Becoming a doctor is a long-cherished dream. For some, like Sai Alekya, a foreign medical graduate (FMG) from Visakhapatnam, it has been a dream since she was all but four. But not all dreams come true, and some take a painfully long time to materialise.
On December 9, as she waited outside the Andhra Pradesh Medical Council (APMC) office located on the premises of Dr. NTR University of Health Sciences in Vijayawada for the Registrar’s response on the issuance of Permanent Registration (PR), Dr. Alekya’s mind was filled with anxiety, despondency and helplessness.
Dr. Alekya, along with 50 other FMGs, had gathered outside the APMC office to stage a protest highlighting their predicament and to get clarification from the APMC about their PRs.
“Weeks have passed by without a proper response from the APMC on what is causing the delay in granting the PRs,” she says.
After completing medical courses equivalent to MBBS (Bachelor of Medicine and Bachelor of Surgery) from other countries, graduates who wish to work or study in India need to clear the Foreign Medical Graduates Examination (FMGE), a screening test, to be eligible for the one-year Compulsory Rotating Medical Internship (CRMI), which Indian medical graduates also undergo. After completing the CRMI, graduates, both foreign and Indian, obtain a PR from the State Medical Council.
The FMGE, conducted by the National Board of Examinations in Medical Sciences, is held twice a year, in June and December. Considered one of the toughest, the pass percentage in 2023, when 10,261 out of 61,616 graduates appeared for the exam, was 16.65%. In 2022, the passing percentage for the exam was 23.35%.
In Andhra Pradesh, 73 FMGs wrote the FMGE in December 2022. They completed their internship in May 2024 and have been waiting for their PRs for six months. They all completed their medical education at universities in Russia, Georgia, Kyrgyzstan, and Kazakhstan.
However, the wait had just begun for Dr. Alekya and her batchmates, who completed their internships in November 2024 since the APMC has put a hold on issuing PRs, citing various factors.
Meanwhile, Dimple Mehta, who graduated from a university in Russia in 2022, said she was in India for nearly a year and went back to write her exams. She cleared the FMGE in January 2023. In June 2023, the Rajasthan Medical Council allotted her a one-year internship. She got her PR on July 11, 2024, and is now working as a medical officer.
States such as Andhra Pradesh, Delhi, Haryana, Jammu and Kashmir, Punjab, Tamil Nadu, and Kerala have denied or withheld permanent registration for FMGs with one year of internship experience. In contrast, States like Gujarat, West Bengal, Rajasthan, Assam, Orissa, Telangana, and Karnataka, amongst others, have issued permanent registration and given post-graduation seats to students.
The problem arose because of the gap in their studies during the COVID-19 pandemic. All these graduates returned to India during the pandemic and continued their studies online during their courses’ penultimate and final years. Some returned to their parent universities and wrote the exam offline, while others did not.
NMC notice
The NMC released a public notice on June 7, 2024, stating that FMGs who attended classes online for any duration during their course completion should compulsorily undergo a two-year internship, which led to protests.
Following the outrage, the NMC withdrew the June 7 notice and issued a fresh one on June 19, stating that all students who have sufficiently compensated physical classes instead of online classes and passed an examination equivalent to MBBS should be eligible for one-year internships.
Dr. Alekya (26) graduated from a Russian university in 2021, and she belongs to the batch that was affected by the pandemic. She was in her final year when the pandemic began.
In 2020, after writing her fourth-year final exams, she came to India in June, as usual, for vacation. It was also the peak of the pandemic. The classes for her final year were to begin in October 2020. Her stay at home, meant for three months, was extended till February 2021 due to travel restrictions and the non-availability of flights.
However, she returned to her parent university, wrote her final exam offline, and practiced there for two more months to compensate for the lost practical sessions.
After returning to India, she wrote the FMGE in June 2023 and was allotted a one-year internship, which she completed in November 2024.
While the wait for PR has just been a little more than a month to date, it has been excruciating for her, burdened as her mind is full of thoughts of uncertainty.
“The students who completed their internships in May 2024 have not yet received the PRs. What will I do if the process takes as long for us, too? The application for the NEET PG-2025 exam starts in April. Will I receive my PR by then?” asks Alekya, her voice cracking.
Raised mostly by her mother, a nurse, Alekya always wanted to be a medical professional like her mother. Her father, who has been ill for a long time, does not go to work.
In the EAMCET in Telangana and Andhra Pradesh, she secured a rank under 7,000 and 12,000, respectively, in 2015. According to news reports, 69,840 students appeared for the medical stream in A.P. in 2015. However, she could not secure a seat in the medical colleges in the two Telugu States.
Nevertheless, determined to make her a doctor, Alekya’s family decided that she should pursue her studies in Russia. “My parents were supportive because it was not just mine but also my family’s dream to see me as a doctor,” says Dr. Alekya, who flew to Russia at 17 in 2016.
Like Dr. Alekya, many FMGs belonging to the two batches affected by the pandemic are worried.
