Foreign medical graduates (FMGs) in India are facing widespread harassment and discrimination, with issues ranging from the absence of stipends and extended work hours to delays in securing internships and the prolonged issuance of essential certificates. These alarming findings were revealed in a Google Forms survey conducted by EdexLive in December 2024, shedding light on the harsh realities that FMGs endure while navigating the medical system in India.
The survey highlighted a grim reality for FMGs, with 78% of respondents reporting that they were not receiving their stipends. Additionally, 60% faced difficulties in securing internship seats in their respective states, while nearly 60% experienced delays from state medical councils in obtaining permanent registration certificates. These findings raise critical questions about the systemic challenges faced by FMGs in India’s medical landscape, and EdexLive digs deeper into this issue.
FMGs & FMGE?
FMGs are Indian citizens who pursue MBBS abroad and return to practice medicine in India. To do so, they must pass the Foreign Medical Graduates Exam (FMGE) and complete the Compulsory Rotating Medical Internship (CRMI). After clearing the FMGE, FMGs are issued a provisional certificate to begin their internship. Upon completing the internship, they receive a permanent registration certificate confirming their residency status. However, delays in issuing temporary and permanent registration certificates, non-payment of stipends, and delays in internship seat allocation have caused significant anxiety among FMGs. Despite a well-defined process, bureaucratic inefficiencies continue to frustrate and hinder their progress.
Survey stats:
Number of respondents: 333
Highest responses from: Andhra Pradesh (AP), Gujarat, Rajasthan, Kerala and Telangana
Countries they graduated from: Kyrgyzstan (highest at 69) followed by China, the Philippines, Russia, Ukraine, Georgia, and other countries.
MBBS fee in other countries: 3 lakh per annum
MBBS fee in India: 10-15 lakh to 1 crore
According to the survey, the major issues reported by the participants are
Delay in internship seat allotment
Limited number of internship seats in domicile
Delay in issuance of provincial and permanent resident certificates
Non-payment of stipends or lack of hike in stipends
Biased treatment between IMGs and FMGs
60.9% of FMGs acknowledged that they were aware of the process of obtaining a license to practice in India is lengthy and arduous.
Among the remaining respondents who admitted to being unaware of the entire process, some expressed frustration over the frequent introduction of new rules and regulations.
Reasons for returning to India:
To take care of parents
With an ultimate goal to serve people of India
Climatic conditions, home sickness, language barrier
Better pay in India
Norm that even to work abroad, a home country license is important
Better clinical exposure and experience in India and other.
Voices of concerns by FMGs
Realising that receiving a permanent resident certificate is a long process, Raghav (name changed) from AP regretted over choosing the medical profession. “The lengthy process of obtaining permanent registration made me question my decision to choose the medical profession. Yet, despite all the challenges, I am content to stay in my country, contributing in some small way to my motherland,” he said.
Riya (name changed) from Rajasthan shared her frustration saying, “It was easy before 2020, but now NMC (National Medical Commission) and SMCs (state medical councils) are making things difficult. They despise FMGEs, and even after passing a national exam, we still face many challenges.”
Harshal (name changed) from Haryana echoed similar sentiments, stating, “I had no idea about the process. It is hideous and self-deprecating ordeal to obtain a licence to practise allopathy in India. New regulations are introduced frequently, but they should instead apply to future batches.”
Karthik (name changed) from Karnataka recalled that “It was not arduous at the time of admission. Regulations were changed in the middle of the course, and I had no other choice but to comply.”
Sahil (name changed) from Maharashtra expressed his regret, saying, “Initially, I was aware FMGE is difficult. However, over time, it turned out to become worse with more regulations very often. I felt regret travelling overseas because FMG doesn't receive the respect they deserve and are taken for granted with no stipends.”
Stipend struggles continue despite NMC regulations:
Stipend-related discrimination remains a significant challenge for FMGs in India. According to the norms of the National Medical Commission (NMC), FMGs undergoing CRMI are entitled to stipends equivalent to those of Indian Medical Graduates (IMGs). However, FMGs claim that they either paid less than IMGs or, in most cases, not paid at all, despite the regulations.
The NMC notice dated December 2023 clarified, “FMGs had a break in their final year and returned to India (Owing to covid pandemic or war) and completed FMG course (including examination) through online mode….Such…. Such students at the stage of CRMI, shall be eligible to receive stipend equivalent to the stipend received by IMGs of that college/ Iinstitution.”
In April 2024, the Supreme Court bench comprising Justices Sudhanshu Dhulia and Prasanna Bhalachandra Varale took note of the submissions of lawyer Tanvi Dubey, representing FMGs about non-payment of stipends during their internships and said, “The medical colleges cannot treat MBBS and foreign medical graduates differently.”
