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What is NLE and why are doctors protesting against it?

A protest by doctors against the government’s decision to make the National Licensing Examination (NLE) mandatory for registration turned violent on Tuesday after the medical practitioners and the police clashed outside the Pakistan Medical Commission (PMC) building.

Doctors from various parts of the country were protesting outside the Pakistan Medical Commission (PMC) office and were chanting slogans against the NLE and the PMC president.

The government’s decision to make the National Licensing Examination (NLE) mandatory for registration has met with criticism from young doctors across the country.

What is NLE?

The Pakistan Medical Commission (PMC) has made it mandatory for all graduates who are currently doing a house job or are ready for it to clear the NLE exam for their permanent registration.

Both MBBS and BDS students must have to clear the NLE for a permanent job and to practise medicine in Pakistan. The move has agitated the medical fraternity which has been protesting for the last many months.

In October 2019, President Dr Arif Alvi had promulgated an ordinance that dissolved the Pakistan Medical and Dental Council (PMDC) and established the PMC. A day later, the NHS ministry sealed the council building and fired its 220 employees.

The PMC has three components: the Medical and Dental Council, the National Medical and Dental Academic Board and the National Medical Authority.

Under section 21 of the PMC Ordinance 2019, it will be mandatory to pass the NLE to obtain a provisional and full licence to practise in Pakistan. The National Medical Authority will hold the NLE at least twice a year according to a schedule approved by the council and it will be applicable to all students graduating after March next year.

After its promulgation, the Medical Teachers Association had termed the NLE an “eyewash” arguing it couldn’t ensure the quality of education in medical and dental colleges.

The reservations

Although the primary reason for the introduction of NLE is the standardization of medical education in Pakistan, it has received a lot of objections from the medical community.

According to the doctors, the exam was introduced in March 2020. Thus it cannot be held legally, as pointed out by a number of people, because the PMC Act is an ex post facto law – which simply means that it cannot apply to batches of students admitted to medical colleges before the PMC Act itself was introduced! Students till the batch of 2024 should be exempted from the exam.

Leeway for the private sector

Many senior doctors and faculty members have labelled the NLE as eyewash by the PMC, “since it is unable to hold up standards in medical colleges”. Medical professionals argue that the PMC’s mismanagement has already resulted in many shady and substandard medical colleges operating in the country.

According to the doctors, another worrying aspect is that through the introduction of the new ordinance and assessment exam, influential private college owners are under no obligation to keep a minimum mandatory strength of qualified faculty – as most of the burden for regulation and quality of education would now fall on the Medical Commission.

The latter body will inevitably fail, because the NLE has been imposed abruptly and without any visible professional preparation; with unknown outcomes, format and mechanisms of examination.