The NMC's Ph.D Diktat: An Overreach That Must Be Corrected

When a Regulator Colours Outside Its Lines

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There is a quiet injustice unfolding in India's medical colleges. It does not make headlines. It does not involve patients or prescriptions. It involves a group of dedicated scientists and educators - the non-medical faculty who teach Anatomy, Physiology, Biochemistry, Pharmacology and Microbiology to generations of medical students - and a regulatory clause that is, on close examination, legally indefensible, academically irrational, and procedurally unjust.

The National Medical Commission, in its Teachers Eligibility Qualifications in Medical Institutions Regulations, 2022, inserted a condition that non-medical graduates holding M.Sc. and Ph.D qualifications can be appointed as Assistant Professors only if the Ph.D was "granted by the recognized Medical College/Institute as regular on campus course in the subject concerned."

Seven words. Enormous consequences.

This article argues that this condition is wrong on every significant count - jurisdictional, legal, academic, and moral - and that the NMC has both the obligation and the opportunity to correct it.

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I. The NMC Has No Jurisdiction Over Ph.D Programs

This is the foundational argument, and it is not subtle.

The Ph.D is India's highest academic degree. It is entirely governed by the University Grants Commission (UGC) - the statutory body established under the UGC Act, 1956, with the explicit mandate to coordinate and maintain standards in university education. The UGC's Minimum Standards and Procedure for Award of Ph.D Degree Regulations (revised in 2016 and 2022) are comprehensive: they govern eligibility, mode of study, duration, coursework, guide qualifications, thesis evaluation, and the conduct of the viva voce.

The NMC, by contrast, is a creation of the National Medical Commission Act, 2020. Its mandate is to regulate medical education - that is, undergraduate and postgraduate medical courses. The Ph.D does not appear in any Schedule of the NMC Act. It is not a "medical course" in any statutory sense. The NMC neither designs Ph.D curricula, nor evaluates Ph.D theses, nor grants Ph.D degrees. Universities do - and universities do so under UGC's framework.

The legal principle here is elementary: a regulator may only act within the domain that its parent statute authorises. When the NMC prescribes the mode in which a Ph.D must be conducted as a condition of employment in a medical college, it is not regulating medical education. It is regulating doctoral education - a domain that squarely belongs to the UGC. This is a textbook case of regulatory overreach, and overreach of this kind does not survive judicial scrutiny.

If the NMC wished to set minimum qualification standards for faculty - which is entirely within its mandate - it should have stopped at saying what qualification is required. The moment it began dictating how that qualification must have been obtained, it stepped into the UGC's backyard.

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II. The "Regular On-Campus" Condition Contradicts UGC's Own Framework

The UGC explicitly recognises two legitimate modes of Ph.D: full-time and part-time. Distance mode is not permitted - a safeguard to protect quality. But part-time Ph.D, conducted under a university's prescribed norms and with all the same academic requirements - coursework, thesis, evaluation - is fully valid and fully equivalent in the eyes of the only body that has authority to make that determination.

Thousands of Indian academics - faculties, scientists, laboratory consultants - have earned their Ph.D through the part-time route, because the demands of a full-time laboratory or teaching roles made the full-time route impractical, not because they were looking for shortcuts. Their theses were scrutinised by external examiners. Their viva voces were conducted. Their universities awarded their degrees. The UGC recognised those degrees. No quality compromise occurred.

The NMC's "regular on campus" clause repudiates this entirely. It effectively tells a non-medical teacher: "Your university found your research sufficient. Your UGC-regulated degree is valid. But we - who have no role in Ph.D regulation - have decided your mode of study was wrong."

On what academic basis? None is offered. On what legal basis? None exists.

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III. Retrospective Application: A Violation of Natural Justice

The 2022 Regulations came into force upon their publication. Yet the NMC is applying the "regular on campus" condition to faculty who registered for their Ph.D programs and, in many cases, completed and were awarded degrees years before 2022.

This is retrospective penalisation - and it strikes at a principle of law so fundamental that it predates the Indian Constitution: no person should be penalised under a rule that did not exist when they acted. The Latin maxim nullum crimen sine lege - no crime without law - and its administrative law equivalent protect citizens and professionals from exactly this kind of arbitrary rule-making.

