Foreign medical graduates stranded

Thousands of Indian medical students, who have earned MBBS degrees from abroad, are struggling to get internships in India even though they have cleared the National Medical Council (NMC)’s mandatory exam.

A new rule by NMC, and one related to domicile have left around 9,000 Foreign Medical Graduates (FMGs) from various states, including national capital Delhi, uncertain of a place in Indian medical colleges for their Compulsory Rotating Medical Internship (CRMI).

The students have raised the issue with the government and NMC but are not getting a suitable response. While FMGs in Rajasthan have been demonstrating since last week, students in Delhi could soon hit the streets. They say that they do not have any future without internship.

Anusha Bansal, who recently completed her MBBS degree from Yerevan State Medical University, Armenia told Patriot, “It’s already been over two months since our result was announced but we have not been allotted seats for internship in hospitals yet. We just want the authorities concerned — National Medical Commission /Delhi Medical Commission (NMC/ DMC) — to look into the matter and provide a solution to this as soon as possible so that we don’t waste any more of our time.”

Anusha explained the process students have to go through after earning their degrees from universities abroad.

“After completing MBBS from abroad, we need to qualify through an exam, Foreign Medical Graduate Exam (FMGE) in India. It is conducted twice in a year, in June and December. If we pass that exam, we will be treated equal to doctors in India,” she says.

However, these graduates will have to undergo internship too before they can be assimilated.

“After passing, we also need to do an internship in a hospital here. Then only we can get permanent registration in India and practice as a doctor anywhere in India.  According to the new guidelines made in 2021 by NMC, DMC has to provide us with the list of hospitals. When we asked DMC about it, it said that the hospitals are not providing the list of vacant seats as they have no vacant seats for interns.”

Smooth in the past

Things were easier until last year as internship was easy to get following the FMGE.

“Until last year, we would approach hospitals for internship on the basis of FMGE certificate. After a test or an interview, we would easily get internship. A lot of hospitals were valid but now NMC has restricted the list to only 12 hospitals in Delhi, such as Maulana Azad Medical College, Lady Hardinge, Safdarjung among others. Most of these are also denying internship due to lack of seats,” she said.

Besides restricting internship to only 12 hospitals, NMC has also put a cap, with hospitals not allowed to give more than 7.5% of their internship seats to FMGs. Earlier, there was no restriction.

“One more reason for this crisis is the 7.5% cap applied by NMC. This was not the case earlier. Earlier, we could do internships in private hospitals too but that is not valid now,” she said.

Even though NMC has restricted the quota of foreign graduate interns to 7.5%, the implementation of this guideline is at the discretion of the respective state governments.

Mohammad Mouzam, another FMG student, said, “We have cleared our FMG exam, which was held on January 20, 2023. Since February 3, 2023, when the FMGE results were announced, we didn’t get any response regarding allotment of internship seats for FMGs and nobody responded to us either at DMC (Delhi Medical Council) or NMC (National Medical Commission) office.”

Student allege misbehaviour

Mouzam, who returned with a degree from China, said further, “We sought answer from Dr Aruna V. Vanikar, President, Undergraduate Medical Education Board at NMC, but she talked very rudely and said that we didn’t seek their permission before going abroad. She said that they don’t guarantee internship. She even went to the extent of saying, ‘whatever you want to do, go ahead and do. Go to court, protest’.”

While students in Delhi are struggling for response from the authorities, those in some nearby states have already started their internships.

“We haven’t yet got any response regarding allotment of internship seats in Delhi whereas students in the other nearby states have even started their internships. NMC issued a public notice on February 22, 2023 according to which a total of 339 seats were available for FMGs in Delhi. Now, however they say there are much lesser seats available for FMGs. Till now, no merit list has been posted on DMC website. When asked they said they can’t do anything.”

7.5% cap is a major reason

The graduates are now demanding that the 7.5% limit by NMC should be scrapped completely and that more seats should be allocated to accommodate qualified students.

