Here’s why foreign medical degrees are no longer fancy

As in most areas of the national capital, the plush and the pocket-friendly exist cheek-by-jowl in Gautam Nagar. If one lane is lined with sprawling commercial spaces, another has tumbling apartment blocks crowding its narrow, winding stretch. But what sets the area apart are the multiple training institutes for medical aspirants that have mushroomed there. Proximity to the All India Institute of Medical Sciences (AIIMS) always made Gautam Nagar a hub for young medical professionals. In the last decade or so, the coaching centres here have drawn another league of medical aspirants - Indians who have done their medical graduation from a foreign country and are seeking to clear the mandatory FMGE (Foreign Medical Graduates Examination) that will help them get the Medical Council of India (MCI) registration needed to practice in India.
According to data from the National Board of Examinations (NBE) - the organisation charged with the responsibility of conducting the FMGE - 62,934 foreign medical graduates have taken the FMGE in the past five years. Those who have studied medicine in the US, UK, Australia, New Zealand, and Canada, and are eligible to practice there are exempted from the screening. Of course, for the average medical aspirant seeking a primary medical qualification, these are hardly the port of call. “As per records, since 2011, China has been the most-preferred destination for obtaining primary medical qualification for Indian students travailing outside India,” said a source in the NBE. Russia, formerly the top choice, is now the second favourite. Ukraine and Nepal are the other popular choices. But unlike Indians shifting to the US or UK for post-graduate studies, the driving force behind a foreign admission for most of these students is economics, rather than the quality of education or opportunities offered by these institutes or countries. “I sat for the undergraduate medical entrance examinations in 2005. But compared to the number of medical aspirants in the country, there are very few government college seats. It is very difficult to get in unless you are among the reserved categories. Most private colleges ask for Rs 30-40 lakh just in donations. My family was unable to pay so much money. So I decided to study in China. The course duration is the same as in India, 4.5 years, plus a year of internship. But I spent less than Rs 20 lakh for my complete MBBS programme and stay in China,” explains Jatin (28) from Kerala.
Those who graduated from China in 2014 say they spent approximately Rs 25 lakh. For most students what also makes a difference is that - unlike in private medical colleges in India, where the entire sum of donation or capitation fee needs to be paid at one go - foreign universities allow you to pay the money in instalments over the years. However, tuition fees, living costs and air fare aren’t the only things that need to be covered. “Most students approach an agent to get them admitted. On an average, an agent charges approximately Rs 2 lakhs for the admission,” says Firdaus, a student who completed his MBBS from China in 2014 and is waiting to clear the FMGE.
While this will be Firdaus’s first attempt at the FMGE, Jatin is among the lucky few who managed to clear the screening at the first go and is now pursuing a post graduate degree in respiratory medicine in Mumbai. For most, though, the years in China or central Asia are followed by months or years of tuition classes, more money spent, and multiple attempts to clear the dreaded screening that will give them the license to practice in India. “I completed my MBBS from an university in China in 2012. But even after five attempts I have been unable to clear the FMGE. I have already paid Rs 1,35,000 in coaching classes. My father, 62, is a farmer. He can’t support my studies any more. He just wants me to get back home and work on the farm now,” says Avinash Singh.

The FMGE was introduced in 2002. Before that, like Indian medical graduates, foreign graduates too only had to complete a year of compulsory internship in India before getting their permanent registration numbers from the MCI. Rajesh Sharma, director of Delhi Institute For Advanced Medical Studies (DIAMS), which was opened in 2003 to coach foreign graduates for the FMGE, believes that the screening test was required at the time. “Back then, Indian medical students were mainly going to Russia or other central Asian countries like Ukraine. At the time, the quality of education there was not up to the mark,” says Sharma. “Today, 60 per cent of my students are from China. Philippines is also fast gaining popularity and offers quality education,” he adds. Students, FMGE coaching centres and agents who help place Indian medical aspirants in foreign universities point out the several advantages of studying in China instead of Russia. “For one, internship in China is recognised by the MCI, unlike that done in Russia. So one can start practising sooner on return,” says Sharma. Until recently, China was also cheaper. “In 2010, it was possible to complete one’s education there for Rs 5 to 7 lakhs less than in Russia. But since then, the Rouble has weakened and China has developed faster so it has become more expensive. Also, most Chinese universities have now put a restriction on the number of Indian students they are allowing every year,” says Sharma.

