though the abolition of election, with which it arrived bundled, does not.

The register and the ethics code: the quiet machinery

For most doctors, most of the time, the regulator is not a permission letter or an inspection. It is a register entry and a code of conduct, and on this machinery the two regimes differ less dramatically than the headlines suggest, in ways that cut against easy verdicts. The 1956 Act built a two-storey register: State Medical Councils, working under their State Acts, enrolled practitioners on State Medical Registers, and the council compiled the Indian Medical Register from them. Registration carried the right to practise, to sign medical certificates and to hold medical office, and removal from a register, for infamous conduct in a professional respect, was the gravest sanction the system held over an individual doctor. The substantive code the registers enforced was the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002, framed by the council and binding on every registered practitioner: the duties to patients, the bar on advertising and fee-splitting, the rules on records and consent, the long catalogue of practices the code named as misconduct. Discipline ran where it had always run, at the State Council, which inquired, warned, suspended or erased, and the council’s role in individual discipline was largely appellate, standard-setting and supervisory rather than original.

The 2019 Act keeps the two-storey structure and re-labels the upper storey with intent. The Ethics and Medical Registration Board maintains a National Register of all licensed practitioners under Section 31, fed by the State registers, and the Act directs the States to have their own councils in place, within three years where none existed, precisely because the design cannot work without them. On ethics, the commission lays down policies and codes under Section 10, and the Board regulates professional conduct and promotes medical ethics, ensuring compliance with the code through the State Medical Council wherever the State Act gives that council disciplinary power, and hearing appeals against State Council action under Section 30. A patient with a complaint therefore travels much the same road under both regimes, beginning at the State Council, and the comparison that claims the new Act nationalised discipline is wrong. What did change is the visibility and portability of the register itself: a single national register, maintained electronically by a named board as the Act’s design intends, replaces a compiled paper record assembled from state returns, and the practitioner’s standing becomes checkable across State lines in a way the old Indian Medical Register, accurate on paper and stale in practice, rarely achieved. It is a modest, mechanical improvement, wholly unconnected to the appointment controversy, and it is the kind of gain that replacement statutes quietly deliver while the argument rages elsewhere. The ethics cell of the comparison thus ends in a draw neither side advertises: the code’s content and the complaint’s destination survived the change nearly intact, because on discipline the documents had never indicted the old regime’s design, only its education empire. The reform, to its credit, mostly left alone the machinery that was not broken.

The patient’s road: complaints, compensation and the limits of both regulators

A comparison written for doctors should spare a section for the person the system exists for, because the patient’s experience of the two regimes reveals a limit both share. A patient harmed by treatment has always had two distinct roads, and neither regulator owns the more travelled one. Compensation for medical negligence runs through the consumer commissions and the civil courts, a jurisdiction created by the consumer protection cases of the 1990s that brought medical services within the Consumer Protection Act, and it ran identically under the council and under the commission, because neither statute made the regulator a compensation forum. What the regulator owns is the other road: professional misconduct, the complaint that a doctor behaved unethically, advertised improperly, split fees, refused records, or practised beyond competence, and that road, as the register section showed, begins at the State Medical Council under both regimes and climbs by appeal, in the new design, to the Ethics and Medical Registration Board and, on commission decisions, to the Central Government. The 2019 Act’s own preamble of purposes promised an effective grievance redressal mechanism as one of the four objects of the new medical education system, and the profession’s critics reply that a promise routed through state councils of uneven capacity, some of them dormant for years at a stretch, is a promise the design does not keep by itself. The fair scoring is that the successor statute improved the appellate architecture above the state council and changed almost nothing at the counter where a patient actually files. Patients who read the change of regime as a change in their own remedies were misreading it, and a comparison owes them the correction: the great MCI vs NMC argument is an argument about who governs doctors and colleges. The law that compensates the injured patient lives in other statutes entirely, and it did not change hands in 2020.

The exit test: one reform in three states of existence

Section 15 of the 2019 Act provides for a common final-year undergraduate medical examination, the National Exit Test, and gives it three jobs. It is the licentiate examination a graduate must pass to practise. It is the basis on which admission to postgraduate broad-speciality courses is made, replacing the separate postgraduate entrance ranking. And it is the screen through which a person holding a foreign medical qualification must pass to obtain a licence, replacing the Foreign Medical Graduate Examination that the old regime ran under Section 13 of the 1956 Act. As a design, it is the logical completion of the standing committee’s critique: a system that never tested its output gains, on paper, a single national output test, indifferent to which university taught the candidate or which country issued the first degree. As a fact, it has to be stated in three separate propositions, because the distance between them is where the comparison on this dimension is honestly scored.

