Why and how unauthorized ultrasound courses should be stopped in India

Monday, June 1, 2015

by Dr Chandrashekhar Sohoni

I am quite sure many of you must have seen advertisements in newspapers, medical journals and other medicine related publications offering certificate and diploma courses in various medical subjects, for example diabetology and ultrasonography. Almost all of these courses are conducted by private institutions without any recognition from the Medical Council of India (MCI) and the central government. All such courses are unauthorized and hence ill-legal. Still, hoards of medical students and practising doctors fall prey to such advertisements. The urge to add frills to the skirt of our recognized degree is so overwhelming that it precludes any intervention by common sense.

Dr Chandrashekhar A Sohoni

Dr Chandrashekhar A Sohoni

As a radiologist, I am specifically interested in the issue of legality of ultrasound courses being conducted by private institutions and even doctors. Here are some of the reasons as to why such courses are ill-legal and how they can be stopped.

1) The Madras High Court verdicts –

• In 2008, the Madras High Court quashed a State government order (GO) which had allowed a certificate course in Diabetology without the prior permission of MCI. The judges reasoned that the executive power of every State should be exercised ensuring compliance with the laws made by Parliament and any existing law applied in that State. Therefore, the GO was ruled unconstitutional and preventable in view of Entry 66 of List I of the constitution. The judges clearly stated that no course in medical education by any name could be started without the permission of MCI and the Central government.

• In 2011, the Madras High Court declared 11 post-graduate diploma courses conducted by Tamil Nadu Dr MGR University as illegal since they were being conducted without the prior approval of MCI or the Central government. Justice N Paul Vasantkumar said: “The university is not empowered to grant permission to any institution or medical college to conduct any PG diploma course in medical sciences without prior approval of the central government as required under section 10A(1) of the Medical Council of India Act, 1956.” The judge also pointed out that according to the MCI Ethics Code Regulations (2002), a physician is supposed to suffix only recognized qualifications. The honourable judge said that “Without such recognition, if any person is allowed to suffix PG diploma in medical sciences along with MBBS degree, the general public will definitely get an impression that the physician is a specialist. Special status can be claimed by any physician only after getting an approved PG diploma and not half-baked diploma courses offered by the university.”

• The above two verdicts make it amply clear that no course in the field of medicine can be conducted without the approval of the Medical Council of India and the Central government. But still ill-legal courses in medicine continue to be conducted in India. Why? Because nobody bothers to challenge them in the court of law. Though suo motu action is possible, medical councils hardly have the inclination or time.

2) The observations of Delhi High Court –

While deciding on two writ petitions — W.P.(C) 6654/2007 and W.P.(C) 6826/2007 — both of which concerned the ambiguity surrounding the definition of a sonologist, the Delhi High Court made the following comments in the year 2010 –

“As a result of the weak definition of the term sonologist” under the PNDT Act, the mushrooming growth of diagnostic clinics is unable to be effectively regulated. The absence of clear rules and guidelines spelling out unambiguously the qualification, training and experience required for operating a diagnostic clinic offering ultrasound tests has resulted in unethical practices being adopted in many such clinics in violation of the PNDT Act going unchecked. These cases underscore the need to amend the PNDT Act to plug the loopholes and reflect the view of the MCI as indicated in its reply dated 4th May 2009 to one of the Petitioners where it suggested that person seeking to run a diagnostic clinic should either possess a post-graduate degree in Radiodiagnosis or should be a specialist who has undergone orientation training in ultrasonography in a recognized medical institution for a minimum period of six months.”

3) The MCI guidelines –

In the meeting held on 26.12.2011 the Board of Governors of Medical Council of India addressed the following issues at the behest of the Delhi High Court:

1. The requirements in terms of qualification, training and experience required to be registered as a “sonologist” to be specified so as to be incorporated in the Pre-conception and Pre-natal Diagnostic Techniques (PCPNDT) Act.
2. The state-wise names of the institutions recognized for the purpose of ultrasound training.
3. Deciding upon the time-frame for prospective implementation of the changed criteria for the purpose of registration or renewal of registration under the PCPNDT act.

As far as the definition of a “sonologist” given by the MCI is concerned, it is a matter of separate debate, especially because the MCI considers gynaecologists as default sonologists without the need for any sort of dedicated training in ultrasound! That issue, however, is outside the scope of this article.

The current topic of discussion warrants attention to the following important decisions taken by the MCI in this meeting as regards ultrasound training for non-radiologist / non-gynaecologist doctors –

• The centres for ultrasound training shall be government recognized teaching institutions.
• Any training centre not recognized and not duly notified by the respective state government will be considered as flouting the PCPNDT Act and appropriate action, (as per the provisions of the PCPNDT Act) will be initiated against the doctors/persons running such non-recognized centres.

