How NMC Is Redrawing the Line for Foreign Medical Graduates

India’s medical regulator, the National Medical Commission (NMC), has recently tightened rules for Indian students pursuing medical education abroad. While these changes have triggered anxiety among aspirants and parents, the regulator insists the intent is not to restrict mobility but to ensure that every doctor practising in India meets uniform standards of training, ethics, and clinical competence.

In an interview with EdinBox, NMC Secretary Dr Raghav Langer, a senior IAS officer, explained the rationale behind the reforms, the lessons from COVID and the Ukraine crisis, and what students must now prepare for.

Q: Why did the NMC feel the need to tighten regulations for foreign medical graduates?

Dr Raghav Langer:
Medical education across countries varies enormously in curriculum design, clinical exposure, duration of training, language of instruction, and internship requirements. In some places, students receive very limited hands-on clinical exposure. In others, courses are shorter than India’s mandated duration. These inconsistencies raised concerns about whether returning graduates were adequately prepared to work in India’s complex and high-burden public health system.

The NMC’s norms are meant to ensure that any doctor entering practice in India, regardless of where they studied, meets minimum standards of training, competence, and ethical practice. This is about standardisation, not exclusion.

Q: Students say the new rules are harsh. How does the NMC respond?

Dr Langer:
We understand that any regulatory change creates uncertainty. But these rules are not sudden. Many of these requirements existed earlier too. What we’ve done is make them clearer, more structured, and more enforceable.

Our message to students is simple: you have global mobility, but Indian accountability.

Q: Was the Ukraine crisis a turning point for the NMC?

Dr Langer:
Absolutely. The COVID-19 pandemic and later the Russia–Ukraine war tested our regulatory system. Thousands of Indian students were forced to abandon their education mid-way due to safety concerns or university shutdowns. Many returned with incomplete degrees and no clarity about their future.

Following Supreme Court directions and student petitions, the NMC introduced a one-time “academic mobility” framework for those affected by the Ukraine conflict. This allowed them to complete their remaining training at recognised foreign institutions instead of restarting their education from scratch.

But these were exceptional relaxations. They are not precedents.

Q: Who must clear the FMGE or NExT to practise in India?

Dr Langer:
Any Indian citizen or Overseas Citizen of India (OCI) who obtains a medical degree from a foreign institution must qualify the Foreign Medical Graduate Examination (FMGE), which is currently the licensing test. Eventually, this will be replaced by the National Exit Test (NExT).

Foreign nationals are not eligible for FMGE.

Additionally, students who joined foreign medical colleges after 2018 must have qualified NEET-UG. Without NEET eligibility, their degree will not be recognised, no matter how well they perform abroad.

Q: What do the current FMGL rules mandate?

Dr Langer:
The Foreign Medical Graduate Licentiate (FMGL) Regulations, 2021, apply to students admitted after November 18, 2021. They require:

• A minimum of 54 months of academic and clinical training
• A 12-month compulsory internship at the same foreign institution
• Training entirely in English
• Mandatory coverage of core subjects like Medicine, Surgery, Paediatrics, Psychiatry, Orthopaedics, Anaesthesiology, and Community Medicine
• Degree certificates attested by the Indian Embassy
  
  

After this, graduates must clear India’s licensing pathway. To address concerns about limited exposure abroad, they must also complete an additional one-year internship in India.

Q: Why is this additional internship in India necessary?

Dr Langer:
India has a very specific disease profile, patient load, and public health challenges. This internship familiarises graduates with Indian treatment protocols, healthcare systems, and ground realities.

Patient safety cannot be compromised.

Q: How many Indian students study medicine abroad, and where do they go?

Dr Langer:
Every year, an estimated 15,000–20,000 Indian students go abroad to study medicine. Popular destinations include Russia, Georgia, Kazakhstan, Uzbekistan, the Philippines, and parts of Eastern Europe. These countries attract students due to lower fees, English-medium instruction, and simpler admission processes.

China was once a major destination, but regulatory and language concerns have reduced its appeal.

Q: Students say implementation remains confusing. What is being done?

Dr Langer:
We acknowledge that communication gaps exist. That’s something we are working on. Clearer guidelines, better coordination with state medical councils, and transparent digital systems will go a long way in reducing confusion.

Q: What does the NMC want students to know going forward?

Every rule is made to ensure a smoother transition. Some may seem stringent, but they apply to all. Foreign students must clear NEET-UG, complete 54 months of training, followed by a 12-month internship, and be registered in their home country. In the NExT screening test, they will also be asked why they wish to practise in India.

COVID-related concessions granted in 2023 were temporary. Online classes meant minimal physical exposure. Students were issued certificates to compensate. But if they lack proper documentation, they must undergo an additional year of training. Ukraine students were given special concessions, but these were exceptional.