In this editorial: MD Biochemistry was a valid DM Endocrinology feeder for 13 years before a 2013 rule change. A High Court judgment upheld the regulator's right to change that rule, but never ruled the science was wrong. This piece argues for restoring the pathway with a structured clinical bridging similar to how any MD graduate bridges their gap during DM training.
The NMC's new sub-committee is being asked to re-consider a change made in 2013, one that Indian courts came close to overturning at the time and that the underlying training has since outgrown.
From 2000 to 2013, MD Biochemistry sat on the approved feeder list for DM Endocrinology alongside MD General Medicine and MD Paediatrics. This is thirteen years of regulatory precedent, tested in real admissions cycles, producing candidates who chose biochemistry specifically because it led somewhere clinical.
When the MCI deleted that pathway in 2013, affected candidates challenged it at the High Court of Judicature at Hyderabad.
In Dr. P. Harsha Vardhan and Others versus Government of India, decided on 31 December 2014, the court upheld MCI's authority to revise its own regulations. But it's worth being clear about what that judgment actually said. The court never ruled that MD Biochemistry graduates couldn't handle endocrinology. It simply said MCI had the right to change its own rules.
The rationale given in 2013 was that biochemistry was a pre-clinical discipline lacking ward exposure. This could have been the case, for 2013. But the MD Biochemistry curriculum today carries meaningfully more clinical postings than it did then, precisely the kind of evolution the 2014 judgment anticipated when it noted that eligibility standards are meant to be reviewed periodically rather than frozen in place. A rule justified by a training gap should be revisited once that gap narrows.
It also helps to look at how NMC treats this question everywhere else. DM Medical Genetics, a field with roots in biochemistry as direct as endocrinology's, is currently open to any MD, MS, or DNB broad specialty, including Surgery and Orthopedics; who have little or no exposure. This was even challenged in the Supreme Court as arbitrary, and it stood regardless.
DM Infectious Disease accepts MD Microbiology as a feeder alongside General Medicine and Paediatrics.
Although surgeons bring a different clinical background, they are still permitted to enter DM Medical Genetics, and a microbiologist can enter Infectious Disease, treating biochemistry as uniquely disqualified from Endocrinology is not a consistent clinical standard; it is an inconsistency in the rules themselves.
And once any candidate clears the feeder bar, admission runs through NEET-SS, the same national entrance exam every eligible background competes through. A candidate who qualifies on merit through that exam should not then have their competence questioned on the basis of which MD they hold.
Immunoassay interpretation and mass spectrometry are not side skills in endocrine diagnostics. They are core to getting the diagnosis right in the first place.
Endocrinology is arguably the most biochemically grounded clinical specialty in medicine, built on hormone synthesis, receptor signalling, feedback loops, and diagnostic assays that biochemistry postgraduates already understand at a depth few other backgrounds match. Complex immunoassay interpretation and mass spectrometry are not side skills in endocrine diagnostics. They are core to getting the diagnosis right in the first place.
This is not a uniquely Indian argument either. The United Kingdom's Chemical Pathology specialty, the closest equivalent to clinical biochemistry, is trained with acknowledged overlap into metabolic and endocrine practice rather than being walled off from patients entirely.
If a comparable health system already treats laboratory-to-clinical crossover as normal, India restoring a pathway it once had for thirteen years is a modest ask by comparison.
The honest objection here is understandable, and it deserves a real answer, not a dismissal. Endocrinology involves genuine ward emergencies: diabetic ketoacidosis, adrenal crisis, thyroid storm.
A biochemistry graduate without General Medicine's bedside training is not automatically ready to manage those alone. But this gap is not one-directional.
A General Medicine graduate does not walk into DM Endocrinology already fluent in immunoassay interpretation, hook effects, or dynamic hormone testing either. That biochemical depth as well as management of complex endocrinology cases is picked up during the DM itself, not through their MD.
If a three-year DM residency is already expected to close that gap for General Medicine postgraduates, there is no principled reason the same residency, or a short bridging period alongside it, could not just as reasonably close the clinical gap for biochemistry postgraduates.
NMC already has a working template for this: DNB holders from smaller hospitals are not simply waved through as equivalent to MD; they complete one additional year of supervised experience first. The same logic could govern MD Biochemistry's entry into DM Endocrinology: full eligibility, paired with a structured clinical bridging year, rather than a blanket yes or a permanent no.
The sub-committee's task, then, is narrower than it might look. Not whether biochemistry belongs in endocrinology at all; history and the courts already answered that question once. The real task is designing the bridge that lets a rule proven workable for thirteen years, and a curriculum that has moved on since, finally match each other again.
National Medical Commission. Competency Based Postgraduate Training Programme for MD Biochemistry (Revised Guidelines). Available at: https://www.nmc.org.in/wp-content/uploads/2022/12/MD-Biochemistry-revised-Guidelines.pdf
Medical Council of India. Postgraduate Medical Education Regulations: MD Biochemistry Curriculum. Available at: https://www.nmc.org.in/wp-content/uploads/2019/09/MD-Biochemistry.pdf
Dr. P. Harsha Vardhan and Others v. Government of India & Others, High Court of Judicature at Hyderabad, Judgment dated 31 December 2014.