Widespread non-payment of stipends
Despite such directives, the survey revealed that around 78.1 per cent of FMGs reported not receiving stipends. Among the remaining, some were still awaiting internship placements, and only 20 per cent confirmed receiving stipends on par with to IMGs.
“I finished my internship in 2023. Never received a single stipend,” said an FMG from Tamil Nadu on condition of anonymity. “IMG received a sizable stipend, but we didn't receive a single rupee. The state government is not complying with the NMC’'s directive to provide a stipend,” alleged an AP FMG Raju (name changed).
While delay in internships has been a long-standing issue, the change in NMC’'s regulations has further complicated the scenario of the FMGs. The COVID-19 pandemic and the Ukraine-Russian war have deeply affected the academic year for all students.
However, medical students are still facing the repercussions due to the delay in the allotment of internships. The concerns associated with internships are:
Delay in the allotment of internship seats and its commencement
Insufficient seats
Protests and threats over internships and stipends
The FMGs across states, including Rajasthan, Tamil Nadu, Madhya Pradesh, AP, Delhi, and Kerala, have repeatedly protested and approached state medical councils, Directors of Medical Education (DME), and other officials. Despite these efforts, the problem persists year after year.
Several FMGs across states have alleged being coerced into submitting affidavits waiving their right to stipends to secure internship seats. This practice, graduates claim, is not confined to a single state and has left many frustrated and helpless.
On condition of anonymity, an FMG from Rajasthan said, “Although we protested for a stipend, my medical college demanded an affidavit stating we will not ask for a stipend.” Another graduate recounted similar intimidation, saying, “They threatened to withhold internship seats unless we signed the affidavit.”
In Karnataka, the approach was reportedly different. An FMG disclosed that the state medical council withheld provisional certificates from candidates who failed to submit an affidavit against stipends.
Anjali (name changed) from Haryana criticised the lack of adherence to NMC directives. “Despite NMC advisory notices, states are not following orders. Colleges claim they lack the budget or funds and continue demanding affidavits against stipends,” she remarked.
Some FMGs expressed regret over having signed affidavits, which now prevent them from raising complaints. “I started my internship two months ago. We have never received a single rupee, but since Kerala Medical Council and my medical college already have my affidavit, we cannot protest,” shared a graduate from Kerala. Others from the state echoed a sense of hopelessness, doubting any positive action would be taken for FMGs.
Similar incidents were reported in Gujarat and Maharashtra. An FMG from Gujarat noted, “The state has already obtained our affidavit, stating that the Gujarat Medical Council is not responsible for stipends; only institutions and the NMC are.”
A graduate from Maharashtra disclosed a more formalised demand: “The hospital where I completed my internship required a non-judicial stamp document stating we would not request a stipend.”
“In addition to not paying us, the college has subtly threatened us and given the Supreme Court and NMC investigation fake documents,” said Priya (name changed), an FMG from Kerala.
“Despite not providing a stipend, we were asked to give money,” Venkat (name changed), an FMG from AP added.
In Tamil Nadu, FMGs reported being forced to wait over a year to begin their internships. “When demand stipends, they extend internships for two or three years, even though the NMC has issued clear directive over internship duration. They threaten us by delaying seats and complicating the licensing process,” a FMG from Tamil Nadu remarked.
Others highlighted stark financial disparities. A graduate who interned in China shared, "Currently, FMG interns in India are paid significantly less than Indian house surgeons for the same workload.”
While stipend-related challenges are widespread, there are isolated instances of compliance. An FMG from Assam disclosed that his cousin, interning at Nagaon Medical College in the state, was receiving a stipend on par with IMGs.
Negligence by council authorities
A staggering 70.5 per cent of those survey admitted that their internships are not beginning on time, exacerbating the challenges they already face. Reports indicate that these delays can extend for a year or longer, leaving graduates in prolonged uncertainty and hindering their professional progress.
“After passing the FMGE, other states are starting internships within two months. However, in Tamil Nadu, it takes over six to eight months for all procedures to be completed and allocations to be made,” said Yashwanth (name changed), an FMG. Similar delays have been reported in Kerala. “It took six months for internships to begin here,” said Anjali (name changed).
The problem persists in Gujarat, Rajasthan, and AP. Bhaskar (name changed), an FMG from AP, highlighted the inefficiency in the process: “Following the allotment of seats, internships begin. However, the biggest obstacle is that the state council forces us to run from place to place for weeks for updates on seat allotment, which causes the delay.”
Why the delay?
