Code of Ethics and Renewal

The medical councils of Karnataka, Maharashtra, Goa and a few other states [Uttar Pradesh, Rajasthan] are enforcing attendance to CME progammes, by citing the need to comply to Code of Ethics clause 1.2.3. Some state Medical councils, such as of Maharashtra and Goa, have gone a step ahead and have linked such compliance to renewal of registration with the respective councils. A similar attempt by the Karnataka Medical Council has been successfully thwarted at the last minute by the unified protest of the medical professionals of the state.

The registrations with medical councils have nothing to do with CMEs. The registrations with the state medical councils are governed by the State Medical Council/Registration Acts/Rules. In Maharashtra and Goa, the state medical council acts stipulate a 5 year renewal, but do not link it to any CME credits. In Karnataka, the medical registration act does not specify a term of 5 years for renewal, nor does it stipulate 30 CME credit points. But, despite such lack of legal sanctions, medical councils of all the three states proposed CME linked renewals; it has now been stopped in Karnataka, but is already going on in Maharashtra and Goa.

All the three medical councils are justifying such CME linked renewal by quoting the section 1.2.3 of the Code of Medical Ethics Regulations 2002 of Medical Council of India. [Karnataka | Maharashtra | Goa] This Code of Ethics reads thus:

1.2.3 A Physician should participate in professional meetings as part of Continuing Medical Education programmes, for at least 30 hours every five years, organized by reputed professional academic bodies or any other authorized organisations. The compliance of this requirement shall be informed regularly to Medical Council of India or the State Medical Councils as the case may be.

This clause only requires a practitioner to attend 30 hours of professional meetings over 5 years and further it suggests the practitioner to report the compliance to the council. This clause has nothing to do with registrations or renewals; it merely asks a physician to participate in professional meetings for 6 hours a year, and such meetings could very well be the regular meetings of medical associations. All it requires is to inform the councils regularly, and that could just be writing letters. But these medical councils have reinterpreted this clause into renewal of registration every 5 years with 30 credit hours of CME!

Why have they changed the requirement from ’30 hours of professional meetings in 5 years’ (6 hours of meetings per year) to ’30 CME credit hours for renewal every 5 years’?

In the absence of a clause in the state medical council Act, Maharashtra Medical Council cites only the Code of Ethics as justification for such CME linked renewals. In Karnataka too, the medical registration Act does not have a clause for 30 credit hours for renewal every 5 years. In Goa too, the medical registration Act has no such clause, and the medical council is citing a circular issued by an under secretary as the basis for such renewals. Can a circular from an under secretary in the dept of health, even though published in the gazette, supersede the prevailing Registration Act in the state? If it is so, why should any state law be enacted by the legislature at all? By circumventing the state laws, are the state councils not demeaning the authority of the state legislatures and themselves?

Most importantly, why are these state medical councils so much obsessed with this particular section 1.2.3 of the Code of Ethics that stipulates 30 hours of learning? Why the same state medical councils are dead silent on the other, and may be much more important, clauses in the very same Code of Ethics Regulations 2002?

For example, the section 1.1.3 of the Code of Ethics 2002 states that a person obtaining qualification in any other system of medicine is not allowed to practice modern system of medicine in any form. Why can’t the medical councils act on the quacks and practitioners of other systems of treatment who openly prescribe, and even demand to be allowed to prescribe, modern medicines?

Section 1.2.1 of the Code of Ethics 2002 states that the physician should practice methods of healing founded on scientific basis and should not associate professionally with anyone who violates this principle. Why the medical councils are then silent on practitioners of modern medicine who employ or support the practitioners of methods that have no sound evidence at all?

Further, section 1.7, on exposure of unethical conduct, requires that a physician should expose, without fear or favour, incompetent or corrupt, dishonest or unethical conduct on the part of members of the profession. Why can’t the medical councils recognise and honour the medical professionals who have upheld these guidelines? [See the irony, how a whistle blower suffered Report 1 | Report 2]

It is indeed baffling that some state medical councils are giving undue importance to just one clause, i.e., 1.2.3 of the Code of Ethics, and even trying to enlarge it further by increasing the hours and by linking it to renewal of registrations. Such state medical councils owe an explanation to the medical fraternity of the respective states.

Table below illustrates how different states are dealing with the issue of CME Credits. All the 6 states listed here have procedures for CME accreditation, and all of them also have renewal clauses in their Medical Registration Acts, but the procedures being followed for renewal are different. In Karnataka, Maharashtra and Goa, the Registration Acts have no provision for linking 30 credit hours of CMEs with 5 yearly renewals, yet all the three are insisting on mandatory renewal every 5 years and linking them to 30 hours of CME Credits. Andhra Pradesh Medical Council Act has provisions for both 5 year renewal and for 30 CME Credits, and the state is insisting on such renewals. Delhi and Himachal Pradesh have provisions for renewals in their State Registration Acts, but not for CME Credits and these two are only insisting on renewals, and do not link renewals with CMEs. It is very clear that Karnataka, Maharashtra and Goa are insisting on CMEs without the mandate of the Registration Acts of the respective states, and Delhi, HP and AP are following the rules laid down in the Registration Acts of those states.

The guidelines for acquiring the 30 CME credit hours are also different from state to state. In Maharashtra, one has to attend 15 days or about 108 hours of CME in 5 years to earn the 30 credit hours; in Goa, 30 hours of CME will be 30 credits and in Karnataka, 120 hours of CME will be 30 credits points! [See the links cited above]

The Case of TCMC and CME Credits:

The Travancore-Cochin Council of Modern Medicine had initiated the process of renewal of registration every five years, tagged to 30 hours of CME programme [30 hours of CME, NOT 30 Credit hours?!] in May, 2004 [See]. After a writ by QPMPA, it had to be withdrawn. The TCMC again issued a notice on Jan 9, 2015, stating that as per regulation 1.2.3 of Indian Medical Council (Professional conduct, Etiquette and Ethics) Regulations, 2002, a physician must participate in professional meetings as part of CME Programmes for at least 30 hours every year (image below). But the relevant regulation 1.2.3 (here) states that a physician should participate in professional meetings as part of Continuing Medical Education programmes, for at least 30 hours every five years! TCMC multiplied it five times! This order has since been withdrawn!