‘Either I clear FMGE or leave India’ : Foreign medical graduates trapped in vicious cycle

NEW DELHI: Alakh Singh* completed his MBBS abroad, at a medical university in China, in August, 2020. Starting from December that year, he has written the Foreign Medical Graduate Exam (FMGE) six times. In his sixth attempt, the last December session, he scored 144 out of 300 – six marks short of clearing the exam.

“In my first attempt, I scored 133. After that I scored more than 140, but could not clear the FMGE. The question papers in my first two attempts were easy and simple. But, now the questions are pretty tough and it is not easy to understand the pattern either. I think I am not able to clear the exam as I am focusing on the subjects that I am strong at, and not on my weaknesses. I think my approach is not right,” Singh, from Varanasi, Uttar Pradesh, told Careers360.

The years of writing the exam have caused him immense stress. “I go to the gym in the evening to beat my stress and depression. My family thinks I should not go for physical FMGE coaching in Gautam Nagar as it would push me towards isolation. I am staying at my home in Varanasi,” he said.

The FMGE is a screening test for Indian graduates of foreign medical colleges. Indians who wish to return and study further or practise in India must qualify the FMGE exam. The problem is, most don’t. The vast majority of the candidates find themselves in Singh’s situation – repeatedly attempting the exam for years together.

Singh is now taking online coaching from Cerebellum Academy after paying an annual fee of Rs 30,000.

“I am preparing for the FMGE June 2024 session. I study for eight-nine hours a day. My online live classes start at 5 pm, but don’t end at a fixed time. On average, the classes end between 11:30 pm to 1 am. I am more disciplined now and hope to clear the exam this time,” he said.

Why MBBS abroad

Most foreign medical graduates (FMGs) Careers360 spoke to said that they wanted to study in government medical colleges in India but had scored too low in the National Eligibility cum Entrance Test (NEET-UG).

“I scored 350 out of 600 in NEET-UG in 2016. I could not secure a government MBBS seat and an MBBS degree from a foreign medical college is cheaper than that in a private college here. I did my MBBS from Georgia which cost me around Rs. 35 lakh, including living expenses,” said Arun Sharma*.

Last year, about 11.45 lakh students passed NEET-UG. However, there were only 1,07,948 seats (56,283 government and 51,665 private) in 704 medical colleges (government and private combined) in India for the 2023-2024 academic session, which means only about 10.6% of qualified candidates were able to study in the country. Top scorers usually go for government seats.

Due to high fees in Indian private medical colleges, many head abroad. The typical cost of an MBBS degree in countries like China, Ukraine, and Georgia is in the Rs.15-50 lakh range, but private colleges in India can charge as much as Rs. 1.5 crore.

In an office memorandum in February 2022, the National Medical Commission (NMC) had brought the fee of 50% of seats in private colleges and deemed universities at par with that of government medical colleges but the decision was challenged in court. The Supreme Court will next hear the case in September, 2024.

Indian students need to qualify NEET-UG even for MBBS admission abroad. However, in July, 2022, the central government told parliament it does not maintain the data of Indian students studying medicine abroad.

NBE FMGE: Licensure exam

FMGE is the licensure requirement for graduates from certain countries to practise medicine in India. Persons holding undergraduate medical qualification from Australia, Canada, New Zealand, the United Kingdom and the United States of America are exempt.

It is a screening exam consisting of 300 questions, split into two papers of 150 each, from all 19 subjects of the MBBS course; each question carries one mark. Students are required to score 50% – or, 150 – to pass this exam. The exam is conducted by the National Board of Examinations in Medical Sciences (NBEMS) in June and December every year.

After clearing FMGE, students register themselves with their respective state medical councils for internships. After internship, they get a No Object Certificate (NOC) from the directorate of medical education and then permanently register themselves as doctors with state medical councils in order to practise in India.

Also read NExT exam must for foreign medical graduates to intern in India: NMC regulations

FMGE passing percentage

The number of candidates appearing for the FMGE has generally increased over time, with occasional fluctuations from June 2014 to December 2023. Between 2014 and 2023, the passing percentage of FMGE has ranged from lowest 4.93% in June 2014 to 32.25% in December 2022. December sessions generally tend to have higher pass percentages in a year, barring some exceptions.

Failing FMGE

The data of FMGE sessions from June 2014 to December 2023 shows that only 56,240 candidates out of 2,93,025 – 19.9% – could clear the screening test.

Candidates blamed it on different reasons and raised concerns about the functioning of the NBE.