The FMGs cite mismanagement, lack of clear guidelines, and inadequate coordination between state medical councils and the NMC as primary reasons for delays in the commencement of internships.
Some believe that the delays in relieving previous internship batches contribute to a shortage of seats and further delays.
Aparna from Kerala observed that “adequate committee or board to supervise how internships are managed and individuals are assigned to hospitals” is a major factor. Another FMG from Kerala added, “There is a shortage of internship seats since the prior batches are not being relieved and their internship period is extended.”
While this pattern is seen in Gujarat, Rajasthan, Tamil Nadu, Kerala and others, the situation for FMGs in AP reveals a different issue. FMGs from the state allege that delays are linked to governance issues.
Prashant (name changed) from AP said, “According to APMC (AP Medical Council) staff, the state’s new governance has delayed the appointment of a chairman and council members. As a result, pending permanent registration requests and new hires cannot be processed."
Amit (name changed) from AP criticised the lack of a structured process. “Communication gaps between medical colleges, state medical councils, and the NMC are the main reason,” he rationalised.
Condemning the delays and vexed with the mismanagement, Tarun (name changed) from Tamil Nadu proclaimed, “I applied to the Tamil Nadu Medical Council (TNMC) in March after passing the FMGE in January 2024. It took over five months for them to issue a provisional eligibility certificate,” adding that he had to make multiple visits to TNMC and travel significant distances to check the status due to no responses to messages, calls, or emails."
Meanwhile, Thakur (name changed) from Rajasthan offered a different perspective, attributing delays to the council’s efforts to address alleged fraud and irregularities in medical exams. “Once such frauds are discovered, correcting them takes time, adding to the delays,” he opined.
Overall, FMGs highlight systemic mismanagement, lack of accountability, and poor communication as the root causes of internship delays. These issues persist despite the clear directives from the NMC, leaving many FMGs in prolonged professional uncertainty.
Insufficient internship seats
The FMGs have consistently raised concerns over shortage of internship seats in various state. The issue has been particularly prominent in Rajasthan, where medical students have organised large rallies and strikes to draw attention to the matter.
The shortage of seats has become a recurring challenge for FMGs. Recognising the gravity of the situation, the NMC issued a one-time relaxation in 2023, allowing 650+ recognised non-teaching hospitals across India to conduct internships for FMGs for a limited period of one year.
In a circular released on May 9, 2023, the NMC stated, “After careful consideration of the situation and issue faced by the FMGs in order to explore seats to complete their internship, it is decided by UGMEB to validate the list of Recognized Non-teaching Hospitals for CRMI issued by the erstwhile Medical Council of India, for a period of one year from the issue of this circular i.e., up to May 2024, for the conduct of internship for Foreign Medical Graduates only.”
However, as the deadline approached, the seat crisis resurfaced, prompting the NMC to extend the relaxation.
On May 15, 2024, the NMC issued a notice extending the period until May 2026, offering an additional two years for FMGs to carry out internships in non-teaching hospitals. The notice read, “Based on various representations received from Medical Councils and FMGs facing difficulties in deploying FMGs for internships, it has now been decided to extend the relaxation period from May 2024 to May 2026.”
Despite these efforts, the seats crisis continues, especially in states such as Delhi, Punjab, and Rajasthan. In Delhi, only 60 seats were available for internship training, while several hundred applications were submitted. In Rajasthan, despite 1,365 students passing the FMGE 2023 exam, counselling was only conducted for 399 seats. In 2024, out of 919 qualified FMGs, only 578 have been allocated internship seats, leaving 341 without an opportunity.
The lengthy time gap between the counselling sessions was criticised by a Rajasthani FMG, who claimed that seats were distributed in two rounds. “But the two-month gap between the two counselling sessions causes us to feel anxious, stressed and panicked,” he added.
While a greater number of the surveyed participants agreed with the shortage of seats, some pointed to the authorities failure to resolve these challenges effectively.
Swati (name changed) from Tamil Nadu said, “Every time we enquire, DME responds that there isn’'t a vacancy. However, since Tamil Nadu has about 3,000 seats, including the private college for FMG, I don''t believe it is the sole problem.”
Delay in issuance of PR & provisional certificates
Condemning the delay in the issuance of provisional and permanent registration certificates, FMGs have attributed the issue to the negligence of the state councils and the concerned authorities.
Survey stats:
59.7% of FMGs reported facing issues with their respective medical councils regarding permanent registration certificates.
A handful of graduates also complained about delays in receiving their provisional certificates.
