Who should ensure the quality of doctors?

(This article was published on November 29, 2006, in The Kathmandu Post)

Since its inception, Nepal Medical Council (NMC) has carried out a couple of exceptional works. Its primary objective is to assure quality care service to the people. But is it doing so? The answer should be for those who are responsible.

NMC has, no doubt, done a remarkable job of ensuring quality education of private medical colleges mushroomed recently. Starting medical licensing examination for fresh graduates and issuing NMC’s temporary and permanent registration seem to be the parameters of ensuring quality education. But this alone does not ensure the quality and its control. It should monitor the quality of the registered practitioners as well. Is NMC doing so? Apparently not. A registered doctor is a doctor for ever in Nepal.

The onus of NMC is to maintain quality, care, and services. It can implement the licensing examination of all doctors every five/seven years. If it initiates so, there will certainly be an uproar from the doctors’ community. When NMC was planning to start medical licensing examination in 1998-99, it became a national issue and the case ended in the court. NMC lost the case then. NMC tried it again in 2001-02 and this time it emerged triumphant.

Since 2001-02, licensing examination has been in place, and it is at least screening fresh medical graduates. However, the quality of licensing examination can still be questioned. How NMC initiates the periodic examination for all doctors? Who will evaluate the senior most doctors?

There will not be anyone to test their examination. NMC should work on it. It should form a board of examination, which will be responsible for evaluating the examination of all specialists or whatever. The board must comprise doctors of all specialties. But again, there will be a question — how will the board members be evaluated? This is a very thorny issue.

But a periodic evaluation of all doctors in terms of their work every year could be the right approach. NMC can ask doctors to produce research papers, scientific papers, case studies and the likes. It should set criteria to evaluate these papers. Nepali doctors work diligently but are poor in inscription and record keeping. Doctors need a mechanism to make them submit a certain number of papers to NMC to renew his/her medical license every one or two years. If s/he fails to do so, the doctor has to sit for the medical licensing examination again and renew NMC registration. If it evolves as a system, it will be beneficial to all.

There will be a lot of literature produced every year. Some of it will be international class. This will put us in the international arena to help increase research works. Some of these papers will highlight the major health issues and problems of the country, which, in turn, will help the government and non-government sectors institute sound policy for better care and/or infrastructure. Such papers will highlight the success stories. This may even promote medical tourism in our country, which will definitely help boost the country’s economy. Already, tourism is a major source of foreign currency. Medical tourism will be a solid boost to this industry.

Such literature will highlight the constraints of healthcare facilities in rural and inaccessible areas. This will attract donors to lunch new projects and assistance. At the international level, the doctors will also be better known and it will create jobs and training opportunities to equip the medical staff with new skills and technologies. NMC can set up a national medical library and publish all the research works. These publications can follow a certain international standard and with work, be recognized as such.

Launching such a scheme will not be an easy task, however. Some of the doctors will view it as over-ambitious and may go against the plan, so the ministry of health has to play a pivotal role in imposing such policies on the medical professionals. Some will raise questions about how this kind of research works assures the quality of doctors and/or healthcare. But let us not forget that for writing a paper, one has to review the existing literature(s). Even if the review involved only a couple of research works, the writer will know a little more than before.

Doctors from rural and inaccessible areas may complain that they don’t have access to literature and that they are mostly busy due to the administrative work. The brighter part is that they can also put down things based on their personal experiences. For instance, some have done marvelous jobs despite the scarce resources they work with. Their papers can describe – and teach others – how to manage the cases with scarce resources, which will trigger new ideas and innovations for the future. They may also attract new donors.

It is easier said than done. However, someone has to take the initiatives. NMC should provide clear guidelines for different types of paper. An editorial and review board will review those submissions. NMC must have an authority to consider or discard them. Without the successful paper, no one should be allowed to continue the practice. For that, every one or two years, doctors would write at least a paper to continue registration with the council.