A teacher who enrolled in a part-time Ph.D program in 2015 did so in full compliance with their university's norms and UGC's framework. They made a career decision - a years-long investment of time, intellectual energy, and often personal sacrifice - under a specific regulatory environment. To now tell them that their degree is not "recognised" for appointment or promotion is not merely unfair. It is legally indefensible. Courts have repeatedly struck down regulations applied retrospectively to deprive individuals of rights or positions they had legitimately acquired.

The NMC cannot create a new eligibility condition in 2022 and then use it to nullify qualifications earned in 2012. That is not regulation. That is retroactive disqualification. It should not survive a legal challenge, and it should not have to come to that.

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IV. The Requirement of a Ph.D for Non-Medical Teachers Is Itself Poorly Reasoned

To understand the full picture, one must also examine whether demanding a Ph.D from non-medical teachers is academically justified in the first place.

Consider the parallel. A medical faculty member teaching Anatomy holds an MBBS and an MD in Anatomy - a structured, examination-based postgraduate qualification that directly trains them in the subject they will teach. Their qualification has a clear, functional relationship to their teaching role.

A non-medical faculty member holding an M.Sc. (medical) in the relevant discipline - a postgraduate programme of similar curriculum and rigour - is similarly equipped for undergraduate teaching. The M.Sc. (medical) provides the content knowledge. What additional classroom competence does a Ph.D confer?

The Ph.D is fundamentally a research degree. It certifies the ability to identify a problem, frame a hypothesis, design a methodology, generate original data, and defend original conclusions. These are valuable capacities - essential for building research culture in medical colleges. But they are not the competencies primarily needed to teach first-year medical undergraduates the histology of the liver or the mechanics of cardiac muscle contraction.

The honest answer to why the NMC insists on a Ph.D for non-medical faculty - while making no such demand of medical faculty beyond their MD - is one of parity by years of training, not by functional need. Medical faculty spend 8½ years in formal education before eligibility (MBBS plus MD). Non-medical faculty, with only a bachelor's and master's degree (B.Sc plus M.Sc), fall short of that duration (6 years). The Ph.D (2-3 years) fills the gap - not educationally, but arithmetically.

If that is the reasoning - and it appears to be - then it should be stated honestly and examined critically. Credential parity is not educational equivalence. And building a faculty policy on arithmetic rather than academic logic produces exactly the kind of arbitrary rule we are now discussing.

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V. The Human Cost Is Real

Behind the clauses and sub-regulations are real people. Associate Professors who taught medical students for fifteen years. Scientists who published in peer-reviewed journals. Tutors who supervised undergraduate students. Academics who pursued a part-time Ph.D because their department needed them in the laboratory and classrooms while they studied - exactly as the UGC's framework intended to accommodate.

These individuals now find themselves in an impossible position. Their degrees are valid in every court of law, every university senate, every UGC record. But under this NMC clause, they may be passed over for promotion, denied appointment, or rendered ineligible for positions they are otherwise fully qualified to hold - purely because their mode of doctoral study does not match a label the NMC had no business applying.

This is not a minor procedural inconvenience. For many, it represents the derailment of a career. That the NMC applied this rule retrospectively makes it not just legally suspect, but profoundly unjust.

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VI. What the NMC Must Do

The correction required is not complicated. It requires neither a legislative amendment nor a prolonged consultative process. The NMC must:

First, delete the words "as regular on campus course" from the relevant provision. The qualification required should be M.Sc. (relevant medical subject) and Ph.D — full stop. Whether that Ph.D was full-time or part-time is a matter exclusively between the candidate, their university, and the UGC.

Second, A saving clause within the amendment to nullify adverse actions taken during the 2022–amendment period, so that the injustices done to those affected are reversed.

Third, acknowledge in future consultations that its mandate over faculty qualifications ends at what qualification is required, not how that qualification was pursued. Respecting the jurisdictional boundary with the UGC is not a courtesy - it is a constitutional and statutory obligation.

