The plight of thousands of Indian medical students who were forced to flee mid-way through their course due to the conflict in Ukraine and the uncertainty over their future has once again brought alive the issues faced by foreign medical graduates (FMGs) in India.
The concerns of FMGs have not changed in almost two decades. Thousands of these medical graudates who return to India are unable to practice or pursue higher studies because they fail to clear the screening test/qualifying examination, necessary for them to secure a registration to practice. The average FMG Examination (FMGE) pass percentage has never gone beyond 20-25% in all these years.
Ill-advised
With at least one lakh FMGs — many are still trying to clear the FMGE, some are pursuing other non-medical options, some are working away from the eyes of the law — languishing in the country, questions are now being raised as to why neither the National Medical Commission ( NMC) nor its predecessor, the Medical Council of India, has ever stepped in to redeem this situation.
“Such sheer wastage of human resource should not go unquestioned. If the FMGs have been consistently failing to clear FMGE, why are the regulatory bodies allowing 20,000-odd students every year to join some random medical schools abroad? Is it not the responsibility of the NMC to counsel students about the pitfalls of pursuing medical education abroad, especially with regard to universities and medical schools whose undergraduate courses might not be on a par with the ones in India,” a senior health professional asks.
The NMC, which replaced the MCI in September 2020, however, has chosen to wash its hands of the entire issue. The MCI at least provided a list of medical schools abroad for MBBS or equivalent courses (based upon the information received from the Indian Embassy/ High Commission of India concerned). The NMC, on its website, clearly states that “... the National Medical Commission does not endorse any list of Foreign Medical Institutions/Universities for MBBS or equivalent course”.
It advises the public at large to seek all course details (the course should be commensurate with the MBBS courses in India) on their own from the university/institution concerned.
“The NMC, which is guiding medical education in the country, cannot absolve itself of all responsibility in the case of students seeking medical education abroad. How are individual students expected to ascertain the credentials of a university abroad on their own,” asks K.V. Babu, member, standing committee on Public Health, IMA HQ
NEET cut-offs hurdle
Every year, the number of students appearing for NEET (undergraduates) has been going up. In the NEET 2020 exam, of the 13.66 lakh students who appeared, 7.71 lakhs qualified. In 2021, as many as 15.44 lakh appeared for the exam, of which 8.70 lakh students were declared qualified.
When the number of MBBS seats available in the country is just over 90,000 and those appearing for the exam crosses 15 lakh, there is no rationale in keeping the cut off for NEET at the 50th percentile (40th percentile for SC/ST students) and declaring so many students as having qualified,” say experts. Since May 2018, only those “qualifying “ in NEET can seek medical education abroad.
The top score in NEET 2021 was 720 (out of 1,200). The marks range at the 50th percentile for unreserved category was 720- 138 . For the reservation category, the lowest cut off for qualifying in NEET was 108 marks.
“The NMC needs to take a more rational approach towards this cut off for NEET qualification vis-a-vis the number of available MBBS seats in the country because year after year lakhs of “NEET-qualified” students are being left in the lurch. Of these, some 20,000 hopefuls will pursue their dreams of a career in medicine in some medical school abroad, which may or may not provide quality education and still end up in the unemployable pool,” Dr. Babu points out.
The NMC Chairman did not respond to these queries from The Hindu.
The FMGE is a tough exam but there is no negative marking and the students have to score 50% to secure a passing grade. The exam is held twice a year and any number of reattempts are possible
The Association of MD Physicians (AMD) , an organisation of FMGs, has been writing to the Union Health Ministry since 2020 that “the archaic practice of applying the percentage-based qualifying criterion (for FMGE alone) defies logic and fairness”.
This is especially so when when every other qualifying exam in the country — NEET-UG, NEET-PG and Super specialty, IIT-JEE Advanced (Engineering), IIM-CAT (Management) and NLU-CLAT (Law) — as well as internationally accepted examinations of SAT and GMAT are determined using the percentile system, points out Rajesh Rajan, AMD president and an interventional cardiologist.
“We have never requested that they dilute the FMGE but we are seeking the intervention of the NMC and the Union Health Ministry so that the conduct of the FMGE is fair and transparent. The National Board of Examinations does not publish the answer keys nor does it offer a chance for revaluation. If the percentile system were to be applied, then students who score up to 35% will clear the exam,” says Dr. Rajan
Expensive process
But the NBE would rather keep the percentage system and fail the FMGs so that for every reattempt, these students will pay ₹7,200 to the NBE, he alleges.
He also points to the discrimination that is meted out to the FMGs at every turn. Except for the FMGE, the application fee for every other competitive exam in the country ranges from ₹2,000 to ₹4,200. An FMG who qualifies for internship has to pay ₹1.2 lakh to the government (Kerala) while the internship fee for a student from a private medical college is only ₹60,000.
“When the government has allowed students to seek an MBBS degree abroad, why should they be discriminated against at every turn? These students are going abroad for MBBS not because they are rich but because they cannot afford the hefty fee charged by private medical colleges,” Dr. Rajan says.
With less than 25% of those pursuing MBBS studies abroad managing to clear the FMGE, what happens to those who do not qualify in the FMGE despite repeated attempts is also something the NMC should be concerned about.
Because these MBBS graduates either end up as cheap labour for some private sector hospitals, working as “clinical assistants” or clandestinely practicing in some rural hospitals. At least 30,000 FMGs in the country are forced to do this, according to the AMD.
Dr. Babu has now written to the Union Health Ministry that the NMC, instead of just issuing an eligibility certificate to all students seeking to go abroad be asked to provide students the details of the best medical schools/ universities abroad.
Incidentally, students who complete their MBBS in Bangladesh, the Philippines and Nepal seem to have a better pass percentage in the FMGE consistently. The NMC should thus evaluate the performance of students in the FMGE over the years, ascertain which are the best colleges/universities that the students can opt for and counsel students accordingly, it is pointed out.
With the NMC planning to introduce the National Exit (NExT) exam as the single qualifying final exam for final MBBS students as well as the FMGs, it would be interesting to see how big a leveller this would turn out to be.