The first proposition is that the test is required. The statute commands it, in the mandatory architecture of Section 15, and no amendment has removed the command. The second proposition is that the machinery for it has been notified. In June 2023 the commission notified the National Exit Test Regulations, and a first sitting, to be conducted by the All India Institute of Medical Sciences in New Delhi and presented as a mock run for the final-year cohort, was announced for the following month. The third proposition is that the test has not been held. The announced sitting was called off after nationwide protests by medical students, who objected among other things to being made the trial cohort for an examination the Act had framed for their juniors; the commission deferred implementation, spoke of mock tests and feedback before any live run, and its academic calendar in the competency-based regulations pointed instead to a first Step 1 sitting in February 2028 for the batch that had begun the MBBS in 2023-24, with the deferral confirmed in terms to the profession’s delegations thereafter. In the interval, the old gates continue to do the work: the National Eligibility-cum-Entrance Test decides postgraduate admission, and the Foreign Medical Graduate Examination, run twice a year by the National Board of Examinations in Medical Sciences, remains the operative screen for foreign graduates, with the low pass rates that have always made it a bottleneck. A licentiate idea that the council’s own Board of Governors floated in 2010, that the standing committee’s logic implied in 2016, and that Parliament enacted in 2019 has therefore spent the whole life of the new regime in the ante-room. The comparison scores the design as a documented-failure answer and the delivery as an open debit against the successor, and it warns the reader against the commonest error in the literature, which is to describe the exit test either as a functioning feature of Indian medical regulation or as an abandoned one. It is neither. It is an enacted requirement, a notified regulation and an unheld examination, and any verdict that collapses those three states into one is a verdict about a statute that does not exist.

The design of the unheld examination is worth a paragraph, because it shows how far the successor regime intended to go beyond anything the council attempted. The notified regulations build the test in two steps: a theory step taken at the end of the final year, spanning the clinical subjects, and a practical and clinical step taken after the internship, so that the licence waits on demonstrated bedside competence and not on written performance alone. Postgraduate merit is to be read off the theory step, which is the provision students contested hardest, since it loads a ranking function onto an examination whose other function is a pass-or-fail licence and whose failure therefore carries a double price. The old regime’s answer to the same problem was to run the two functions in two separate examinations, a university degree for competence and a national entrance test for postgraduate rank, with all the duplication and coaching economics that separation produced. Reasonable systems differ on the merger. What is not reasonably deniable is that the merger cannot be evaluated until it is run, and that a reform whose centrepiece examination exists only in regulations has, on this dimension, delivered a blueprint where the old regime, for all its faults, delivered examinations that actually happened every year.

The reform case in its strongest form

The strongest version of the government’s case does not rest on the Desai arrest, which was one man’s prosecution, but on the accumulation of independent institutional witnesses who reached the same conclusion by different routes. A Group of Experts under Professor Ranjit Roy Chaudhury, asked to study the 1956 Act, recommended replacing the council’s structure with a commission over segregated boards. A parliamentary committee of the whole political spectrum, after hearing the council itself, recorded its president’s admission of corruption in sanctioning colleges, called the body captive to private commercial interests, and recommended complete restructuring under a new law. A committee of NITI Aayog under its Vice Chairman, Dr Arvind Panagariya, framed the draft Bill and named the structural defect without euphemism: where the regulated elect the regulators, the regulator’s incentives point at the electorate, not the public. Two Boards of Governors and two Supreme Court oversight committees supplied the operational evidence: given repeated chances to run the old statute honestly under supervision, the institution would not or could not. When Dr Harsh Vardhan, the Union Health Minister who piloted the 2019 Bill, described it on the floor of Parliament as an anti-vested-interests Bill and one of the great reforms of his government, the rhetoric was doing what rhetoric does, but the documentary spine underneath it was real. No serious participant in the debate defended the proposition that the council of 2016 was working. The argument was always about the remedy.

The remedy’s defenders make three further points that deserve their full force. The first is comparative: in the United Kingdom, the General Medical Council’s governing council, after reforms completed in 2013, consists of twelve members, six medical and six lay, every one appointed, and nobody suggests that British medicine is regulated by a ministry. Appointment, they argue, is the modern norm for professional regulators, and election is the anomaly that India mistook for a democratic virtue. The second is architectural: separating standard-setting, assessment, registration and ethics into different boards, publishing ratings, graduating sanctions and disclosing members’ assets are the standard instruments of contemporary regulation, and a comparison that scores the 2019 Act down for its appointment clause should also score it up, dimension by dimension, for importing the entire toolkit at once. The third is about the alternative actually on offer. The choice made in 2019 was not between the 2019 Act and some reformed elected council with disclosure rules and removal powers that nobody had drafted. Successive amendment bills to repair the 1956 Act had been introduced and had died; the National Commission for Human Resources in Health Bill had been returned by the Standing Committee in 2013 with federal and bureaucratic objections; the profession’s own associations, in decades of the old regime, had used their considerable political strength to defend the council’s structure rather than to reform it. A legislature choosing in 2019 chose between the Bill it had and the machine that had produced 2010, 2016 and 2018. On that menu, the reformers say, the verdict writes itself.

