Medical education abroad has become a workaround for India’s seat and fee constraints, yet returning graduates still face a homecoming that prolongs licensure, training, and entry into practice
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Every year, India’s medical education system turns away the vast majority of aspirants. In 2025, a record 2,209,318 (22 lakh) candidates appeared for the NEET-UG* entrance exam, even though the country has only about 129,025 (1.29 lakh) MBBS* seats across all medical colleges. Nearly half of these seats (around 48 per cent) are in private institutions, where fees can range from INR 60 lakh to over INR 1 crore. Interestingly, 1,236,531 (12.36 lakh) candidates qualified; even after clearing the exam, the overwhelming majority still stood outside the gates of India’s medical colleges. It reflects a stark mismatch between aspiration and capacity.
The Economic Survey 2024–25 bluntly observed that high domestic costs and limited seats push “thousands of students” to pursue medical degrees abroad each year. In March 2026, the National Medical Commission (NMC) was still issuing new rules for foreign medical graduates (FMGs), notably mandating additional hands-on training for any part of an MBBS course completed online during the pandemic. However, following widespread protests and representations from FMGs over its 6 March notice, it was forced to withdraw and supersede the circular. For Indian students who study medicine overseas, completing the degree is often only the beginning of a longer struggle. As the pathway to a medical seat at home narrows and becomes more expensive, studying abroad increasingly appears as an act of necessity. What, then, are those left out of India’s medical colleges meant to do?
Faced with intense competition and exorbitant fees at home, many Indian medical aspirants see foreign universities as their only viable option. The Ministry of External Affairs estimates that nearly 1.25 million Indian students were pursuing higher education abroad as of January 2025. If health professions account for 2.8 percent of outward mobility, as a 2025 NITI Aayog working paper notes, this would translate into roughly 30,000–35,000 Indian students going abroad for health-related education, including medicine. Over the course of a five- or six-year degree, these outflows accumulate, and at any given time, well over one lakh Indian students would be studying medicine abroad across dozens of countries. Russia remains a leading destination for Indian students, while China continues to host a significant, though smaller, student presence.
It would be a mistake, however, to treat FMGs as a monolith. The quality of education and clinical exposure varies widely across overseas institutions.
It would be a mistake, however, to treat FMGs as a monolith. The quality of education and clinical exposure varies widely across overseas institutions. Some Indian students enrol in established universities recognised by the relevant authorities in their host countries, while others enter institutions with uneven academic standards, variable clinical exposure, or less favourable outcomes upon return to India. Language and curriculum differences can pose challenges, such as studying in Russian or Chinese mediums or encountering different disease profiles, yet many students adapt and even thrive. Crucially, several FMGs earn their degrees fully equipped with the skills and knowledge to become good doctors. Their real trials begin when they return home.
The bottleneck begins with the Foreign Medical Graduate Examination (FMGE), a national multiple-choice licensing exam that FMGs must pass to practice in India (intended eventually to be replaced by the NExT* exam for all graduates). Pass rates in the FMGE have historically been low. In the December 2025 session, only 23.95 percent of foreign graduates passed, with 150 marks out of 300 required to qualify. The Economic Survey 2024–25 invoked a similarly poor pass rate from an earlier year as evidence of the “sub-par quality” of many foreign medical programmes, particularly those marked by weak clinical training.
Passing the screening test, however, is only the first hurdle. After the FMGE, an Indian citizen with an overseas MBBS must complete a one-year compulsory rotating internship (CRMI) in India, even if they have already completed an internship or clinical training abroad. This requirement, in place for decades, was further formalised by the NMC’s Foreign Medical Graduate Licentiate (FMGL) Regulations 2021, which stipulated that those who obtained their degree after November 2021 must complete their entire 12-month internship in India (among other conditions). The result is that a six-year slog through medical school abroad often turns into an eight- to ten-year odyssey before a person can actually register as a doctor in India. The FMG experience is best understood as a pipeline, and Figure 1 maps the stages that often extend the journey by years.