The protesting foreign medicos say they have given their exams offline and have compensatory certificates, yet they are being denied PR. They add that APMC Registrar I. Ramesh informed them that some have not “sufficiently compensated for their practical sessions” per the NMC guidelines.
When asked about the reasons for the delay in issuance of the PRs in July 2024, the Registrar informed them that the APMC Council members had yet to be elected and nominated and that he did not have the power to make decisions in this matter. He also said the FMGs needed to undergo a two-year internship as per the NMC guidelines.
V. Aruna Vanikar, former president of the Undergraduate Medical Education Board, NMC, New Delhi, who signed the two June 7 and 19 circulars, said the decision regarding who is eligible for a PR lies with the State Medical Council (SMC). Despite the June 19 notification, if the SMC feels two years of internships are required, they can allot the same, said Ms. Aruna Vanikar, who was relieved from her duties on September 24.
In Telangana, the Medical Council Vice-Chairperson, Srinivas Gundagani, told The Hindu that they followed only one rule when deciding the duration of internships. “All those who took the final year exam offline got one year, and those who did not go back got two-year internships,” he said.
“But all of us were given one year, and now they are asking us to wait. Besides, we have all passed the FMGE, which is supposed to test our medical knowledge. Our batchmates in other States have also written the exam and got the PR too,” points out Karthik, another FMG belonging to the batch that wrote the FMGE in December 2022, cleared it on the first attempt and completed the one-year internship in May 2024.
Council formation awaited
Six months on, the State government has yet to nominate members to the Council. The 23-member Council, with 13 members elected by doctors, six nominated posts, and four ex-officio members, was dissolved when the government changed in June. Director of Medical Education D.S.V.L. Narasimham said the matter is under the government’s purview.
To add to the delay, the NMC, on November 19, issued an advisory to the SMCs to “invariably seek confirmation of the medical degrees from the concerned foreign medical college/university through concerned Indian Embassy/ High Commission either before granting Permanent Registration or before recommending them for registration in NMR (National Medical Registrar)“.
“What did they do from June to November?” asks Dr. Karthik, who returned to his parent university in Kyrgyzstan to complete the course. He has the compensatory certificate but has yet to get his PR. He says the vetting process should have been done before the allotment of internships to them when a Provisional Registration was issued.
“I have made four visits to the APMC office, along with my daughter, so far. Every time we come, we hear a new reason. We do not think they have sent our degrees to the Embassy,” says a distraught father from Kakinada. His daughter cleared the NEET PG but cannot attend counselling without a PR.
“We are sending all the degrees and marks lists to the concerned Indian Embassies. Genuine degree holders will be given a PR as soon as the vetting process is completed”I. RameshRegistrar, Andhra Pradesh Medcial Council
However, Dr. Ramesh clarified that the vetting process for certificates takes time. “We are sending all the degrees and marks lists to the concerned Indian Embassies. Genuine degree holders will be given a PR as soon as the vetting process is completed,” he assures the medicos. He adds that the process of ruling out fake degrees is for the benefit of society.
The FMGs feel that the main reason for the delay in issuing a PR to them is also the bias against them. “The discrimination against FMGs is not new to us. It is entrenched in the Indian medical system,” says Dr. Karthik, who finds it difficult to explain why he is idle at home. “Being jobless at this age and after spending a fortune on studies is hard, to say the least,” adds Dr. Karthik, his voice reflecting the angst he is going through.
“We have been made to feel lesser than our Indian counterparts because we did not get a rank in the EAMCET and had to leave for other countries to study”Sai AlekyaForeign Medical Graduate
“We have been made to feel lesser than our Indian counterparts because we did not get a rank in the EAMCET and had to leave for other countries to study,” adds Dr. Alekya, who wants to help her mother clear the loans to the tune of ₹40 lakh, and the delay is leading to thoughts of depression.
Indian Medical Association State member S. Dinesh Reddy, who graduated from a Ukrainian university in 2011, says there is a general feeling that education standards in foreign universities are low, and that is why FMGs are made to jump through many hoops.
“The standards are the same everywhere. But how much we make out of the education at any university depends on an individual,” Dr. Dinesh Reddy says, adding that the very purpose of FMGE is to screen the graduates.
Pawan Kalyan’s assurance
They met Health Minister Y. Satya Kumar Yadav thrice and Human Resource Development Minister N. Lokesh, but in vain. Fed up, the FMGs now knocked on the doors of Deputy Chief Minister Pawan Kalyan, who had assured them that he would look into the issue.
Last week, the Andhra Pradesh Health Department released a notification for recruitment to the Civil Assistant Surgeon post (280 positions). Although eligible, none of the FMGs can apply without a PR.
“We have not received internship stipends, which is against the NMC rules. Yet, we completed it. Now, we should at least be given PRs without much more delay. We have already spent eight years getting a degree. How many more years should we wait,” says another graduate, Chandra, on call.
(Names of students changed to protect identity)
Published – December 20, 2024 06:47 am IST