The profession’s case in its strongest form

The profession’s case begins by refusing the implied charge that to defend election is to defend Desai. The Indian Medical Association’s protests were dated, specific and repeated: a twelve-hour nationwide shutdown of private hospitals called for 2 January 2018 against the Bill of 2017, with the Association’s president Dr Ravi Wankhedkar calling the Bill anti-poor, anti-people, non-representative, undemocratic and anti-federal; a nationwide withdrawal of routine services called for 28 July 2018; resident doctors’ strikes through the passage days of August 2019; and a further withdrawal proclaimed for 8 August 2019, deferred after the Health Minister’s clarifications and assurances, in a week that also saw floods in several States and the death of a former Union minister, with an IMA delegation under its national president Dr Santanu Sen meeting the minister and an appeal carried to the President to withhold assent. A movement that can be deferred by assurances is not a movement defending corruption. It is a movement defending a constitutional intuition about professions, and the intuition has a pedigree. A profession, on this view, is a body of knowledge held in trust; its standards are internal to the practice in a way that the standards of a market are not; and self-regulation, in which practitioners submit to the judgment of practitioners, is the mechanism by which every mature democracy, from the German medical chambers elected by the profession to the older constitution of the British council itself, has policed that trust. Replace election with appointment and you do not merely change the personnel pipeline. You change the direction of accountability. The regulator stops fearing the profession’s verdict and starts fearing the ministry’s, and Section 45, the direction clause, and Section 55, the supersession clause, are the instruments by which that fear is kept credible. The Acts’ defenders note, correctly, that a direction has to be written and a view heard first; the profession answers, also correctly, that the clause reserves to the Government the final decision on what counts as policy, which is the whole game in a single proviso.

The profession’s second argument is about bundling, and it is the argument this article’s table vindicates. The reform that opponents feared most was never the rating board. It was Section 32, the Community Health Provider: the commission may grant a limited licence to practise medicine at the mid-level, as Community Health Providers, to persons connected with the modern scientific medical profession who meet criteria the commission specifies by regulation, and such providers may prescribe specified medicines independently in primary and preventive healthcare and under supervision elsewhere. The category is not defined in the Act. The Standing Committee that examined the Bill of 2017 had already forced the removal of the bridge course, by which practitioners of other systems were to be crossed over into modern medicine, on the ground that such a course should not be mandatory and that capacity-building belonged to the States; the 2019 Act returned with a differently labelled door to a similar room. Whatever the merits of mid-level practice for a country short of doctors, and the merits are arguable, the licence has no connection of any kind to a failure of the Medical Council of India. The council did not create India’s doctor shortage, and no committee found that it had suppressed a mid-level cadre the country needed. A provision with distributive consequences for every village in India rode into law inside a Bill whose justification was the corruption of a regulator. The profession’s name for that manoeuvre was blunt, and the comparison table’s “unrelated” column is the same point with the adjectives removed.

The third argument is empirical humility, and it is the argument the next section must answer honestly. A nominated regulator is a hypothesis, not a result. The hypothesis says that selection by search committee, functional separation and published ratings will produce cleaner and better decisions than election did. The hypothesis may be right. But the evidence that would prove it, decision-level evidence about recognition integrity, rating accuracy, reversal rates on appeal, learning outcomes of graduates, does not exist in any public series that spans the change, and the evidence both sides actually brandish, the growth in colleges and seats, is consistent with the reform working and with standards being diluted to admit volume, which is why each side cites the same numbers for opposite conclusions. The profession asks, not unreasonably, why a change of this constitutional size was entitled to be believed in advance of its evidence, when the burden on every other actor in the system, a college seeking permission, a doctor seeking registration, a graduate facing an exit test, is to prove compliance in advance. It is a good question, and the verdict section returns to it, because it identifies the evidence that would settle the argument and therefore identifies what the verdict is actually made of.

What the growth numbers can and cannot prove

Both sides of this argument keep one set of numbers in their pockets, and the numbers are real. The Union Health Ministry told the Lok Sabha in February 2025, in a written answer by the Minister of State, Smt. Anupriya Patel, drawing on the commission’s own figures, that the number of medical colleges had risen from 404 in 2014 to 780, and the number of MBBS seats from 54,348 in 2014 to 1,18,190. At the commission’s launch in September 2020 the ministry had made the same point with the figures of that day, MBBS seats up from around 54,000 in 2014 to around 80,000, and postgraduate seats roughly doubled over the same span. The growth straddles the change of regime: it began under the reconstituted council and the Boards of Governors, and it accelerated under the commission. The government reads the series as the reform working, a regulator finally willing to let capacity grow. The profession’s critics read the same series as the reform’s danger, a rating board waving through colleges attached to district hospitals and a pipeline diluting the very standard the exit test was meant to guarantee.

Taken carefully, the series proves neither reading, and the comparison should say why in terms a statistician would accept. College and seat counts are measures of permission, not of education. They rise when a regulator approves more institutions, and they rise for reasons that have little to do with the regulator: a centrally sponsored scheme to build colleges onto district hospitals, the upgradation of existing colleges to add seats, state government investment, and private capital chasing a scarce and expensive credential. The regulator is one valve in that pipeline, and the counterfactual, what the elected council would have approved in the same years with the same schemes running, is unknowable. What would test the reform is output evidence: whether graduates of the expanded system pass common measures at stable rates, whether published ratings predict anything about the institutions they grade, whether recognition decisions survive appeal and audit at higher rates than the old council’s did, whether the incidence of the old pathologies, the ghost faculty and the inspection-day hospital, falls in the commission’s own assessment records. No public series assembles those measures across the 2020 boundary. The honest sentence, and the brief for this article requires it to be written plainly, is that the verdict on outcomes is not yet available to anyone, supporter or critic, and that a comparison which pretends otherwise is selling certainty the record does not contain. What can be judged is design: whether the statute aims its changes at the failures its predecessor demonstrably had. That is the judgment the table makes, and it is the only judgment the evidence supports.

