Addressing the Foreign Medical Graduate Crisis in India: Challenges and Solutions for Parents

Students in India are increasingly pursuing a medical education abroad, but it poses a great challenge when they return. Thousands of students are exposed to this problem, among them being Ananya, Aastha and Husna who opted to pursue MBBS in Russia because of the financial limitation and lack of availability of medical seats in India. We describe the major issues, solution options, and practical advice to help your child overcome this complicated landscape below.

Problems that Foreign Medical Graduates Encounter

Most of the time, the decision to study medicine in foreign countries is necessitated rather than a desire. The exorbitant prices of medical colleges in India, which can easily reach up to 1 crore, versus more reasonable ones in other countries, such as 40 lakh in Russia over six years of study for an MBBS, drive many students to India's competitors like Russia, China and the Philippines. However, there are severe obstacles to the reentry of FMGs:

Foreign Medical Graduate Examination (FMGE): 

FMGs are required to pass the FMGE before practising in India, which has historically had a low pass rate of less than 25%. The rigour of the exam, as well as the difference in the foreign curriculum, is a major challenge. Australian, Canadian, New Zealand, UK and US graduates are exempt as this standard is unequal with the domestic graduates being subjected to no similar exam at present, as the National Exit Test (NExT) has been halted.

Clinical and Cultural Differences: 

Foreign training tends to differ in the patient profile, disease and treatment prevalence and protocols. The volume of patients exposed the students to by the Indian medical colleges and even more so the government medical colleges, as compared to many others that are foreign. Such a gap places FMGs in poor positions to address the healthcare requirements of India.

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Internship and Policy Fragmentation: 

FMGs are receiving fewer internship experiences, which are largely in the government sector, with an imbalanced policy in individual states. This absence of a national policy complicates the process of reintegration, since it has to be in accordance with the rules of the National Medical Commission (NMC) and a guided internship.

Emotional and Financial Cost: 

The uncertainty of passing FMGE and securing internships comes with a great emotional cost to the students and their families. The financial burden of approximately Rs 40 lakh and above is a burden that is further compounded by a lack of confidence in the abilities of FMGs in society.

Systemic Problems and Policy Lapses

This is aggravated by the fact that there is no unified national policy on FMGs. According to Neethi Rao of the Centre for Social and Economic Progress (CSEP), effective reintegration is not ensured by the lack of coordinated governance between the state and the central authorities. The insufficiency in the health sector reduces regulatory power and insufficient seats in Indian medical colleges that are attractive to students, coupled with inadequate infrastructure in certain medical colleges, makes students seek other countries.

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India is short of rural doctors, but FMGs are underused because of the limitations on licences and the bridge programmes.

Proposed Solutions

To resolve the FMG crisis, specialists suggest some steps:

• Standardised Testing: Dr. Dilip Bhanushali, the President of the Indian Medical Association (IMA), proposes that FMGE/NExT be converted into a standardised exam for all graduates, making the test fair.
• Access to Internships: One of the principles that should be implemented to guarantee equal remuneration of FMGs in case of an internship to offset the current shortage.
• Centralised Support: The establishment of a digital portal and FMG Support Cell to the NMC or IMA to provide guidance and to respond to grievances.
• Orientation Programmes: Mandatory sessions on Indian clinical norms to reduce the training gap.
• Transparency and Equity: Publication of clear guidelines on NMC, equal entry to NEET-PG to FMGs who pass licensing exams and a list of current approved foreign institutions.
• Mental Health Support: Resources are provided with the purpose of reducing the emotional load on FMGs and their families.

Guidance for Parents

To help your child with this:

• Monitor FMGE timetable and policy modifications on the NMC and NBEMS websites.
• You should encourage your child to study diligently in FMGE, maybe with special coaching programmes in foreign curricula.
• To be recognised, foreign institutions were researched before enrollment, by the list of NMC was updated.
• Discussion of mental health support services, which might involve counselling, to overcome the pressure associated with licensing and reintegration.

The healthcare system in India is one of the beneficiaries of its FMGs, although systemic barriers need to be overcome so that the benefits can be realised. By staying active and educated, you can help your child pursue a wonderful career in the medical field in India.

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