New Delhi, June 30, 2021: India’s medical education regulator, the National Medical Commission recently released a draft regulation that will govern the eligibility and acceptability of foreign medical graduates to practice medicine in India. Other than mandating these foreign graduates to have qualified the National Eligibility cum Entrance Test (Undergraduate), or NEET (UG), the draft regulation proposes that applicants must have had English language as the medium of instruction in their foreign medical school of graduation, completed an internship of 12 months, be registered to practice in the country of education for 10 years, and qualify the Foreign Medical Graduates Examination until the Indian exit exam, NeXT, comes into force.
While a minimum standard of uniform competence should be expected of any MBBS graduate who wishes to practice in India, overtly stringent rules suggested in the NMC’s draft Foreign Medical Graduate Regulations, 2021 will end up creating a new set of barriers, resulting in a loss of opportunity to improve the healthcare worker pool in the country.
As per the current rules, anyone who has completed MBBS in countries other than the US, the UK, Australia, New Zealand, and Canada, is required to appear for an entrance exam, the FMGE, to get a license to practice in India. There are approximately 40,000 Indian students enrolled in such medical colleges abroad and nearly 70,000 such graduates in India. The rate of passing this exam has been abysmal, thus allowing only a limited subset to be able to practice medicine in India. Between 2015 and 2018, more than 60,000 students appeared for FMGE and a mere 14 per cent of them passed the exam. Since the NMC has introduced plans for a two-part exit exam called the National Exit Test (NeXT), these students will be required to pass that when it comes into force according to the reports published in theprint.in.
NMC draft regulation misses a lot
The reason Indian students choose to study in foreign medical schools is two-pronged: the inability to qualify for government medical colleges or the few government quota seats in private medical colleges, and the exorbitant fees in private medical colleges.
While the NMC’s draft regulation makes some hits in scrapping a separate eligibility exam in the future as it makes NeXT the only qualifying exam, it misses a lot, ending up over-regulating, and not necessarily protecting the quality of healthcare provided or ensuring patient safety.
Restrictions in terms of requirement of 12 years of schooling with subject combination of Physics, Chemistry, Mathematics, and Biology, and with practical courses in these subjects, is uncalled for. The mandatory requirement of NEET for students wishing to study abroad is unnecessary too. Why should a student who has had a different combination of subjects, and who has not appeared for NEET and decided to take a plunge into medicine after a break of a few years, be denied the opportunity to seek the exit exam in order to practice in India as long as they have qualified in medicine?
The Covid-19 pandemic has brought forth the dire situation of lack of doctors and other healthcare workers in India and more particularly the inequitable distribution of such human resources. Various foreign medical graduate representative bodies have been demanding that they be taken into the workforce to serve in the pandemic. In fact, few states such as Gujarat planned their deployment in Covid teams, albeit temporarily. While the activities of informal providers (colloquially called ‘quacks’) during Covid has grown manifold and states such as West Bengal have planned to rope in quacks for Covid management in rural areas without qualified doctors, the plea of foreign medical graduates (FMGs) to be offered an opportunity to help enhance the Covid-19 response health workforce through temporary licences or short training programmes for inclusion have not been heard by Indian healthcare mandarins, despite senior politicians arguing their case.
Criteria NMC can adopt
Medical graduates from many low- and middle-income countries (and some high-income countries) move to high-income countries like the US and the UK after their primary medical qualification (MBBS) in India for reasons like better pay, good working conditions, and career progression among others. To be able to practice in the US, graduates have to qualify the United States Medical Licensing Examination (USMLE) and the Professional and Linguistic Assessments Board (PLAB) in the UK. One can appear for USMLE if they have studied in colleges approved by Educational Commission for Foreign Medical Graduates (ECFMG); for PLAB, it’s the colleges listed under the Foundation for Advancement of International Medical Education and Research (FAIMER)’s World Directory of Medical Schools or in World Federation of Medical Education.
For USMLE, until now colleges were approved by the ECFMG, but from 2024, they plan to accredit the regulatory bodies of the countries the students belong to. This makes sense because if the regulatory body has good standards, the colleges under it will be expected to maintain those as well. The NMC and the Indian medical fraternity largely have had long associations with the ECFMG given the vast number of Indian doctors in the US and Europe and with FAIMER in running regional centres and training hundreds of medical teachers.