The composition of the growth sharpens the caution. A large share of the new capacity arrived through schemes rather than through regulatory philosophy: the centrally sponsored scheme that attaches new medical colleges to existing district and referral hospitals, under which the ministry’s own answer recorded 157 colleges approved and 131 functional, and the upgradation of existing government colleges to carry more seats, together with new All India Institutes. Those pipelines would have delivered colleges under either regulator, because money and buildings, not assessment doctrine, were their moving parts. What a regulator controls is the quality gate the new capacity passes through, and on that gate the only honest cross-regime measure would be the deficiency and failure record of the colleges each regime admitted, compared like for like across the boundary. That record, assembled and published, would be worth more than every speech made on either side of the 2019 debate. It does not exist in public, and its absence is itself a finding about both regimes: the old council never published its assessment outcomes in usable form, and the commission, for all its statutory duty to publish ratings, has not yet produced the long, consistent series that would let an outsider grade the grader.

The verdict, and the evidence that would overturn it

Count the verdict column. Of the seven dimensions, four changes address a documented failure of the predecessor: the separation of functions, recommended in terms by both the Roy Chaudhury experts and the parliamentary committee; the reconstruction of assessment, aimed at the input-counting, insider-inspected, binary-sanctioned process that the committee indicted and the Desai prosecution exemplified; the statutory exit test, aimed at a system that never examined its own output; and the fee guideline power, aimed at a silence in the old statute that courts and committees had been filling and lamenting for decades. One change addresses a perceived failure: the abolition of election, which treated as the disease what the documents showed only as the disease’s host, a body with no disclosure, no removal and no conflict rules, defects the same Act cures by other clauses that would have worked under election too. Two changes address no identified failure at all: the demotion of the States from voting members to an advisory audience, and the subordination of the regulator to written ministerial directions on policy, backed by removal and supersession. The deciding factor, the test this series applies to any institutional replacement, is that mapping between change and documented failure; a reform earns belief on the dimensions where the map holds, and owes evidence on the dimensions where it does not.

The verdict follows the count. On the engineering of regulation, the National Medical Commission is the better instrument, and it is better in ways the Medical Council of India’s defenders have never seriously answered: no honest reading of the Ninety-second Report survives the claim that the old machine could have been left as it was. On the constitution of regulation, who holds power over the profession and through what chain of accountability, the 2019 Act made a change that its own justification does not reach, and it bundled into the same statute a licensing power over mid-level practice that no failure of the council had anything to do with. The reform is therefore two reforms. One follows from the evidence and should be kept and completed, beginning with the exit test that remains unheld. The other follows from a preference for executive control and should be judged as such, openly, and not smuggled into respectability by the first reform’s merits. A reader who wants a single sentence may have this one: the diagnosis was capture, the remedy was control, and only half of the remedy was treatment.

The evidence that would change this verdict is specifiable, which is what makes the verdict a verdict rather than a mood. If the commission publishes ratings whose grades track independent measures of institutional quality, if recognition refusals survive appeal at rates the council’s never approached, if the exit test is held and its results are published by institution so that output failure has an address, then the appointment hypothesis will have earned the belief it was given in advance, and the perceived-failure cell in the table should be revised towards documented success. If, instead, the direction power is used to settle a recognition or standards dispute, if search-committee appointments reproduce the old coterie with better paperwork, if ratings inflate while graduate outcomes stagnate, the unrelated cells will have shown their purpose, and the verdict on the whole settlement darkens accordingly. Either development is observable. The comparison commits itself to the test either way.

Recommendations differ by reader, as they should. The doctor and the medical student should read the settlement as settled law with one open file: registration, discipline and admission run under the new Act and its transition rules, examined in the next section, while the exit test hangs over every cohort as an enacted requirement whose first sitting has been promised and postponed in turn; the rational response is to prepare for the gate the statute describes, not for the postponements the calendar has so far delivered. The policy reader should keep the two reforms separate in every future debate, concede the four documented cells to the government without conceding the other three, and treat any proposal to extend the direction-and-appointment model to other professions as a new claim requiring its own failure record, not as a precedent this one established. The aspirant should learn the comparison as a table with a count, because that is how the examination asks it; the revision structure in the education laws exam guide shows how this cluster’s statutes are organised for answer-writing, and the seven-dimension table above is built to be lifted whole into an answer on regulatory reform, and it converts without alteration into a revision deck through the ReportMedic presentation viewer, which is the fastest way to drill the count until it can be reproduced from memory.

Two more changes the table could not hold

A seven-row table is a discipline, not a census, and two further changes deserve the mapping test before the verdict hardens, because each is quoted in the debate as though its classification were obvious. The first is the interface machinery of Sections 50 and 51. The Act requires an annual joint sitting of the commission with the Central Councils of Homoeopathy and of Indian Medicine, empowered to approve educational modules across systems and to promote medical pluralism, and it empowers State Governments to build the capacity of healthcare professionals for primary care in rural areas. Under the old council, the systems regulated themselves in parallel silos and met mainly as adversaries in litigation over cross-practice. Run the test: no document in the failure record identified the absence of an interface as a defect of the Medical Council of India, whose statutory remit never extended to the other systems at all. The interface belongs to the same family as the Community Health Provider licence, an independent health-policy programme about the shape of the workforce, carried into law by the vehicle the council’s collapse supplied. It may be wise or unwise; it is not a repair.