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And, finally

India's non-medical faculty in non-clinical departments are not peripheral figures. They are the scientists who ensure that medical students understand, before they ever see a patient, how the human body is built, how it functions, how drugs work, how laboratory tests assist diagnosis and how chemistry underpins life. They deserve a regulatory environment that respects their qualifications, acknowledges their academic standing, and holds itself to the same standards of rationality and legality that it demands of others.

The NMC's insertion of four words - "regular on campus course" - into a subordinate regulation has caused disproportionate harm. It was made without adequate legal basis. It was applied retrospectively without justification. It contradicts the framework of the only body authorised to regulate doctoral education. And it discriminates against a category of faculty who had done nothing wrong.

Good governance demands self-correction when an error is identified. The case has been made. The burden is now on the NMC to act - not in the interest of any one category of teachers, but in the interest of the principle that regulation must be lawful, rational, and just.

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 Problems, more problems, and solutions

The so-called non-medical teachers possessing medical M.Sc/Ph.D qualifications who are working in various capacities ranging from Tutors to Professors & HOD are protesting against the unjust norms set by the NMC.

Clarity on the medical M.Sc courses:

The majority of MBBS graduates typically opt for specialization in clinical disciplines, and they consider pursuing postgraduate studies in non-clinical disciplines as a last resort, often after numerous unsuccessful attempts to secure clinical seats. As a result, thousands of postgraduate seats in non-clinical subjects remain vacant each year.

With the establishment of more medical colleges and an increase in MBBS seats within these colleges, the shortage of faculty members has become more pronounced. This shortage is particularly acute in newly established colleges, as well as those situated in remote, hilly, and suburban areas. Due to the scarcity of medically qualified teachers, the education system resorted to appointing non-medical teachers starting in the 1960s. However, historically, the permissible ratio of non-medical teachers was limited to 30% (50% in Biochemistry).

Medical M.Sc courses in the five non-clinical subjects were initially included in Schedule-I of the Indian Medical Council Act. However, as MBBS graduates began to show less interest in these courses and opted for MD programs in the same subjects, the Medical Council of India (MCI) gradually stopped taking interest in these courses. In the late 1980s, MCI stopped granting permission to medical colleges to initiate these courses, and eventually, it completely withdrew its support from them.

At one point, over 100 medical colleges used to offer these courses, but now the number has dwindled to less than 30, including in AIIMS. These courses are primarily conducted within medical colleges, utilizing identical curricula, syllabi, and resources as MD programs. They run concurrently with MD courses, guided by the same teaching methods and faculty. However, regardless of their chosen specialty, all students are required to complete a mandatory one-year study in human anatomy, physiology, and biochemistry, mirroring the curriculum of first-year MBBS students.

All aspects of the M.Sc. course, including university examinations, resemble those of the MD course. Successful candidates are awarded their degrees by the health university under the faculty of medicine. Although there may be differences in the graduate degrees between medical and non-medical teachers, their postgraduate degrees are quite similar. Consequently, aside from clinical practice, both groups of degree holders are well-suited for similar roles and employment opportunities.

It is unfortunate that the regulatory body consistently provides inaccurate information in its affidavit when referring to the medical M.Sc courses. It appears to use misinformation as a political tool to advance its agenda.

Appointment of non-medical teachers:

The practice of appointing non-medical teachers to instruct in non-clinical subjects, which form the foundation of medical sciences, is not exclusive to India. In fact, the percentage of non-medical teachers varies widely in different countries, ranging from 30% to 100%. Only 8-11% of teachers in non-clinical subjects at medical colleges in the United States hold medical qualifications, while the majority are non-medical professionals.

The appointment of non-medical teachers in the non-clinical subjects should be a matter of policy, rather than a temporary measure extended to medical M.Sc postgraduates. The regulations outlined by the World Federation of Medical Education (WFME) emphasize the importance of balanced participation from both medical and non-medical teachers.

The presence of teachers with either set of qualifications brings dynamism to teaching, a fact emphasized by the Board of Governors in supersession of MCI when rejecting a demand to exclude non-medical teachers. Non-medical teachers should be an integral part of medical education to prevent a monopoly of one-degree holders, which can lead to stagnation. Both sets of degree holders can complement each other, rather than compete with each other.

