By Vishal Kumar Singh
Imagine this: You spend Rs 40 lakhs and six years studying medicine abroad and still can’t practice in India. This is the plight of Ananya, Aastha, and Husna, three Indian students currently in their final year of MBBS in Russia. For them, studying medicine abroad was not a dream but a necessity.
“I didn’t want to waste another year here and, in comparison to India, abroad seemed like a better and more affordable option,” says Aastha. “Taking a private seat was never an option because of the cost, so I looked into MBBS abroad and found Russia,” adds Ananya.
Husna’s story is similar. “I took MBBS in Russia because I didn’t have the money to get admission in private colleges in India, and I didn’t get enough marks in NEET-UG to get into a government college.”
The economics are clear. Aastha estimates her total cost at around Rs 40 lakh for six years in Russia, including living expenses — far less than what most private medical colleges in India charge.
But affordability comes with its own anxieties. “It has truly impacted my mental health a lot because the uncertainty always keeps me spiraling,” Aastha says. “I have not got enough exposure compared to the students who studied in India.”
Husna echoes the same fear. “It has had a big impact on my mental health because since I’m in the 5th year, I just keep thinking about how I’ll manage once I go to India. There’s already a lot of discrimination happening regarding FMGEs.”
ETHealthworld explores the challenges faced by Foreign Medical Graduates (FMG) in India, from licensing hurdles and lack of clear policies to the emotional and financial toll on students and families. It also examines proposed solutions and brings together perspectives from experts, institutions, and policymakers.
According to data shared by the Centre for Social and Economic Progress (CSEP), the choice to study abroad is usually financial, not aspirational.
“As seen in the table below, medical education in some foreign countries can be more accessible than expensive private medical colleges in India,” explains Neethi Rao, Fellow, Health and Human Development team, CSEP.
Source: CSEP
“The wide variations in pricing between government, private, and deemed colleges and different types of quota seats in each of them, along with the overall shortage of seats in domestic medical colleges, has created a market outside the country for Indian medical aspirants,” Rao added.
“There is no single, consolidated policy addressing all aspects of reintegration. Any such policy would require close coordination between state and central governments, which is, in fact, true for many areas of public health,” she stated.
“The inadequate government priority to the health sector and its underfunding plays a role in the lack of governance and regulatory capacity to enable such a policy to operate effectively,” adds Sandhya Venkateswaran, Senior Fellow, Lead of Human Development work, CSEP.
Yes, requirements do exist: passing the Foreign Medical Graduate Examination (FMGE), completing a supervised internship, complying with NMC regulations. But in practice, the pathway is fragmented and confusing, varying widely across states.
The FMGE Debate
For students, FMGE looms large. Pass rates remain historically low, below 25 per cent. “The failure rates for the exam are high, partly as a result of differences in training and curricula in other countries,” says Venkateswaran.
“Students who have completed their postgraduate medical degrees (MD and MS) from Australia, Canada, New Zealand, the United Kingdom, and the United States are exempted from FMGE. Domestic graduates currently do not have a standardised exam, since NExT is still stalled.”
By contrast, Dr. Kirti Singh, Director Professor of Ophthalmology, Guru Nanak Eye Center, Maulana Azad Medical College, & Associated Hospitals, views FMGE as essential.
She states, “If you go to any other country in the world like the U.S. or the U.K., they will not allow you to practice until you clear their exams. Every country has its own certifying exams according to their population needs and disease profiles. So, when foreign medical graduates — whether from Russia, China, or any other country outside India — come back to their parent country to practice, they must qualify for the certifying exam, which is the Foreign Medical Graduate Exam conducted by NBEMS. That is an essential criterion to know whether they can fit in and practice safely and with respect in their own country.”
She believes the exam itself is solid: “It is very well designed, and the National Board has a rigorous system in place to ensure that all aspects of medicine are covered and that all the questions are correct. In fact, the questions are moderated and rechecked multiple times.”