The second change is quieter and, for lawyers, the most revealing in the Act. Section 9(6) provides that a person aggrieved by a decision of the commission may appeal to the Central Government within thirty days. Under the statutory scheme the appeal against the regulator lies, not to a tribunal, not to a court in the first instance, but to the ministry that appoints the regulator, receives its reports, may direct it on policy and may supersede it. The older pattern in Indian regulatory design, visible in the tribunal experiment discussed earlier in this article, routed such appeals to appellate tribunals staffed with judicial members, precisely to keep the sponsoring ministry out of the appellate chair. Defenders of the clause answer that the Government is accountable to Parliament in a way no tribunal is, and that a thirty-day governmental appeal is faster than a tribunal queue. Both things are true, and neither answers the mapping question: no committee, court or oversight body had identified the absence of a governmental appeal as a failure of the 1956 regime, whose grievance was the opposite condition, a regulator too entangled with the interests around it. The appeal clause belongs with Sections 45 and 55 in the control column of the settlement, and adding it makes the unrelated count three in substance even though the table, which scores dimensions rather than clauses, holds it inside the direction row. A verdict that has priced the table should price this clause too: it is a small provision that tells the truth about the large one.

The commission’s first years, and the spread of the template

The successor’s early operation adds texture that a purely textual comparison would miss, and the texture runs in both directions. The commission was constituted on commencement in September 2020 under its first chairperson, Professor Suresh Chandra Sharma, carrying forward the Board of Governors’ work programme: the competency-based curriculum the board had framed, the streamlining of permission processes, and the seat expansion the ministry celebrated. It issued the fee guidelines of February 2022 that gave Section 10(1)(i) its first working content, and the National Exit Test Regulations of June 2023 that gave Section 15 its machinery. It also supplied the profession with its most telling exhibit. In August 2023 the commission notified a new code of professional conduct to replace the 2002 regulations, a code whose provisions, including directions on prescribing generic medicines, drew immediate organised protest from the Indian Medical Association; within the month the commission placed its own notified code in abeyance and the 2002 code continued in force. Read one way, the episode shows the appointed regulator listening, exactly as its defenders promised appointment would allow it to do without electoral terror. Read the other way, it shows that the profession’s veto survived the abolition of its electorate, exercised through the same associations and the same strike threats as before, and that formal accountability upwards coexists with practical accountability to the organised profession whenever the profession chooses to mobilise. Both readings are true, and together they state the mature position on the appointment question: the 2019 Act changed who can be removed and who can be directed; it did not, and probably could not, change the political weight of a million doctors.

Parliament, meanwhile, treated the medical settlement as a template. The architecture of a compact appointed commission standing over autonomous boards, with a search committee, an advisory council and an exit-test logic, reappears in the statutes enacted for the neighbouring professions, including the National Nursing and Midwifery Commission Act, 2023 and the National Dental Commission Act, 2023, each replacing an elected council of the old pattern. That replication raises the stakes of this comparison beyond medicine. If the mapping test is the right way to judge a replacement, it must be run profession by profession, on each predecessor’s own failure record, because a template copied without its diagnosis is the bundling error at national scale: nursing and dentistry had their own councils, their own records and their own documented failures, which are not the Medical Council of India’s and cannot be borrowed from it. The medical verdict in this article is therefore a method as much as a result. The result is local. The method travels.

What carried over when the council ended

Institutional replacement frightens the people inside the institution being replaced, and in 2020 the frightened people were every registered doctor and every recognised college in India. The statute answered their anxiety in its last two sections, and the answers are clear enough that the anxiety can be retired. Section 60 of the 2019 Act repealed the Indian Medical Council Act, 1956 with effect from 25 September 2020 and dissolved the council, and its savings clauses protect the previous operation of the repealed Act and every right, privilege, obligation and liability acquired under it. A specific clause carries the practical load: any order made, any licence to practise issued, any registration made, any permission to start a new college or a higher course or an increase in admission capacity, and any recognition of a medical qualification granted under the 1956 Act and in force at commencement continues in force until its own expiry, for all purposes, as if it had been issued or granted under the new Act. Section 61 makes the commission the successor in interest of the council, inheriting its assets and liabilities, and keeps the educational standards, requirements and other provisions of the old Act and its regulations in force until new standards are specified under the new one, with everything done under the old standards deemed done under the corresponding provisions of the new. Section 49 protects students mid-course: a student studying for a degree, diploma or certificate at commencement continues and completes the course on the syllabus as it stood, and is deemed to have completed it under the new Act, and even an institution whose recognition lapses must maintain the required standards until its admitted students finish. Courts have applied the scheme as written; the Kerala High Court, in proceedings brought by the Quilon Medical Trust in January 2021, worked through Sections 60 and 61 to hold that the repeal and the dissolution of the Board of Governors took effect on 25 September 2020 while the standards and actions of the old regime continued under the savings. No doctor’s registration lapsed because the council died. No college’s recognition evaporated. The register moved house; the names on it did not move.

