May 29, 2020
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The Grim Gatekeeper

A doctor with a foreign degree? You fail!

The Grim Gatekeeper
Narendra Bisht
The Grim Gatekeeper

A Fine Sieve

  • The qualifying test for doctors with foreign undergrad degrees is a breaker: few manage to clear it; some despite many attempts
  • It’s run twice a year by the National Board of Examinations
  • Candidates say it’s tough and tests PG-level knowledge
  • Policymakers wonder if the test is holding up a supply of doctors
  • Quality control is also a concern


Thousands of doctors fail this examination every year, many despite being repeaters. These are Indians with undergraduate medical degrees from abroad. Failure to clear this screening test, administered twice a year by the National Board of Examinations (NBE), leads to a curious result: they may become general physicians in most countries, but not in India, which is short of some 10 lakh doctors.

The test, first run in 2002, has acquired notoriety with low pass percentages. In 2003, it was as low as nine per cent; last year, it was 27 per cent. Every year, there are 20,000-30,000 candidates, and it’s being debated whether it might be ham­p­ering a good supply of doctors. Some pol­icy experts say the test needs a rel­ook; others, especially teaching doctors, say rigorous tests like this ensure high standards. Then there are complaints from failed candidates, who say the test is unfair. Speaking from Moscow, Shr­iharsh Jain, who has failed four times, says, “I’ve always wanted to work in India, but haven’t been able to clear the test. They ask PG-level questions.”

Dr A. Najeerul Ameen, director of the All-India Foreign Medical Graduates Association, complains of opacity. Candidates aren’t allowed to take away question papers and those who fail are given neither their score nor the opportunity to look through their evaluated answer sheets. This contravenes standard practices in most important exams, including the civil services exams. One failed candidate was unable to get to go through his answer sheets even after filing an RTI petition. Dr Ameen also wonders why the test cannot be held at centres across the country instead of only Delhi, when a fee of some Rs 5,000 is charged. The Supreme Court has heard pleas against the test but upheld it twice, in 2002 and 2009.

Dr Bipin Batra, executive director of the National Board of Examinations (NBE), says the results are only an honest reflection of the candidates’ performance. He says undergraduate courses from abroad have problems at all three stages: student input, which is of poor quality; education process, in which there’s “little in terms of high standard of education”; and output, where the quality of examination is “questionable”. On openness, he says, the screening test isn’t run in isolation from policymakers: it’s governed by regulations issued by the Medical Council of India (MCI) and the central government, in compliance with Supreme Court orders. “The NBE is in constant touch with stakeholders for inputs and suggestions,” he says. “The final call, however, lies with the health ministry and MCI.”

The shortage of doctors may have prompted the government to move a National Commission for Human Resources in Health Bill, with a provision for easing the entry of doctors with foreign undergrad degrees. But the parliamentary committee on health rejected the bill. The health ministry is now working out a system to allow NRI doctors to teach, research and work at selected institutions (including charities) in India. A ministry official, however, cautions against any hasty decision on the screening exam, for it might imperil the quality of India’s doctors.

The NBE has earned a reputation for  stringent quality control: its dnb qualifying exams in medical specialities and super-specialities have a high standing across the world. The government and the MCI might consider helping NBE add to that a reputation for transparency. One reason for doing so might be to avoid the accusation of choking India’s supply of much-needed doctors.

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