Figure 1: The Long Return Pathway for FMGs in India
Source: Author’s Own
In practice, the internship stage has proved to be another major chokepoint for FMGs. Internships are undertaken at teaching hospitals affiliated with medical colleges or at certain approved hospitals, but until recently, FMGs often struggled to find vacant slots. State medical councils were sometimes reluctant to accommodate foreign graduates, citing limited capacity or lower stipends. In some cases, FMGs were asked to wait for months (or pay fees) to secure an internship post. After the Ukraine war and COVID-19 disruptions led to a surge of returnee students, this internship crisis intensified. The courts and the NMC had to step in with ad hoc solutions, such as permitting some students to undertake supervised training in non-teaching hospitals, or directing states to open more slots.
Under the revised position, graduates who can show that their online training was already compensated by physical instruction abroad need not undergo additional clerkship in India. Those who cannot do so must still bear the burden of proving equivalence.
Pandemic closures and war left thousands of FMGs, particularly in China and Ukraine, with interrupted clinical training and a regulatory mess on their return. The NMC’s 6 March 2026 public notice was later withdrawn and superseded by a clarificatory notice dated 18 March 2026, following concerns raised by affected FMGs and related stakeholders. Under the revised position, graduates who can show that their online training was already compensated by physical instruction abroad need not undergo additional clerkship in India. Those who cannot do so must still bear the burden of proving equivalence.
Even when FMGs dutifully clear all exams and fulfil all requirements, they often face the indignity of unequal treatment. An example is the dispute over internship stipends. In India, medical interns (graduates in their compulsory year of training) are paid a stipend by the hospital or college, usually a modest amount set by the state or institution (often INR 10,000–50,000 per month in government hospitals). Yet in some institutions, FMG interns were paid less than their Indian-educated counterparts, or nothing at all. This discrimination led to protests and court cases. In a landmark decision in February 2026, the Supreme Court of India ruled that FMG interns must be paid the same stipend as Indian MBBS interns.
All of these challenges create a pervasive sense that the system is stacked against foreign medical graduates. Some scepticism about quality is warranted, given the uneven standards of global medical schools. But the distrust goes both ways. Foreign medical graduates currently face a different threshold for entry into practice. They must pass a dedicated screening examination, even though questions of educational quality and standardisation extend beyond foreign institutions alone. NExT was conceived as a common exit framework, but until it is fully operational, the regulatory pathway remains uneven.
India undeniably needs to ensure that any doctor licensed to practise medicine meets appropriate standards. Patient safety and medical quality are non-negotiable. However, there is a difference between rigorous assessment and bureaucratic purgatory. At present, the latter too often defines the FMG experience. If India is to make the most of this pool of trained manpower and treat returning students with basic fairness, several changes are both urgent and obvious.
All of these challenges create a pervasive sense that the system is stacked against foreign medical graduates. Some scepticism about quality is warranted, given the uneven standards of global medical schools.
The return pathway for FMGs should be made smoother and faster. This requires a centralised internship allotment system for FMGs, akin to postgraduate counselling, to efficiently match graduates to available hospitals. Once an FMG has passed the required exam and is performing the same internship duties as any other MBBS graduate, there must be no differentiation in their treatment. Finally, and most fundamentally, India must continue to expand and reform medical education at home. The outflow of Indian students will only truly reduce when the push factors are addressed, including more government medical colleges, regulated and affordable fees in the private sector, and policies to correct the geographical maldistribution of seats.
As India marches toward self-sufficiency in producing doctors, it cannot ignore those already out there, scattered across the globe in lecture halls from Guangzhou to Manila. These students embody both a market failure—the inability of India’s system to meet demand—and a human aspiration that refuses to settle. Setting high standards for foreign graduates is reasonable, but a nation that prides itself on being the world’s largest source of doctors and healthcare workers should also ensure that returning graduates are assessed through a system that is competent, equitable, and efficient, and be pragmatic enough to welcome all its doctors back into the fold, provided they can demonstrate competence.
K. S. Uplabdh Gopal is an Associate Fellow with the Health Initiative at the Observer Research Foundation.
*NEET-UG = National Eligibility cum Entrance Test (Undergraduate)
*MBBS = Bachelor of Medicine and Bachelor of Surgery
*NExT = National Exit Test
*NEET-PG = National Eligibility cum Entrance Test (Postgraduate)
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Dr. K. S. Uplabdh Gopal is an Associate Fellow with the Health Initiative at the Observer Research Foundation. He writes and researches on how India’s ...
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