Around 38.1% of participants mentioned the following concerns they faced during the process: Long duration for verification procedures | Delay in the onset of counselling or delays in permanent registration | Agents asking for money for permanent registration
Long wait for permanent registration
The FMGs across various states are voicing concerns over the delayed issuance of permanent registration certificates, blaming negligence on the part of state medical councils. Many graduates report waiting for several months or even years for their permanent registration, despite completing their internships.
“I applied for permanent registration seven months ago, and I finished my internship in May 2024. The State Medical Council’'s carelessness is the only reason I haven’'t received my registration yet. Furthermore, they have not even confirmed the day on which I will receive my registration,” said an FMG from AP on condition of anonymity.
Urging accountability, another graduate from the same state emphasised, “It is necessary to question the concerned authorities who are accountable for this carelessness. The process must be quick and transparent.”
In Rajasthan, an FMG reported waiting for more than three months to receive their permanent registration. “I called them 1,000 times (or numerous times), but never received any response. I had to visit the medical council multiple times to receive my permanent registration,” the graduate stated.
In Kerala, FMGs expressed frustration with the prolonged wait times for permanent registration. “Not even a provisional certificate has been issued. According to some of our seniors, we will have to wait for three to four years for permanent registration with the Kerala Medical Council,” an FMG said on condition of anonymity.
Around 300 FMGs from AP are reported to be waiting for permanent registration, with some alleging that the state medical council is undermining their qualifications. “We are around 300 people who completed internship, yet the state medical council is not granting permanent registration. They claim that all FMG degrees are deceptive,” said Shanmukh (name changed), an FMG from AP.
In a troubling claim, he added, “The state council registrar is questioning FMG’s integrity, stating we are worth less and lack knowledge in the subject.”
Partial & prejudiced
The survey revealed that approximately 90.6% of FMGs feel they are treated differently compared to IMGs. The disparities in treatment are notably observed in several key areas such as duty hours, stipend and treatment or behaviour.
One anonymous FMG disclosed, “I was offered lower pay than local graduates even after receiving my permanent license.” Another said FMGs were allotted additional duties when IMGs were on leave.
Aastha, an FMG from Haryana, shared her frustration with the treatment she faced despite clearing the necessary tests. “Even after clearing the test, the hospital staff, physicians, and even IMGs treat us as though we only completed the degree for financial gain and have no knowledge. IMGs and NMC representatives made these kinds of statements at conferences, who claimed that we could earn degrees in India without even attending a university.” She further added that they were often told they didn’t meet the Indian medical requirements and lacked expertise and experience.
Bhavya from AP spoke out against the perception that FMGs only succeeded by chance. “Not all students succeed by chance. Many IMGs who couldn’t clear NEET PG are employed in private hospitals, and many FMGs have done so as well.” She also raised concerns about the NMC’s discriminatory stance, asking, “The government is in charge of issuing certificates to foreign medical graduates; if they object, we wouldn’t be travelling overseas to study. Why would NMC discriminate against IMGs and FMGs?”
Harshita from Kerala raised another issue regarding the internship process. “State medical councils take great liberty when allotting internship years, and in my opinion that is against the NMC rules. Many peers around me were asked to do two or even three years of internship despite meeting the criteria of NMC, and I find that really unfair."
In addition to these disparities, the extended waiting times for internships and certification have caused significant anxiety among FMGs. Many expressed concerns about the financial and emotional stress they face, with several relying on financial support from their families due to the delays in beginning their careers. The prolonged period of unemployment has left many FMGs feeling idle and uncertain about their professional futures.
After-effects of pandemic & Ukraine war
The FMGs have raised concerns over the prolonged and often discriminatory treatment they face in India, worsened by the COVID-19 pandemic and the ongoing Russia-Ukraine war. During 2020, many FMGs were forced to attend classes virtually from their home countries due to the pandemic, while the war in Ukraine further impacted their education, with many students facing delays and disruptions in completing their courses.
In response, the NMC amended the CRMI rules, mandating the FMGs who attended online classes during the course of their study repeat the CRMI for an additional year.
“FMGs who have attended their classes online for any duration during their course completion are required to qualify the FMG Examination and subsequently undergo a Compulsory Rotating Medical Internship (CRMI) for a period of two/three years (a schedule of 12 months to be repeated) as mentioned in the Circular dated 9.5.2023 and as per the public notice uploaded on 7th December 2023,” the June 7, 2024 notice read.
Following backlash from the graduates, the NMC revoked the notice. The notice dated June 19, 2024 read, “In continuation to the Public Notice of even number dated 07th June, 2024, it is clarified that all students who have sufficiently compensated classes in physical onsite in lieu of the online classes and subsequently passed examination equivalent to MBBS in India, shall be eligible for one year mandatory internship as specified in the CRMI Regulations 2021.”