It is incorrect to assume that possessing a specific qualification or lacking it has a direct impact on the quality of teaching. Within both sets of qualifications, there are excellent, mediocre, and subpar teachers. The crucial factor determining a teacher's ability to educate effectively is their postgraduate degree, whether it's a medical M.Sc or MD; the undergraduate degree may have minimal influence. Thus, the quality of teaching ultimately depends on the individual's knowledge, skills, and attitude as a teacher. Medical education should draw benefits from both sets of qualifications, and the selection should prioritize the best candidate, regardless of their specific qualification.

MD in non-clinical subjects:

In many developed countries, medical colleges do not provide MD programs in non-clinical subjects. Typically, these subjects are primarily taught by scientists holding Ph.D. degrees, with only a few doctors who have a keen interest in research. MD programs are primarily offered in clinical subjects. In contrast, India has a significant number of non-clinical doctors, who are included in the count of doctors for calculating the doctor-patient ratio. However, these non-clinical doctors do not engage in patient care or contribute directly to healthcare services. Therefore, offering MD degrees in non-clinical subjects in India is irrational. Instead, these programs be replaced with medical M.Sc courses for MBBS graduates, as was the practice in the past.

Monopoly, dominance, and NMC's abuse of position:

Both the MCI and the present NMC are predominantly composed of medical professionals. In contrast, the General Medical Council in the UK maintains an equal representation of both medical and non-medical individuals. Initially, there was a proposal to limit the composition of medical professionals to 60% in the NMC, but this proposal was thwarted by the medical community, ultimately resulting in the dominance or hegemony of doctors in the NMC.

 Despite divisions among doctors regarding clinical and non-clinical specialties, they consistently unite when their interests are at stake. They tend to prioritize their own interests and often restrict or exclude non-medical individuals from various competitive arenas. This behavior can be seen as an abuse of their dominant position. 

When the NMC solicits public feedback, the majority of the responses come from the medical community, which represents a substantial majority. Conversely, the feedback from non-medical individuals constitutes a small minority and can easily be overshadowed. Consequently, it's important to recognize that all feedback received by the NMC tends to be inherently biased.

Over the years, the NMC has systematically eroded the authority of non-medical teachers and has consistently modified regulations to place them at a disadvantage. These changes in norms are inherently discriminatory and are intended to disenfranchise non-medical teachers. This pattern of denials and restrictions can be attributed to the underlying concepts of pride and prejudice within the medical community.

The pride that doctors take in their qualifications often leads to a prejudice against non-doctors, resulting in a general unwillingness or resistance to extend the same rights or dignity to non-doctors as they afford themselves. This sense of self-supremacy, which is seen as a 'superiority complex', prevents them from treating others with the same level of respect and equality. In essence, this is nothing but 'academic apartheid'. When the regulatory body itself practices discrimination at the highest level, it sets a discouraging precedent, encouraging individuals at the college level to perpetuate discriminatory practices.

Discriminations, and denials of opportunities:

Unjust Ph.D. Requirement: There is an unwarranted insistence on requiring a Ph.D. for the Assistant Professor position, despite the absence of such a mandate by the UGC. The demand for a Ph.D. for entry-level demonstrator roles appears to be a deliberate attempt to undermine the value of a Ph.D. and restrict the appointment of non-medical teachers. Equating postgraduate and doctoral qualifications (MSc+PhD) with an undergraduate degree (MBBS) is both belittling and unfair.

Discrimination Against Medical MSc: Despite the equivalent quality of medical MSc and MD courses, medical MSc is unfairly treated and not recognized as a basic qualification. Medical MSc is intentionally excluded as a postgraduate qualification in the NMC's faculty declaration form, despite there being a substantial number of graduates, ranging from 5000-8000.

Exclusion from Faculty Training programs: Non-medical teachers are systematically and unethically being denied/excluded from faculty training programs like the revised basic course workshop, CISP, and AETCOM.

Denial of Examiner Opportunities: Fundamental roles of a teacher to serve as undergraduate examiners are being denied to non-medical teachers despite possessing decades of teaching experience.

Limited Tenure for Tutors/Demonstrators: The tenure for tutor/demonstrator roles has been restricted to a mere 3 years, seemingly designed to discourage non-medical teachers from continuing in these positions.