In other words, no private institution or doctor can conduct ultrasound training courses with the aim to provide certification of competence. Some private institutions conducting unauthorized ultrasound courses even claim of being recognized by Indian Medical Association (IMA) and Federation of Obstetrics and Gynaecological Societies of India (FOGSI) for the purpose of ultrasound training. IMA and FOGSI are non-governmental medical associations. No medical association has a legal authority to certify practice competence of doctors. Only MCI has the authority to lay down the criteria for doctors’ training and qualification, and that too in accordance with the Indian Medical Council Act (IMC Act), 1956.

Doctors need to realize that there are no shortcuts to a medical qualification. Doctors’ persistent greed for adding more and more clusters of alphabets to their medical titles primarily feeds the mushrooming business of unauthorized courses in medicine. While they rightfully oppose the practice of allopathy by non-allopathic doctors, allopathic doctors conveniently turn a blind eye towards the malpractice of unauthorized courses in modern medicine. It is the duty of medical associations to take such malpractices to their legal conclusion. Medical associations should not allow their names to be annexed to such malpractices. Court of law is the ultimate way to seek justice. Courts can help, but only when an illegality is officially brought to its notice. So doctors, here is an opportunity for redemption.

Dr Chandrashekhar Sohoni
Consultant Radiologist
Medcliniq Health Centre, Karve Road, Pune

Categories: OPINIONS

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Comment by Dr.K.L. Sehgal
2015-06-01 03:02:01

There are many PG courses which are not recognized by MCI. But are recognized by state medical councils.MD radiology in many govt. colleges is not recognized by MCI?
Most MD gynecologist and many PG diploma holders in Radiology lac basic and hands on knowledge of ultrasound. That’s why they go to private colleges .
Govt.should conduct one exam for all doctors including MBBS doctors to test their skills.
Basic training should be given at MBBS level.
In all developed countries techs and nurses do ultrasound.
PNDT has exceeded in in its jurisdiction in recommend training for doctors.
Ultrasound courses are beyond the preview of MCI (RTI) reply.
Why Radiologists do not want other doctors to do ultrasound.?They do this only in specialized circumstances.Why don’t they concentrate on CTs AND MRIs.
Radiologists hardly know pathophysiology of most diseases.All doctors should do ultrasound in their respective fields
Skill enhancement ,teaching each other is included in Hippocrates oath.
Such debates should be kept outside of this bulletin.

Comment by dr. nidhi bhatnagar
2015-06-01 07:30:23

I completely agree with Dr. Sehgal that education and politics should be not mixed . Its almost like saying stethoscopes are domain of physicians only. Ultrasound should be judiciously used in the wider academic and patient interest . Pcpndt act should not be used as tool to wage civil war amongst our own brethren…..medical education and progressive options should not be boxed and suffocated .
Definitely teaching should be structured and with proper licenses.

Comment by Rajan GB Dr
2015-06-01 07:35:07

I would like to disagree with Dr Sohoni’s views.

MCI has too much work. UGS training is minuscule part of it.

The world of educational training and courses on offer is getting decentralised. Look at Umedy, Coursera. These are high quality open online courses with global learners and teachers. This is the future of education.

It’s called the “Third Wave” an improvement in the human civilisation after agriculture and centralised industrial production.

What we need is good, independent and transparent healthcare rating agencies that would help the public choose medical services offered based on ethical practices, cost, quality, training & infrastructure.

Even a well trained, paramedic could do a basic screening USG/ECHO. Doctors can no more afford to live in well.

Comment by Dr aniruddha
2015-06-01 07:56:58

Training centres which claims to give qualifications which unable to get PC PNDT certificate registration should be immediately BANNED !
However there are centres which train already qualified Radiologists or Post graduate clinicians for performing sub speciality ultrasound like ‘ musculoskeletal,Tranrectal,sonomamo etc ‘should be allowed.

Comment by Dr.S.M.Raju
2015-06-01 09:30:47

All the training center that imparts training in ultrasounds should be banned . Also ban usage of all Chemistry analyzers (semi and fully automated) including hormone analyzers by unauthorized persons including pathologists. More automated means more qualified persons should use it

Comment by Ramdas
2015-06-01 10:56:19

Please dont have a tubular vision, have a broad vision before you give your opinion. Dont consider all your colleagues from the medical fraternity as greedy professionals, as you mentioned. They are not fools to attend trainings and CMEs to update their knowledge and skills, in country which reasons out doctors as culprits for the health indices. No proactive action is taken to rejuvenate the systems amd the MCI or even to scrap the diseased entity.

Did you forget about the Fellowships from medical colleges in India and abroad, degrees from UK, Australia etc, which are seen on the doctors nameplates.