Students insist that, with an eye on the FMGE and to ensure a steady flow of Indian students, universities abroad have evolved an improved pattern of education. “The curriculum in India and these countries is similar. Indians and other foreign students such as those from Pakistan or Bangladesh are not taught in the same class as domestic students. We study Indian books and Indian doctors and professors come down as visiting faculty members,” says Rohit Singh, a medical graduate from China, who has been in New Delhi for a year now trying to clear the FMGE. Some universities have tied-up with coaching centres in India. Delhi-based surgeon Vineet Gupta, who opened the Medical Institute for Screening Test (MIST) in 2012, has tied up with three Central Asian universities. “When I was a senior resident physician, many of the graduates from Russia didn’t even know how to apply a catheter. That is not the case now. Most hospitals in India have foreign medical graduates working for them,” he says. He admits, however, that a small section of Indian doctors are still prejudiced against foreign medical graduates and prefer to work with those trained in India.

While mindsets may change with time, it is less easy to ignore the NBE records. In the past five years, the percentage of foreign medical graduates who have cleared the FMGE has varied between 13.09 to 26.9 per cent. “The suboptimal performance by foreign medical graduates in the screening test is related to the deficient level of training and teaching at institutes from where these graduates are obtaining their primary medical qualification. Besides variance in course curriculum and syllabus in foreign medical colleges vis-a-vis the curriculum notified by the MCI in Graduate Medical Regulations, there is less clinical exposure for foreign medical graduates, which is one of the most important reasons for poor performance in subjects like community medicine, obstetrics and gynaecology and paediatrics,” says a source in the NBE. “The absence of entrance tests in foreign medical institutes is also a key factor”. The NBE says that, between 2005 and 2013, the Ministry of Health & Family Welfare sent delegations to countries like China and Russia to analyse the quality of medical education there. They found the result to be far from satisfactory. It is ironical then that the MCI, on its website, puts up a list of available colleges in China every year.

Most foreign medical graduates admit that their practical knowledge and clinical exposure is less than what is given at Indian institutes - government and public. Language is a challenge. “While most Chinese institutes have English medium classes for Indian students, in Russia the course includes a year’s training in the local language. That is not enough to give the students a good enough grip to study in the language. Even when classes are held in English, Indian students, who have studied in vernacular medium schools find it difficult to keep up,” says Sharma. The alien language is especially a hurdle when it comes to practical study or clinical duties. “Most patients, whether in China, Russia or Ukraine, speak the local language,” says Dia (25), who is preparing for her second shot at the FMGE.

The students and coaching centres accuse the NBE of being high-handed and uncooperative. “They ask post-graduate level questions in the FMGE,” says Jatin. Adds Sharma, “Results are not declared for more than a month. Calls to the helpline go unanswered or generate no satisfactory answers.” Some, like Rohit, accuse the NBE of being hand-in-glove with privates colleges in India. “The poor show at the FMGE is just to give out the message that it’s better to study in India. Not just foreign graduates, students of private Indian colleges too should have to clear the screening “ he says. Others smell a money-making scheme. “Every time a candidate sits for the FMGE, he or she has to pay Rs 5,500. It’s a lot of earning for the Board,” says A Najeerul Ameen, president of the All India Foreign Medical Graduates Association.
The additional expenditure definitely makes a difference for aspirants. “If a foreign graduate takes two years to clear the FMGE, that comes to about Rs 7-8 lakhs in tuition and FMGE registration fees,” says Sharma. DIAMS charges Rs 55,000 for a six-month training programme. “The total is still less than what one would have had to pay at a private college in India,” he says. But families, who have already spent lakhs on foreign education, are often without the means to pay Rs 7-8 lakhs more, or to wait until the students can begin practising. “There is now pressure on me to get married,” says Akansha, a graduate from Russia, who will be attempting the FMGE for the third time when it’s held on December 9-10.
At preparatory classes in Gautam Nagar, students busily answer mock tests and pore over books. Conversations are all about possible questions. Perhaps this time, some of them will manage to crack the FMGE and get that coveted license.
(Names of foreign medical graduates have been changed to protect their identities.)

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