Several MRCP-UK ( Membership of the Royal College of Physicians of the UK ) programmes starting in private hospitals over with Indian regulators having little or no control have raised concerns about the postgraduate medical education structure in India being undermined by a British body. This has also forced the Medical Council of India MCI ) to re-examine the equivalence of MRCP with Indian postgraduate qualifications.In the MCI executive committee meeting on June 5, the issue of equivalence of MRCP was referred to a three-member sub-committee. Responding to TOI's queries, MCI president stated that the subcommittee recommendations would be taken up this week in the executive committee.It all started with the MCI issuing a notification in March last year that postgraduate medical qualifications awarded in the US, UK, Canada, Australia and New Zealand would be considered equivalent to MD/MS/DM/MCh for teaching appointments at the level of assistant professors.MRCP, a post graduate qualification granted by the Royal College of Physicians in UK (RCP-UK) was earlier one that could be completed only after three years' training in UK hospitals after clearing two levels of written examinations and a third test of clinical skills. After starting centres in India for the written exams, centres to take the clinical skill exam were also started, and now there are centres offering the entire MRCP along with the three-year training earlier done in UK.Institutions starting MRCP programmes do not have to follow standards set by the MCI or the National Board of Examination, which control postgraduate medical education. In India, getting post-graduate seats allocated is tough as institutions are inspected to ensure they fulfill criteria such as number of patients, faculty number and qualifications and infrastructure. Private hospitals entering into MoUs with the MRCP's Joint Royal Colleges of Physicians Training Board (JRCPTB) are starting off offering as many 10-25 seats. In response to queries from TOI, JRCPTB clarified that it followed a system that looked "for outcome standards rather than structural standards".It added that getting an MRCP would "simplify the process of recruitment to higher training in UK" and also give exemption from the screening test required to work as a doctor in UK. This would be an obvious advantage for UK with its perennial shortage of doctors, but could lead to India losing doctors in even greater numbers.The British era law and system of regulating medical education was replaced by enacting the Indian Medical Council Act in 1956 to design a system suitable for India. One of the objectives of the council is "reciprocity with foreign countries in the matter of mutual recognition of medical qualifications"."With this move, MCI and NBE could become irrelevant as private hospitals and colleges opt for the MRCP programme. They charge about Rs 20 lakh per annum, which is cheaper than PG seats in some private medical colleges. Today, they claim equivalence, and tomorrow they could claim they are superior to Indian PG degrees. Will the Royal College allow MCI to start a course in UK?," asked a medical college faculty member.