Two clarifications matter because the popular accounts get both wrong. The first is that the council was not abolished in 2010. It was superseded in 2010, governed by a Board of Governors, reconstituted in 2013, superseded again in 2018, and dissolved only in 2020 when its Act was repealed; collapsing that decade into a single abolition erases the decade in which every remedy short of replacement was tried and produced its own evidence. The second is that the State Medical Councils were not abolished at all. They are creatures of state legislation, they continued through the transition, and the 2019 Act builds on them: the Ethics and Medical Registration Board maintains the National Register under Section 31, regulates conduct in harness with the State Councils, ensuring compliance with the code of ethics through a State Council wherever the State Act gives that council disciplinary power, and hears appeals from State Council action under Section 30. States that had no council were directed to establish one within three years of the Act. The general position described in this article is information about a public statute and its history; it is not advice on any individual registration, recognition or disciplinary matter, and anyone facing a live question of that kind needs advice on the facts of that case, because registers and recognitions turn on dates and documents that general writing cannot see.

Where the general verdict does not hold

Four situations qualify the verdict, and a comparison that hides its exceptions is an advertisement. The first is rural primary care, where the profession’s case against Section 32 is weakest. The documented reality the licence addresses, though not a failure of the council, is a shortage and maldistribution of doctors that the elected regime also failed to shift; a State confronting unstaffed primary health centres may reasonably judge a trained, limited, supervised mid-level cadre better than an empty chair, and the Act leaves the criteria and the extent of practice to regulations that can be drawn tightly or loosely. The verdict’s objection is to the bundling and the undefined category, not to the existence of the problem, and in a State that defines the cadre honestly the unrelated cell does less damage. The second situation is the small and the new institution, for whom the graduated ladder and published ratings are a mixed gift: a monetary penalty that a large corporate chain absorbs as overhead can close a small charitable college, and a published rating can freeze a new institution’s reputation at its weakest year. Proportionality in the use of Section 26 is where the commission’s maturity will be proved, and the verdict’s confidence in the assessment cell assumes that proportionality. The third situation is the minority and deemed institution, where the fee cell of the verdict operates under constitutional constraints the table compresses. The Supreme Court’s fee jurisprudence, from Islamic Academy through P. A. Inamdar, was built substantially in cases brought by unaided and minority institutions asserting the autonomy of Articles 19(1)(g) and 30, and the seven-judge settlement protected that autonomy while barring profiteering. A guideline power exercised against that settlement will be litigated institution by institution, and its real reach over the colleges where fees bite hardest is a question the courts, not the commission, will finally answer; the documented cell records the power’s enactment, not its survival in full. The fourth situation is the honest search committee. The entire appointment design depends on a selection process that actually selects for ability and independence; India’s experience with search committees across regulators is uneven, and a committee that behaves as a postbox converts every safeguard in Sections 5 and 6 into ceremony. The verdict given here is a verdict on the statute’s design against the predecessor’s record. The statute’s operation, like the exit test, remains a promise partly redeemed, and the comparison that began by refusing to judge character ends the same way: the documents convict the old design, the new design answers four of the seven counts against it, and the remaining three counts await the only evidence that can settle them, which is the commission’s own conduct over time.

How to argue this comparison

The comparison repays being argued in a fixed order, because the order is what stops the debate collapsing into the character quarrel it usually becomes. Begin with the documented record and refuse to leave it until it is fully stated: an arrest at the recognition desk, a president’s admission recorded by a parliamentary committee, a finding that quality meant infrastructure, two supersessions and a resigned oversight committee. Then state the statutory changes one dimension at a time and make each change report to the record: separation, assessment, output testing and fee power report directly; election’s abolition reports to a theory about electorates; the advisory demotion of the States and the direction power report to nothing in the file. Only then take the sides at full strength, the reformer’s accumulation of independent witnesses against the profession’s pedigree of self-regulation and its bundling objection, and let the verdict fall where the count puts it. An answer, an editorial or an interview conducted in that order cannot be ambushed by the Desai story, because the story is inside it, and cannot be ambushed by the appointment clause either, because the clause has been priced before the verdict is announced. The deeper habit the comparison teaches transfers beyond medicine. Indian legislation replaces institutions constantly, councils with commissions, boards with authorities, tribunals with tribunals, and the public argument almost always asks the wrong first question, whether the new body is better. The better first question is the one this article has used throughout: better at fixing what, documented where, and what else did the replacement carry in its luggage? A reader who asks those three questions of the next replacement statute, in whatever sector it arrives, has the whole method, and the medical case will have done the work a comparison exists to do.

Frequently Asked Questions

Q: What is the main difference between the Medical Council of India and the National Medical Commission?

The main difference is the source of authority. The Medical Council of India, under the Indian Medical Council Act, 1956, was a large body of well over a hundred members, the substantial majority elected by registered practitioners and university medical faculties, which concentrated standard-setting, recognition, assessment, registration and ethics in one council. The National Medical Commission, under the Act of 2019, is a compact body of thirty-three appointed members which distributes those functions across four autonomous boards for undergraduate education, postgraduate education, assessment and rating, and ethics and registration, and which is expressly bound by the Central Government’s written directions on questions of policy.

Q: Was the Medical Council of India elected and is the new commission nominated?

Yes on both counts, with one refinement each. Under Section 3 of the 1956 Act, the council’s members were elected from State Medical Registers and university faculties, nominated for each State in consultation with its government, and nominated in a small bloc of eight by the Central Government, and the council elected its own president. Under Section 4 of the 2019 Act, every member of the commission is appointed by the Central Government: the chairperson, ten ex officio members, and twenty-two part-time members, of whom nineteen reach the commission through State and State Medical Council nominations on rotation. Appointment, not election, fills every seat.

