The Union health ministry said on Tuesday that it could take three years to operationalise the common nationwide final-year exit exam for undergraduate medical students under the new regulatory structure for medical education approved by Parliament last week.

Under the proposed regulatory structure called the National Medical Commission (NMC), final-year MBBS students across the country would need to take a National Exit Test (NEXT) that would enable them to practise medicine and seek entry into postgraduate medical courses.

The health ministry said regulations to operationalise the NEXT would take into account theoretical and clinical skills to establish common standards of knowledge and skills of doctors across the country. “There is a three-year window before NEXT becomes operational,” the health ministry said in a statement, adding that this would provide ample scope for detailed negotiations on the contours of the exam.

The NMC Bill, 2019, proposing the NEXT among other changes, has triggered concern among sections of medical students about the bill’s implications on their careers. The health ministry statement appears intended to allay concerns relating to the NEXT and fees in private medical colleges.

The health ministry has pointed out that the NMC will regulate 50 per cent of seats in private colleges. With nearly 50 per cent of India’s estimated 68,000 MBBS seats in government colleges, the ministry said, almost 75 per cent of MBBS seats “would be available at reasonable fees”.

“State governments would still have the liberty to decide fees for the remaining seats in private medical colleges on the basis of individual Memorandums of Understanding signed with colleges on the basis of mutual agreement,” the ministry said. “It is not correct to assume that colleges would be free to arbitrarily raise fees for unregulated seats.”

It said the transparency provided by the NEXT results would lead to the regulation of fees through market forces. “Colleges would have to provide quality education commensurate with the fees charged by them, otherwise there would be no takers for their management quota seats.”

The ministry also said India needs cadres of trained “community health providers” to address the shortage of doctors and specialists, pointing out that 57 per cent of personnel at present practising modern medicine do not have a medical qualification.

The Indian Medical Association, the country’s largest body of doctors, has opposed the proposal for community health providers, arguing that only MBBS doctors should be allowed to practise modern medicine.

The ministry said that several countries, including China, the UK and the US have permitted community health workers or nurse-practitioners into mainstream healthcare services. The community health providers will have a “limited licence” to practice certain elements of medicine.