Sonu Kumar* earned his medical degree from Georgia in 2022 and has been taking the FMGE for the last three sessions. After scoring just 100 and 120 in his first and second attempts, respectively, he took coaching and scored 130 in his third attempt last December. FMGE June 2024 session would be his fourth attempt. “Difficult question papers and exam patterns are the major reasons behind my failures,” Kumar said.

Sharat Verma* from Jaipur obtained his degree from Georgia’s New Vision University in January, last year. So far, he has had two unsuccessful attempts – June and December, last year.

“In my first attempt, there were a lot of clinical questions but in my second attempt, there were one-liner questions. The issue is that NBE keeps changing patterns and does not fix marks for specific topics,” he said. He will be making his third attempt in June.

Also read The FMGE problem: Foreign medical graduates allege discrimination, seek reforms

FMG student leaders and coaching managers also blame the lack of seriousness among students.

Dr Kaushal, media coordinator of All FMGs Association (AFA), cleared the FMGE in his first attempt and that too without coaching.

“Most FMGs do not start studying from their first year of MBBS. They try to catch up in the last year only to pass the exam. When they come back to India, it is tough for them to revise all the subjects in just six months and one year. It is a huge burden on them,” he said.

Dr Apurva Dalvi, national convenor of All India Medical Students Association’s (AIMSA) foreign medical student's wing, pointed out that the curriculum abroad is different from the Indian one. “Some candidates face challenges due to limited clinical exposure during their education abroad, which affects their practical skills and readiness for the exam,” he added.

Rajesh Mishra, manager at Next MCI Gurukul (NMG), a coaching centre in Delhi’s Gautam Nagar, said FMGE results leave thousands of students with marks above 140 but below 150 leading to an increase of repeaters in the coaching.

Lack of transparency

The NBEMS has been conducting the FMGE since 2002. But FMGE aspirants, student leaders and coaching owners have been raising concerns regarding its functioning. They demand that NBE should provide question papers and answer keys and declare the results within a week.

NBEMS asks FMGE aspirants to sign a non-disclosure form while filling the application form barring them from sharing the content of the exam. A student needs to pay Rs 7,080 as examination fee but is not provided a physical question paper or answer key after the examination.

“No content of this exam must be shared with friends, acquaintances or third parties, including sharing through online means or via social media. Violation of any act or breach of the same shall be liable for penal action and cancellation of the candidature,” NBEMS had said in its FMGE December information bulletin.

Verma said that FMGE is the only exam in India for which students have to sign a non-disclosure agreement. “This means if a student who scores 149 and is not satisfied, cannot see his/her OMR sheet. We cannot discuss the question paper too. NBEMS does not provide question papers or answer keys to students…There should be transparency.”

Vidit Shah* from Ahmedabad graduated from a medical college in the Philippines in July 2022. “I am still unemployed and not able to do anything because of NBE policies. In the FMGE December 2023 session, there were questions with no correct answer in the options. But nobody can do anything about it since it does not provide any answer key which we can challenge,” he said.

In many cases, NBEMS does not issue admit cards due to “deficiency” in their documents. However, it does not refund the fee. “Admit card shall not be issued to candidates who are declared ineligible before conduct of examination. In such cases, the entire fees will be forfeited,” NBEMS said in the information bulletin.

Also read Foreign medical graduates demand FMGE answer key, NBE cites privacy

Careers affected

Mishra of NMC coaching believes that FMGs are trapped in a vicious cycle.

“Without clearing FMGE, a foreign medical graduate is nothing more than just a Class 12-pass student. FMGs cannot go for any other field for jobs either. Once a student fails in the June session, he starts preparing for the December session and then again for the June session if he fails in December, and this cycle goes on,” he said.

“Everybody keeps asking me about the FMGE results and it is embarrassing to tell them that I could not clear. People will make fun of me if they get to know that I failed to become a doctor even after spending Rs 35 lakh to get an MBBS degree from Georgia,” Kumar said.

Verma has been living in Gautam Nagar since November last year. “Last year, two students died by suicide in Gautam Nagar. There is pressure among students. I have to clear the FMGE. I have no option but to keep writing the exam until I clear it,” he said.

Also read NBEMS introduces time-bound sections in NEET-PG, NEET-MDS, FMGE, GPAT and other exams

Shah, who has had three consecutive unsuccessful attempts, said his future is “on hold” till he clears. “Either I have to clear FMGE or leave the country to practise abroad. If I do not clear in the June 2024 session, I will migrate to another country. There is no other way.”

FMGE June 2024 exam will be held on July 6.

*Students’ names changed on request.