Q: Why was the Medical Council of India dissolved?

The dissolution in September 2020 was the end of a decade-long record. Its president, Dr Ketan Desai, was arrested by the Central Bureau of Investigation in April 2010 in a corruption case arising from college recognition, and the council was superseded by ordinance and run by a Board of Governors until its reconstitution in 2013. The Ninety-second Report of the Parliamentary Standing Committee in 2016 then documented systemic failure, including captivity to private commercial interests and assessment by infrastructure counts alone. After a Supreme Court-appointed Oversight Committee resigned in 2018 citing non-cooperation, the council was superseded a second time, and the 2019 Act repealed the 1956 Act and dissolved it for good.

Q: Did the new law change how medical colleges are inspected?

Yes, in structure, personnel and consequence. Under the 1956 Act, inspections were physical visits by inspectors and visitors appointed by the council under Sections 17 and 18, feeding a recommendation on which the Central Government granted or refused permission, and assessment turned on counting infrastructure and faculty. Under Section 26 of the 2019 Act, the Medical Assessment and Rating Board controls assessment and rating, may hire and authorise third-party agencies to inspect, must publish ratings in the public domain, and can respond to failure with a graduated ladder of warning, monetary penalty, reduced intake or stopped admissions before recommending withdrawal of recognition.

Q: Has the change improved medical education?

The honest answer is that the outcome evidence does not exist in a form that settles the question. The design evidence points one way: assessment against published ratings, graduated sanctions, a fee guideline power and a statutory exit test all answer defects the parliamentary committee documented in 2016. The delivery evidence is incomplete: the exit test has been enacted and its regulations notified, but no sitting has been held, and postgraduate admission and foreign-graduate screening still run through the older examinations. College and seat numbers have grown greatly, which the government cites as success and critics cite as dilution, and no public outcomes series spans the change. The verdict on design is available; the verdict on results is not.

Q: Why did doctors protest against the new commission?

The profession’s associations objected to the loss of self-regulation, not to the exposure of the old council’s corruption. The Indian Medical Association struck work for twelve hours on 2 January 2018 against the Bill of 2017, calling it anti-people, non-representative, undemocratic and anti-federal, called a nationwide withdrawal of routine services in July 2018, and struck and marched again through the passage of the Bill of 2019. Its stated grounds were that an appointed commission bound by government policy directions is not an independent regulator, that fee guidelines covering only half of private seats licensed profiteering on the rest, and that the mid-level Community Health Provider licence in Section 32 would legitimise inadequately trained practice.

Q: What happened to registered doctors during the transition?

Nothing was lost. When the 2019 Act repealed the 1956 Act on 25 September 2020, Section 60 saved the previous operation of the old law and provided that every licence to practise, registration, permission and recognition granted under it and in force at commencement would continue in force until its own expiry, as if granted under the new Act. Section 61 made the commission the council’s successor in interest and kept the old educational standards running until replaced. A doctor registered through a State Medical Council under the old regime remained registered, on the same register, without re-application, re-examination or any fresh fee for the transition itself.

Q: Which medical regulation model gives the profession more say?

The elected model does, by construction, and the comparison is about what that say costs. India’s old council gave registered practitioners and university faculties the substantial majority of seats and the choice of the president. The United Kingdom moved the other way: since the reforms completed in 2013, the General Medical Council’s council of twelve, six medical and six lay, is wholly appointed. German medicine keeps the older pattern through elected state medical chambers. India’s commission sits at the appointed end of the spectrum, with the profession heard through associations, consultations and the advisory council rather than through seats it fills by vote.

Q: Do State Medical Councils still exist after the National Medical Commission?

Yes. State Medical Councils are created by state legislation, and the 2019 Act did not abolish them; a common claim that it did is simply wrong. The Act builds the state councils into the new architecture. The Ethics and Medical Registration Board maintains the National Register under Section 31 in harness with them, enforces the code of professional conduct through a State Medical Council wherever the State Act gives that council disciplinary power, and hears appeals against State Council decisions under Section 30. States that had no such council were directed to establish one within three years of the Act’s commencement.

Q: Who fixed the fees of private medical colleges before the National Medical Commission Act?

Not the Medical Council of India, which had no fee power under the 1956 Act at all. After litigation over capitation fees, the Supreme Court filled the gap: in Islamic Academy of Education in 2003 it directed every State to set up a fee fixation committee headed by a retired High Court judge, and in P. A. Inamdar in 2005 a seven-judge bench confirmed that model, holding that unaided institutions kept their autonomy subject to a prohibition on profiteering and capitation. Fee control before 2019 was therefore judicial in origin and state by state in operation, which is why the 2019 Act’s guideline power for half of private seats was a genuine transfer of function.

Q: What sanctions can be imposed on a medical college that fails to meet standards, and how did they change?

The change is from a cliff edge to a staircase. Under the old regime the realistic sanctions were refusal of permission or withdrawal of recognition, the second of which stranded enrolled students and was therefore threatened more often than used, leaving deficient colleges in a long twilight of warnings. Under Section 26 of the 2019 Act, the Medical Assessment and Rating Board may issue a warning, impose a monetary penalty, reduce the institution’s intake, or stop admissions, and only at the top of the ladder recommend to the commission that recognition be withdrawn. Graduation lets the regulator punish proportionately, which makes punishment usable.

