If you are an Indian medical student looking to pursue a Bachelor of Medicine, Bachelor of Surgery (MBBS) course abroad, you might have to reconsider your decision.
The Supreme Court recently upheld the National Medical Commission (Foreign Medical Graduate Licentiate) Regulations, 2021, which outline some stringent norms that make it impossible for Indian students to practice back home after completing their MBBS course in a foreign country.
For instance, the regulations say that foreign graduates can practice in India only if they are registered with the professional regulatory body of the country they have obtained the degree from and have got a license to practice there. These norms had come into force on November 18, 2021.
“Courts, sometimes, were swayed by sympathy to the plight of a few students, little realising that the plight of the patients who would go to them will hardly come to light and the impact such decisions would have on the population would never be known,” said Justice V Ramasubramanian while delivering the judgment in favour of new NMC regulations.
Health and legal experts, however, say that a license to practice in a foreign country has more to do with the immigration policy and requirement of medical professionals in that country than the doctors’ skill and training.
The SC was also concerned about the commercialisation of education and the decline of education standards in general and that of medical education in particular. It said that overambitious parents, hapless children, exploitative and unscrupulous founders of infrastructure-deficient educational institutions, paralysed regulatory bodies and courts with misplaced sympathy are the factors that have led to the current scenario.
The judgment has greenlit norms that will not only jeopardise the careers of more than 15,000 students who have already gone abroad but also shatter dreams of millions of Indian students who wish to get a foreign degree in medicine and then practice in India.
The Doctors’ Dilemma
While countries like the Philippines, Bangladesh, Georgia, Nepal, Ukraine, Armenia, Russia, China, Kyrgyzstan, Kazakhstan, among others, receive over 10,000 Indian students every year for the MBBS courses, none of them issues a license to practice only on the basis of a degree obtained there. That makes it even more difficult for foreign medical graduates.
Referring to tight NMC norms, a section of health and legal experts also says that making regulations that discourage students from going abroad is not the right solution as not every educational institution abroad is substandard, something that has been a point of concern.
Some of the foreign institutions are far better than many Indian colleges, says Dr Rahul Bhargava, a leading bone marrow transplantation specialist and clinical haematologist.
He adds, “The NMC has ignored the fact that many MBBS degree holders from abroad are well placed in India and patients have really benefited from the skill and exposure that they have.”
The experts say that the NMC should have instead made multilayer screening norms so that incompetent and unskilled candidates could be filtered out. They give the example of the United States where MBBS degree-holders from any country can practice if they crack the US Medical Licensing Examination—a three-step test to practice medicine in the US.
“The regulations reflect the inability of the NMC and the Government of India to put in place a fool-proof screening and exit test for foreign graduates so that not a single incompetent or untrained doctor can pass through,” says Bhargava, who is currently associated with Gurugram’s Fortis Hospital.
Why Just Medicine?
Experts also argue that if the reason behind the norms of the NMC if the concern for patients' lives, the same restrictions should be imposed on other professions as well. An unskilled civil engineer or ill-trained lawyer with a foreign degree can be as damaging to the society as an incompetent doctor, they say.
“After all, the Bar Council of India has permitted law graduates from overseas to practice, subject to training and conditions,” says India’s former additional solicitor general Sidharth Luthra, who feels that the NMC’s norms and the subsequent SC judgment curtails the right to practice medicine in India with a foreign degree.
Dr (Major) Gulshan Garg, orthopaedic surgeon and chairman of the Sankalp Charitable Trust, says that an unskilled civil engineer with a foreign degree can construct a weak residential structure that can pose a threat to many.
“Why are courts oblivious of the fact that lakhs of students go abroad to do various degree courses but they do not need to fulfil conditions that have been imposed on medical professionals?” asks Garg, whose petition in the Supreme Court had led to the implementation of the National Eligibility and Entrance Test in 2016.
Uday Shankar, professor, Hidayatullah National Law University, Raipur, concurs with Garg.
He adds, "It is pertinent to mention that the measurable standards to be adopted for judicial review should consider all professional courses to be pursued by Indian citizens abroad.”