A recent notice from the National Medical Commission (NMC) allowing non-teaching hospitals to accommodate Foreign Medical Graduates (FMGs) for their Compulsory Rotatory Medical Internship (CRMI) has proved to be insufficient help. FMGs from all over the country continue to grapple with various other issues, which haven't been extensively discussed, but need to be addressed, if a secure future is to be guaranteed to these students.
Students complain that though the NMC notice certainly catered to the unavailability of internship seats, few states are yet to start seat allotment. "The Medical Education Sector of Rajasthan is unnecessarily delaying the process. Whenever we approach the authorities regarding this, they say that it would start soon. But is already late and there is no clarity on the situation," says Rakesh Gurjar, an FMG from the state.
How things look in Kerala
An FMG from Kerala, on the condition of anonymity, admits that the Kerala Medical Council has also put students in a similar fix. "The Council has a strict rule that we cannot start our internships until we have the provisional registration, while at the same time, the granting of this registration is being delayed. The authorities mention that the verification of documents is taking time, but our Class X and XII certificates are already verified and do not need to be re-verified," the student says.
She adds that their problem doesn't end here. The council is also not issuing them No Objection Certificates (NOCs) so that they can go to other states to practice. The situation gets even more muddled with the private hospitals of the state not participating in the CRMI seat matrix. "Though their names are mentioned in the NMC notice, the private hospitals have filed a case against allowing internships to FMGs. As such, there are very limited seats," the FMG says.
According to her, the Kerala Medical Council also does not publish a merit list, as a result of which, students have no clue if they would be getting a seat or not. "One needs to score 150 marks to qualify for the Foreign Medical Graduate Examination (FMGE). I scored 200, and still have no clue about a seat. There are many more like me, who are waiting for a seat for the last one to two years," the student says.
The delay over various procedures after FMGE is a matter of great anguish to students. Zeenat, an FMG from Uttar Pradesh is also waiting for her provisional registration. "I applied for the exam in December and appeared for it in January. The results were declared in February and internships were supposed to start thereafter. But we are still waiting," she says.
The FMG from Kerala adds that after the completion of CRMI, which was made two years instead of one, the students have to write the National Eligibility Entrance Test Postgraduate (NEET PG) exam. Totalled with the time taken to complete their MBBS, till they earn residency, the process takes about 10 years. "Thus, delays in the process only lengthen the process and also hamper our chances to practice abroad. If we are questioned about the gaps, we cannot justify those in any way," she adds.
A cost factor involved?
Along with time, the students are also worried about the financial factor. "In these 10 years, we do not earn anything. We are not provided with any stipends during CRMI. We come from middle-class families and are not financially so strong as to keep waiting forever. We are required to start earning soon," Zeenat says.
In addition to no stipends, few private hospitals ask FMGs to pay for CRMI, Rakesh says. "The NMC recently conducted a survey through Google Forms on how many hospitals do so and we filled about a hundred responses. But no action was taken. The fees charged goes up to Rs 1-3 lakh, whereas CRMI should be provided free of cost," he adds.
The student also mentions that FMGs need to pay Rs 5,000 for obtaining their temporary and permanent registrations, whereas, Indian Medical Graduates (IMGs) pay only Rs 2,000 for the same. The discrepancy in fees also reflects in the FMGE, which is the most expensive exam in India, while NEET PG which is similarly conducted, charges much less, says Dr Jaswant Singh, Founder of DPGI coaching classes for FMGs.
One of the most expensive exams
An FMGE application costs Rs 7,080, while the NEET PG exam fee is about half this cost. "Both are conducted online. The number of chapters is the same and the difficulty level is on par with that of NEET PG. There are 300 questions in FMGE and 200 in NEET. I don't think extra questions are a reason for charging such high fees. The exam centres provide no extra facility to FMGs, and would be charging the same for NEET PG," he adds.
Speaking on this, Dr Ashwini Dalmiya, Executive Member of Delhi Medical Council (DMC) and President, Delhi Medical Association (DMA), says, "There is the mentality that FMGs would be able to pay more as they have completed their education abroad. The policymakers are quite insensitive to their needs."
The NExT problem
Dr Jaswant mentions that uncertainty over the FMGE date for the June session this year is an added worry for the students. The National Board of Examinations (NBE), in a notice, said that the tentative date of the exam is July 30. However, without a fixed date, students are confused.
The delay in the exam is due to uncertainty over the conduction of the National Exit Test (NExT) in place of NEET PG this year, Dr Jaswant explains. However, he adds that if the exact date of the exam is notified two months in advance, the FMGs would be spared the mental disturbance. "It would be better if the date is given in advance," Dr Dalmiya agrees.
Moreover, a few FMGE aspirants are yet to receive their eligibility certificates, the DPGI founder says. This certificate is a pre-requisite to appear for the exam. "The exam is coming up, and students have been emailing the NMC for clarification as to why their certificates are pending, but have not received a reply," he adds.
Considering the overall problematic scenario for FMGs in India, Dr Dalmiya concludes that a clear-cut policy should be made for them. He emphasises the issues with CRMI and explains why the government should take immediate action.
"The FMGE is a standard set by the government for students who finish MBBS abroad and wish to practice in their own country. If one appears for the exam, and qualifies on those very set standards, whose responsibility is it to give them seats?" he questions, adding that the government cannot wash its hands off that responsibility.
"Now the CRMI has been made two years. But without a clear policy, there is no clarity on where the current batch of students will go for their internship next year. If the next batch of students scores more than the current batch, the names of students of the current batch will never be mentioned in the merit list," Dr Dalmiya elaborated. He added that the policy cannot be made by the NMC and the decision lies with the Ministry of Health.
