Doctors in waiting: Why foreign medical graduates are on tenterhooks

Students wait for NMC to clear the air over internship, licence and registration guidelines

Indian medical graduates enrolled in higher education institutes in China, Malaysia, and the Philippines have been waiting for nearly two years for clarity on their careers ahead. The National Medical Commission (NMC), the regulator, had last year mandated that foreign medical graduates, or FMGs, who had completed their fourth and fifth years online due to the pandemic, require a two-year internship after their MBBS instead of one.  

Since the NMC’s circular mandated this retrospectively, it covered even those FMGs who had received their provisional and permanent registration certificates, throwing them into a tizzy. While the mandate is clearly applicable to the batch of 2015, the 2016 batch, which would have graduated in 2021 after internship, is also left unsure.

As the matter went to court, in December 2022, the Supreme Court directed the Centre to form a committee and help clarify the issue of internship. In January, the Centre sought more time from the court to respond and was granted six more weeks.

There are other regulatory hurdles, too, that have kept the students on tenterhooks. For example, there is confusion around the registration guidelines and the cut-off dates for acquiring the degrees.

Registration complexities 

Under NMC’s regulation 4 (b), notified in November 2021, FMGs must be registered with the regulatory body of the country where they studied medicine. Also, this registration should be on a par with the licence to practice medicine in that country.

A student studying medicine in the Philippines explains why it’s not always easy to meet this requirement. In some countries like China, the degrees are registered with government bodies or ministries of education and hence meet the NMC’s criteria. This is not the case in other countries such as Malaysia and the Philippines.

“The Philippines Licence Medical Examination is open only for Filipino citizens,” the student says. Similarly, Malaysia does not let foreign students appear for the licensing exam nor does it provide registrations to FMGs.

The NMC hasn't yet given a list of governing bodies, universities or institutes in foreign countries that meet regulation 4(b). Nor has it provided alternatives for countries like Malaysia and the Philippines where registration or local licensing is not accessible to Indian graduates.

A critical gap that students point out is that the NMC circular addresses students impacted by the war in Ukraine and the ones affected by the pandemic-related restrictions in China. It does not address students from countries such as the Philippines and Malaysia, which also imposed pandemic restrictions and have different rules for registration.

NMC did not respond to questions emailed by Business Standard on the matter.

Deadline dilemma  

After an MBBS degree, FMGs have to clear the Foreign Medical Graduates Examination (FMGE) and a screening test conducted by the National Board of Examination (NBE). Only then are they given a provisional medical registration, after which comes the internship.

Citing a Supreme Court order of April 29, 2022, the medical regulator says only those FMGs who have received their certificate of degree completion on or before June 30, 2022 are eligible to appear for the upcoming FMGE.

However, because of the pandemic-related operational delays, “many students received their certificates after July 10 and are worried they will have to wait a year to sit for the exam,” says Ankit Mehra, CEO of Delhi-based higher education financial aid and advisory start-up, GyanDhan.

Students also say they have received contradictory advice from the NBE.

Rehan Khan, a student of Jianghan University, Wuhan, says, “The NMC says its deadline (June 30) is final by order of the Supreme Court. But officials at NBE told me I can appear for the FMGE if I have got my provisional certificate before October 31.”

A few FMGs Business Standard spoke to have decided to apply for the exam even though they aren’t sure if they’ll be allowed to sit for it.

Besides the mental stress, the confusion and the delay is also taking a financial toll on the students and their families.

“With no provision for a stipend, the extra year of internship not only puts us at a disadvantage financially but also hampers our chances in the job market,” says Samiksha Das (name changed), who was enrolled in a college in Beijing.

She points out that by the time she and her batchmates will finish the extra year of internship, career-wise, they will be behind those who began their MBBS after them. “I never thought it would take me 10 years to become a doctor.”

900,000 reasons to fly out

In July 2022, a record 1.8 million candidates – one million of them women – appeared for the National Eligibility-cum-Entrance Test (NEET). Of these, 993,000 cleared the exam. It is a big number – especially if you consider that there were only 91,927 MBBS seats available this year.

A large chunk of those who don’t get a seat in Indian medical colleges turn to options abroad.