Rejection of Feedback and Appeals: Feedback and appeals submitted by non-medical teachers or their associations are persistently rejected as if we don’t exist or our issues don’t matter.

Denial of HODship: Senior professors possessing non-medical qualifications are unfairly denied the opportunity to head departments despite seniority and decades of experience.

In essence, non-medical teachers are subjected to a second-class status, characterized by restricted roles, rights, and privileges. 

Political lobbying and the after-effects:

As the MCI transitioned into the NMC, a group of non-clinical medical professionals made concerted efforts to exert pressure on the NMC in order to exclude non-medical teachers from the medical education system. Their previous attempt to influence the MCI had proven unsuccessful. 

The NMC responded by significantly reducing the allowable percentage of non-medical teachers, lowering it from 50% to 15% in Biochemistry and from 30% to 0% in both Pharmacology and Microbiology. While these changes were initially meant to apply to new medical colleges starting from 2020 onwards, they were, in practice, being applied retrospectively to all colleges.

Existing non-medical teachers, particularly tutors and demonstrators, were facing termination of their contracts or non-renewal, citing the new regulations. Even those with four years of teaching experience and M.Sc qualifications were being denied promotions to the Assistant Professor position. Previous guidelines that required a Ph.D. for the Associate Professor and higher positions were being ignored. Instead, a Ph.D. was being demanded for the Assistant Professor position in MSR 2020 guidelines, a requirement not mandated by the UGC. Taking it a step further, NMC has now mandated a Ph.D. as a requirement for the lowest entry-level non-teaching position of tutor in the MSR 2023 guidelines. This change appears to be aimed at discouraging non-medical candidates from entering the field of medical education. Furthermore, the term of employment for tutors was limited to three years, seemingly to prevent them from getting promoted to higher posts.

Individuals in Pharmacology and Microbiology were among the hardest hit by these changes, as they were effectively barred from applying for teaching positions in any other institution. They faced restrictions on transferring to different colleges or relocating to other cities. In essence, they found themselves trapped within the same college and were at the mercy of the college management. These limitations hindered their opportunities for career advancement and their ability to explore new job prospects. Such restrictions appear to contradict the principles enshrined in Articles 19(1)(e) and 16, which uphold the rights of citizens to move freely between states and seek employment anywhere within India.

It's all about jobs for doctors and filling vacant PG seats:

The persistent vacancy rates of 40-50% in postgraduate (PG) seats within non-clinical specialties are expected to perpetuate the shortage of medical teachers in these fields. Additionally, medical colleges are grappling with revenue losses stemming from these unoccupied PG seats. In certain states, private medical colleges have established agreements with the government, obliging them to allocate a specific percentage of PG seats at reduced fees. Consequently, these institutions allocate non-clinical PG seats to the government quota while retaining the more lucrative clinical seats for themselves. 

Given the lack of interest among MBBS graduates in non-clinical seats, medical colleges are compelled to relinquish the clinical seats, which negatively affects their interests. Thus, there is a pressing need to address the vacancies in non-clinical seats. To address these vacancies, efforts have been made to attract MBBS graduates by offering incentives such as freebies, lowering the qualifying percentile to accommodate lower-scoring MBBS students for PG seats, reducing tuition fees, or even providing the seats free of charge.

Most MBBS graduates aspire to pursue clinical practice, as non-clinical subjects do not provide opportunities for clinical work. Typically, careers in non-clinical fields are centered around teaching in medical colleges. While there is some competition for teaching positions from M.Sc/Ph.D. candidates, this is a relatively minor factor that discourages MBBS graduates from pursuing PG studies in non-clinical subjects.

Despite the numerous vacancies in PG seats, a significant number of MBBS graduates are currently pursuing MD degrees in non-clinical subjects with the hope of securing faculty positions in medical colleges. The association of non-clinical medicos has actively lobbied the NMC to create provisions that would facilitate job opportunities for these individuals.

As a result, the undergraduate board of the NMC made the decision to significantly reduce and eventually stop the appointment of non-medical teachers. This decision serves a dual purpose: firstly, it aims to encourage the occupancy of MD seats in non-clinical subjects, and secondly, it seeks to create job opportunities for medical postgraduates, albeit at the expense of non-medical candidates.