Clinical Gaps and Cultural Differences in Patient Profiles
Prof. Kirti also acknowledges that returning FMGs may face some real disadvantages. First, the teaching they have received differs in the type of patient profile, the diseases seen, and the treatment protocols. When they come back to India, they have not encountered many diseases our patients have and even the medicines we use in our country. The structured training and assessment also vary in foreign countries and are often very different from training conferred by Indian universities.
“In addition, in our country, the patient load in any medical university, especially the government ones, is very high. This ensures that most medical students trained in Indian universities have seen many patients, unlike in some universities abroad, where due to lower population, patient footfall is less. This translates into fewer types of patients seen by students trained outside India.”
Proposals for Change
Dr. Dilip Bhanushali, President, IMA, listing out the major problems, said,”Low FMGE pass rates, limited internship opportunities, no uniform policy across states, recognition and quality concerns about some foreign institutions, financial and emotional burden, bureaucratic hurdles, and discrimination are the critical issues which is to be addressed.”
He listed out the solutions, “Revamp FMGE/NExT into a standardized test for all, guarantee internships with equal stipends, create a centralized digital portal for FMGs, maintain a regularly updated list of approved foreign institutions, mandate orientation courses on Indian clinical norms, provide mental health support, ensure FMGs who clear licensing exams are equally eligible for NEET-PG with transparent counseling and state quotas, and involve IMA in advocacy and monitoring.”
“Recognise and treat FMGs at par with Indian MBBS after clearing NExT. Internship Rights: Central directive to ensure fair access to internships. Transparency: Publish detailed NMC guidelines and timelines. FMG Support Cell: Set up under NMC/IMA to handle grievances and guidance,” he notes.
Are We Wasting Talent?
“Despite the government adding over 8,000 MBBS seats this year, India still sends more than 20,000 students abroad annually for medical education,” says Dr. Vinitaa Jha, Director–Research & Academics, Max Healthcare. “Unfortunately, many Foreign Medical Graduates face significant barriers — licensing exams with pass rates historically below 40%, limited internship opportunities restricted largely to the government sector, and the absence of structured bridge programs.”
“The outcome is a paradox: rural India struggles with doctor shortages, while trained professionals remain underutilized. Unless we create better pathways for assessment, skill alignment, and deployment, we risk wasting both human potential and an opportunity to strengthen our healthcare system.”
Neethi Rao adds another layer: “In general, there isn’t a clear policy conception or imagination of foreign graduates as a health system resource for India. If the government were to develop policies to support rural aspirants to obtain foreign medical degrees and then absorb them in rural hospitals close to their homes, that could be one way of addressing some of the current geographic disparities in healthcare access.”
Is India Failing Its Aspiring Doctors?
“In many ways, yes,” says Dr Jha. “The fierce competition for limited medical seats forces thousands of aspiring doctors to study abroad, often at great financial and personal cost. Once they return, many face a maze of licensing hurdles, limited guidance, and societal skepticism about their skills.”
“This anxiety is not borne by the student alone — the parents also shoulder that emotional and financial burden for years until their child clears the FMGE exams.”
Rao agrees: “Absolutely yes. The emotional strain of having all their hopes resting on a single examination, the physical and financial strain on the families… is tremendous. The quality of our medical colleges also widely varies, with poor regulation and quality standards, so that the pool of desirable seats is even lower. Add to that the fact that many colleges may be situated in geographic locations that lack adequate social infrastructure, including basics like reliable transportation, physical safety, sanitation, etc.”
The Way Forward
For students like Ananya, Aastha, and Husna, the future still feels uncertain. Their plan is simple: return to India, attempt FMGE, and hope to carve out a career in medicine. They, like thousands of FMGs, aren’t asking for shortcuts, only for a fair shot. India’s healthcare system has gaps to fill and a pool of trained talent waiting to serve. The question is whether policy will catch up with reality.