Many radiologists have them. Look around your colleagues, and you can notice, ofcourse, with an open mind and a corrected vision.

You may have a pertinent issuse and its Right and duty to raise it. But, never do the mistake of thinking that you have the solution or answer to it. Hope you know, that, all the stakes holders you mentioned like the MCI, COURTS, Various State Governments, Professional associations and lastly our friends, Doctors of medicine, are atleast as intelligent as you are, if not more.

Well Wisher.

Comment by Dr Saurav Deka
2015-06-01 11:48:29

Yes ,ultrasound is need to be learn by every practising doctor .I have seen many trauma cases (especially at night ) where person died because of internal abdominal bleeding and lack of knowledge of ultrasound by resident doctors and waiting for the radiologist till morning .Same case in Gyanecology,neurology also .
So there is need of “Emergency radiology certificate course ” for the benefit of patient which MCI should legalised so that pursued by all doctors .
However I agree with Dr Chandrashekar for elective & diagnostic purpose only radiologist should given authority .

Comment by Abhishek Bhartia
2015-06-02 02:14:30

In our country it is hard to sometimes know what is correct and what is wrong. Whereas its hard to argue against regulations that should protect the public from being duped by doctors displaying dubious qualifications, we know that the very body entrusted to uphold standards – the MCI – is ridden with corruption. All hospitals have to routinely have to deal with products of government teaching institutions that often have substandard training. Over-regulation strangles innovation – something that is desperately required in education in India. Private courses are also likely an indication of inadequate supply by the government.

Comment by Dr. (Major) Chandan
2015-06-08 07:24:05

After MBBS any skill should be allowed to be developed and thats the way the medical science will develop. Ultrasonography is very useful tool and all Doctors should be allowed to practice it like we use Stethoscope.

No one has raised the question about ECG being interpreted by Non Cardiologists and there are so many such issues.

The sonologist issue is bye product of PC & PNDT act.

There were time when diploma holders have worked as professor and HOD

Comment by Dr.B.Ravi Kumar
2015-06-10 18:51:17

It is very common that non invasive cardiologists do not like physicians doing basic echo like ejection fraction in left ventricular failure patients.

Comment by Dr Leena Jain
2015-06-18 11:08:13

Dr Chandrashekhar ,a simple & humble question can a radiologist come and do ultrasound in a small town where only two mbbs doctors are there, rest,are nonallopthic and ultrasound cases are hardlyh 8 or 10 per day, when he earns 5 digits in town.I think No.Then there is a necessity of that MBBS doctor to do USG,training becoz he cant send the pts for merely for an ultrasound 30 km far,mainly labour pts. And unethical practices doesnot depend on degrees.It depends on the will of the doctor.Violation of PCPNDT act also done by Obs/Gynecs and DMRD s.If this hurts,anybody please i apologise.

Comment by Dr.Ashok
2015-06-29 20:10:40

For ultrasound pratice requirement is knowledge of Anatomy,pathology with training & expeience of
Ultrasound which a MBBS doctors fulfils so he should be encouraged to do practice of Ultrasonography.
Thousand of MBBS doctors are providing these service in our country since arrival of ultrasound successfully & with expertization..

Comment by Dr Sakshi
2015-08-19 12:40:39

Interesting Debate!

While there is a big big need in skill enhancement of Ultrasonography for doctors working in remote areas, is availability of Ultrasound machines also a problem in such places?
Asking this question because even if we somehow train MBBS doctors on ultrasonography, how will they get access to good machines (which are costlier – Upwards of 6 lac)? Or are there any cheaper machines available in market?

Comment by Kusuma Kumari G
2016-01-19 11:49:21

India sleeps in its villages. Let the RADIOLOGISTS who are very upset about MBBS doctors doing ultrasoudn come and work in rural areas. Then the problem will be solved. MBBS can do basic sonogrpahy and sonogrpahy is no rocket science I wish they understand the relaities of indian rural health care scenarion

Comment by Kusuma
2016-02-12 08:43:02

Degrees don make you a better Doctor Skill does. SKill can be acquired with out degress

Comment by Dr M Ravikumar
2016-06-21 11:56:27

With respect to the Radiology Professor who taught me the fundamentals of Ultrasonography, let me write that Sonologists are not a threat to Radiologists,who are the Masters of imageology..and many Sonologist work as locum Sonologists in Scan centres..So many ultrasound centres need Sonologosts,and they cannot afford full time Radiologists.. as they don’t have CT/MRI.But when the scan centres approach for Registration, they do not grant it for a Sonologist who underwent 6 months training after MBBS,as stipulated by MCI…
even in rural areas…

Comment by solomon
2016-06-29 21:28:46

We are Interested in Online Short Courses in Ultrasound. Particular interest in obstetric, abdominal and small part
Kindly send detail information

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