The primary role of the NMC is to establish policies and guidelines that maintain the quality of medical education, rather than engaging in political strategies to occupy PG seats or secure jobs for doctors. By doing so, the NMC appears to be behaving more like an association of doctors focused on advancing their self-interests, rather than fulfilling its role as a regulator.

Role of ministry in ensuring justice:

While the MCI and NMC primarily are bodies 'of the doctors, by the doctors and for the doctors' furthering the interests exclusively of doctors, the union government is entrusted with the responsibility of safeguarding the welfare of all stakeholders. While the regulatory body tends to be self-centered, the policies of the Ministry of Health and Family Welfare (MoHFW) are grounded in reality and uphold principles of universal justice and equality. The NMC Act empowers the government to supersede the NMC on any matter, including policies. Given the inherent bias of the NMC, it is unlikely to ensure a level playing field for non-medical individuals. Therefore, the ministry's intervention is entirely justified. However, it is shocking that the NMC, after initially submitting an affidavit to the Delhi High Court to comply with the ministry's directives, later reversed its stance and exhibited defiance.

Unjustifiable pretexts - myths vs facts:

The rationale employed by the NMC to disqualify non-medical teachers appears to be weak and unsubstantiated. For individuals who have already covered Anatomy, Physiology, and Biochemistry in the first year of their medical M.Sc. program, integrating these subjects for non-medical teachers should pose no significant challenge. In practice, integration with clinical subjects has been ongoing for many years, albeit under the term "applied aspects," even if it was not formally recognized as "integration." Non-medical educators have successfully implemented these integrations since their introduction a few years ago. It's worth noting that while some non-medical teachers may have been excluded from participating in teacher training programs, many have actively participated in critical training sessions, including the revised Basic Course Workshop (rBCW), Curriculum Integration Support Program (CISP), and Attitude, Ethics, and Communication (AETCOM).

The integration component constitutes only a minor portion, approximately 20%, of the overall syllabus. It's crucial to recognize that the fundamental aspects of health and illness, such as the human body, diseases, and diagnostic and treatment methods, remain constant. A shift in curriculum, therefore, does not alter these core principles. The new curriculum cannot be used as an excuse to disqualify teachers who have been teaching for years/decades or prevent them from the academic role of examiner. Furthermore, the early clinical exposure component comprises just 9 hours in each subject. This relatively minimal requirement can easily be fulfilled by medical teachers, who already make up a significant majority, ranging from 70% to 100%, of the faculty.

Non-medical teachers constitute a small minority, with some colleges lacking any non-medical teachers at all. At most, they can make up to 30% of the total faculty strength. The majority of faculty members in these institutions are medical teachers. Hence, the claims of subpar teaching quality cannot be solely attributed to this minority group of teachers.

Proposal to shift non-medical teachers into research:

The NMC's current proposal plans to relocate non-medical teachers, some of whom have served as Professors for several years or even decades, to research positions, ostensibly to create job openings for doctors. However, this plan is illusory, as there simply aren't enough doctors to fill these positions. Forcibly redirecting an individual's career against their wishes is not only unethical but also inhumane. The process of shifting will not happen as envisaged. While permanent government employees may be accommodated into new positions, privately-run institutions are more likely to terminate the employment of non-medical faculties resulting in job loss of thousands. 

It is to reiterate that medical M.Sc courses are historically meant to create teachers for undergraduate teaching, these are no different from MD courses and the false notion that M.Sc courses are meant for research has to be debunked.

In conclusion, what needs to be done?

1. The presence of non-medical teachers should be an integral part of medical education, and colleges should have the freedom to appoint them on merit up to a limit of 30%.

2. All forms of discrimination against non-medical teachers must be abolished.

3. The NMC Act should be amended to ensure that every board, committee, or sub-committee includes 50% non-doctors to ensure fairness and equity.

4. All discriminatory and contested guidelines in the CBME and MSR 2023 should be amended immediately or withdrawn.

5. In order to strengthen and regulate the standards of medical M.Sc courses, a new body 'National Commission for Scientists in Healthcare and Medical Education' must be framed.