“Our demand is that NMC should allot internship to all FMGs of Delhi as soon as possible and remove the 7.5% cap fixed by NMC since the pass percentage of FMGE for January, 2023 is 39%. So, this 7.5% cap cannot provide internship seats to all FMGs. We want this cap percentage to vary according to pass percentage of FMGs, so that each and every FMG can get internship seat in his or her home state, and be allowed internship in all Diplomate of National Board (DNB) teaching hospitals in Delhi,” Mouzam concluded.

Delhi resident Tanmay, who graduated with MBBS degree from the Philippines, shared his pain with Patriot, “Even two months after our FMGE result was declared, we couldn’t get an internship in Delhi. There is no guarantee that we would get a seat. We students are suffering. Our future exams will also be hampered by it. When we talked to NMC, they washed their hands off it.”

All India Medical Students’ Association (AIMSA), one of the largest medical students’ organisations of India, is also concerned about the matter and is raising it against the state and Union government.

The body’s Twitter post read, “All over India FMG graduates are being treated step-motherly, seats are not allotted for internship and in some places stipend is also not being given for internship, many medical colleges are demanding money from them for internship. @official_aimsa requests the Honorable @PMOIndia & @mansukhmandviya, to take this problem of FMG into immediate cognisance @ashokgehlot51 @RajGovOfficial @narendramodi @OfficeOf_MM @NMC_IND @ANI.”

A female student, who has completed MBBS from Mauritius, said on condition of anonymity, “We cleared a very tough exam of FMGE. We need 50% marks in it to qualify, it is not a joke. But I have not yet confirmed my seat. We are not asking for anything for free. We did everything, cleared the exam first, then demanded our internship seat. And they had seats. A few days ago, an official of DMC accepted that around 200 seats are available but they are not allotting them to students. We saw in Covid too that we need doctors.”

She said further, “Without this one-year internship, we are nothing but useless. We can’t start practicing, can’t apply for further studies. Everything depends on this internship. We are feeling useless now.”

Dr Jaswant Singh, expert and founder of Doctor’s Planet Global Institute (DPGI), a coaching institute for FMGE, said, “The issue is very clear. This time, the FMG result was better than previous years and around 9,000 students qualified. NMC provides a quota of 7.5% to the state which is not enough and all students can’t be accommodated. After this, states also apply the domicile policy. The trouble is in all the states. In Rajasthan, only 399 students have got internship even though 1300 students cleared the exam there. Delhi hasn’t even released the merit list yet. There is no surety on the number of seats. As many as 2,400 forms were filled in Delhi, out of which 250 are domicile students. They will give internships to only 36 students with even many domicile students not getting seats. The situation in Maharashtra and in Jammu and Kashmir is also the same.

“Secondly, the FMG exam will be conducted in June again as a process. Then more students will clear it. Where will they go. So, NMC should act and remove the quota of 7.5%. Also, they didn’t give a stipend during internship to students. The problem is very big. We will fight for it and have sent a letter to all state governments as well as PMO, NMC, and the opposition. Now we are waiting and watching. If nothing happens, we will strike,” Dr Jaswant concluded.

Dr Manish Jangra, Founder of a national voluntary organisation of young Indian doctors, Federation of All India Medical Association (FAIMA) said on this matter, “For the last three months, these students have had no work. We are not using their skills. There is already lack of doctors in hospitals, so when the students will work in hospitals, this will be beneficial for both the doctors and patients. DMC should find an alternative solution to this issue soon.”

The ratio of allopathic doctors to India’s population is 1:1445, which is significantly lower than the World Health Organisation’s prescribed standard of 1:1000.

A meeting between the students’ body and the authority concerned will be held this week.

National President of AIMSA, Dr Jitendra singh wrote on Twitter, “Representatives of #AIMSA will meet the Union Health Minister and NMC Chairman on Tuesday regarding the internship issues of FMG graduates.”

Patriot also tried to talk to the member of the National Medical Commission and Delhi Medical Commission, Dr Rajeev Sood on this matter.

He said, “I am busy now with some guests and will talk to you later. When Patriot tried again, he did not take the call.”