Q: Where does an appeal lie against the medical regulator under each regime?

The routes multiply under the new Act. Under the 1956 settlement, the council’s recognition decisions were in practice challenged in the constitutional courts, and disciplinary appeals moved between State Medical Councils, the council and the Central Government in a structure litigants found slow and unclear. The 2019 Act builds a ladder inside the statute: the Ethics and Medical Registration Board hears appeals against State Medical Council action, the commission hears appeals against its autonomous boards under Section 10, and Section 9(6) gives a person aggrieved by a commission decision an appeal to the Central Government within thirty days, with writ jurisdiction untouched.

Q: Could the government remove members of the old council, and can it remove members of the commission?

The contrast is sharp. Under the 1956 Act the Central Government had no power to remove the council’s president or any member, even on proof of corruption; its only remedies were to supersede the entire council or amend the Act, which is why a single arrest in 2010 required an ordinance. Under the 2019 Act, Section 7 empowers the Central Government to remove the chairperson or any member on stated grounds, including conviction for an offence involving moral turpitude, incapacity, or acquiring a financial interest likely to prejudice the office, with a hearing required where the ground turns on conduct. Section 55 even permits supersession of the commission itself.

Q: Did the National Medical Commission change the NEET entrance examination?

It codified and completed it rather than creating it. The National Eligibility-cum-Entrance Test began under the old council’s own regulations, was struck down by the Supreme Court in 2013 in the Christian Medical College Vellore litigation, was restored on review in 2016, and was written into the 1956 Act itself by an amendment in 2019. Section 14 of the 2019 Act then made NEET the uniform entrance examination for undergraduate admission in every medical institution, including those governed by their own Acts of Parliament, with common counselling, which is why the separate entrances of the All India Institutes ended from the academic year 2020-21.

Q: Why did the reform committees treat professional election itself as a conflict of interest?

Because of who the electorate was. The NITI Aayog committee of 2016, which framed the draft Bill, reasoned that where the regulated elect the regulators, a candidate for the council is chosen by the very college owners, faculty and practitioners whose permissions, inspections and discipline the council controls, so the winning platform is leniency rather than standards. The parliamentary committee’s Ninety-second Report added the composition evidence: a body drawn heavily from the corporate and private sector, regulating the sector it was drawn from. The committees treated election not as democracy within a profession but as a structural interest, which is why their remedy was selection on merit criteria instead.

Q: How many members did the Medical Council of India have, and how many does the commission have?

The old council grew with its categories until it ran to well over a hundred members: one for each State in consultation with its government, one for every university with a medical faculty, one elected from each State’s registered practitioners, seven elected nationally by practitioners, and eight nominated by the Central Government, under a president the members elected themselves. The commission has thirty-three members fixed by Section 4 of the 2019 Act: a chairperson, ten ex officio members and twenty-two part-time members. The difference in size is itself a design statement, from a deliberative assembly of the profession to a working board meant to decide and be answerable for decisions.

Q: Who disciplines a doctor for professional misconduct under each regime?

The ground level barely changed, because discipline was always state work. Under the old settlement, State Medical Councils, acting under their State Acts and the ethics code the council framed in its 2002 regulations on professional conduct, etiquette and ethics, conducted proceedings and could remove a name from the State Register, with the council superintending standards. Under the 2019 Act, the Ethics and Medical Registration Board owns the national ethics function: it maintains the National Register, frames the conduct framework, works through State Medical Councils where their Acts confer disciplinary power, and hears appeals against their decisions, while the commission sets ethics policy under Section 10.

Q: Had an exit test for doctors been proposed before the National Medical Commission Act?

Yes, repeatedly, and by the council’s own custodians. The Board of Governors that ran the council after the 2010 supersession proposed a post-MBBS exit test, alongside a common entrance examination and the grading of colleges, a decade before Section 15 enacted the idea. The parliamentary committee’s 2016 finding that the system never tested the competence of the graduate it produced gave the proposal its analytical basis. What the 2019 Act added was not the idea but the statutory compulsion, making one examination serve as licentiate test, postgraduate merit basis and foreign-graduate screen. The unheld state of the test means the proposal’s long prehistory continues.

Q: What changed for foreign medical graduates seeking to practise in India?

The destination changed; the road, so far, has not. Under Section 13 of the 1956 Act, an Indian citizen with a foreign medical qualification had to pass a screening test, the Foreign Medical Graduate Examination conducted by the National Board of Examinations, before enrolment on a register. Section 15 of the 2019 Act assigns that screening function to the National Exit Test, which a foreign graduate must qualify for a licence on the same terms as a home graduate. Because the exit test has been enacted and regulated for but not held, the older screening examination continues to operate as the practical gate, twice a year.

Q: Do patients and lay members have a place in either regulator?

Only in the newer one, and only at the margin. Every route into the Medical Council of India ran through the profession or through governments advised by it; no seat existed for a patient, a consumer representative or any lay voice. The 2019 Act reserves three of its part-time seats for persons of standing in fields that expressly include consumer or patient rights advocacy, alongside management, law, medical ethics, health research, science and technology and economics, and it surrounds all members with published declarations of assets and professional engagements under Section 6. Three seats among thirty-three is representation of a token kind, but it is a category the old statute did not contain at all.