Despite this revision, many FMGs continue to feel that they are treated unfairly, with 93.9% of participants in a recent survey claiming they are treated like “stepchildren” compared to Indian Medical Graduates (IMGs). Several FMGs shared their experiences of being discriminated against, highlighting differences in treatment related to work pressure, leave policies, and duty allocations. One FMG shared, “If we take leave, we are told the work-pressure will be more for IMGs. But if IMGs are absent, we have to compromise and perform double duties.”
Manju (name changed), an FMG from Kerala, recalled the challenges of completing their education under difficult circumstances, stating, “
IMGs took online courses and tests during the COVID-19 pandemic. Similarly, we travelled back to university, finished the remaining clerkship, completed our internship, and returned to India. Yet, our state medical council is not accepting our clerkship certificate and is requiring us to pursue a one-year internship and one-year clerkship, a total of two years, without a stipend.”
Some FMGs have taken legal action to challenge these policies. In December 2024, the Kerala High Court upheld the state medical commission’s decision to mandate two-year CRMI for FMGs who missed their offline classes during COVID and the Ukraine war.
“While the IMG students finished their courses right away, we FMGs gave up all ofall our time, money, and energy for our degrees. , yYet, we continue to be mistreated. There is no licensing exam for IMGs in India; even after studying for and passing it, we are still denied our rights,” the Manju lamented, pointing out the differences.
Another FMG from Rajasthan, Rahul (name changed), shared experiences of prejudice, saying, “IMGS are not even required to come for posting, while registers are kept separately for FMGs during night shifts. IMGs can record attendance even if they arrive an hour late, but if we are ten minutes late, we are recorded marked absent."
While many FMGs voice dissatisfaction with the treatment they receive, there are also instances of positive experiences. Like the saying goes, every coin has two sides. One FMG shared a more uplifting memory, saying, “No hospital staff member ever treated me or my fellow FMG interns differently during my two months of work experience in India. Indeed, a few of the physicians were quite interested in learning about their experiences attending medical school overseas,” an FMG reminisced.
However, they added, “Not everyone outside the healthcare system, in my opinion, has a positive attitude towards FMGs. Additionally, a well-known Malayalam YouTuber recently created a controversial video in which he ridiculed foreign medical graduates,” the FMG added.
An FMG from Jammu and Kashmir, Momin (name changed), took a different approach, suggesting that the issue may be subjective, saying, “The issue may be subjective at first, though. Naturally, it will show up after you are prepared with the necessary information and skills, truthful, and committed to your task.”
Meanwhile, FMGs from Ganesh Shankar Vidyarthi Memorial Medical College (GSVM) in Kanpur and Government Medical College in Idukki reported that their institutions were supportive and did not discriminate against IMGs.
Survey stats
When asked if given a chance, would they reconsider the medical field?
49.2% of surveyed FMGs said they would not reconsider the medical field.
Reasons for pursuing MBBS abroad:
Hefty fees in India
Better quality of study abroad from world-class professors
Unable to secure a government seat due to high competition
Limited seats for general category candidates and reservation
Better exposure abroad
High NEET cutoffs
Complicated counselling process
Less toxicity abroad
Good infrastructure and good mental health status
One FMG expressed, “Its a collective work for a positive outcome as it impacts our nation’'s social structure. We, as FMGs decided to return India for rendering the services. Despite the challenges, we choose this sector in order to study and improve every day,” said an FMG. He further stressed the urgent need for a well-structured and organised panel to bring about much-needed changes.
Uma from AP said, “There are enthusiastic individuals at both extremes, whether they are IMGs or FMGs, and others who are not! We faced difficulties securing a medical seat in India due to our rank, funds, or reservations. We worked hard to obtain degrees from abroad, and we now hope the councils and others will notice our efforts and help us instead of undermining our qualifications."
Senthil (name changed) from Tamil Nadu emphasised the toll these delays take on FMGs, stating, “Many of my friends quit after passing the FMGE exam, believing that completing a three-year internship would waste their lives. In Tamil Nadu, obtaining a licence requires 11 years, which is the worst situation in South India.”
Finally, Jaya V from Gujarat voiced a pressing concern, urging for reconsideration of FMG internship duty hours: “We are interns, and during our study years, we need time to prepare for NEET PG, INI-CET, or UPSC CMS exams. Our duty hours in hospitals should be fixed to allow for proper study time” Jaya suggested.
These voices reflect the collective hope and perseverance of FMGs, who seek fair treatment, clarity, and support as they work toward achieving their professional goals.
