Studying medicine abroad offers an alternative to IndiaтАЩs limited seats and high fees, but returning doctors often face delays in licensing, training, and starting their careers at home. Every year, most aspiring doctors in India are left without a seat. In 2025, a record 22 lakh candidates appeared for the NEET-UG exam, while the country offered just about 1.29 lakh MBBS seats. Nearly half of these are in private colleges, where fees can soar from тВ╣60 lakh to over тВ╣1 crore. Even among the 12.36 lakh students who qualified, the vast majority still couldnтАЩt secure a spot, highlighting the huge gap between ambition and opportunity. The Economic Survey 2024тАУ25 pointed out that high costs and limited seats push thousands of students to pursue medical education abroad each year. In March 2026, the National Medical Commission (NMC) introduced new rules for foreign medical graduates (FMGs), including extra hands-on training for parts of MBBS completed online during the pandemic. After protests from FMGs, the NMC had to withdraw and replace the circular. For Indian students studying medicine overseas, earning a degree is often just the first step in a longer journey. With fewer seats and rising costs at home, studying abroad is becoming less a choice and more a necessity. So what options remain for those left outside IndiaтАЩs medical colleges? Why Indian Students Still Leave to Study Medicine Abroad Facing intense competition and soaring fees at home, many Indian medical aspirants view foreign universities as their only realistic option. According to the Ministry of External Affairs, nearly 12.5 lakh Indian students were studying abroad as of January 2025. Health professions make up about 2.8% of this outward mobility, which works out to roughly 30,000тАУ35,000 students pursuing medicine and other health-related courses overseas each year. Over a five- or six-year program, these numbers add up, meaning that at any given time, well over one lakh Indian students are studying medicine across multiple countries. Russia remains a top choice, while China continues to attract a sizeable, though smaller, number of students. ItтАЩs important not to see foreign medical graduates (FMGs) as a single group. The quality of education and clinical experience varies widely across overseas universities. Some Indian students join well-established, recognised institutions, while others end up in colleges with uneven academics, limited clinical exposure, or uncertain outcomes back home. Language and curriculum differences can also be challengingтАФstudying in Russian or Chinese, or dealing with unfamiliar disease profilesтАФbut many students adapt and even excel. In fact, several FMGs complete their degrees fully prepared to be competent doctors. The real test, however, often begins only after they return to India. Why Returning to Practice Is So Tough The first bottleneck for foreign medical graduates (FMGs) is the Foreign Medical Graduate Examination (FMGE), a national multiple-choice licensing test required to practice in India. This exam, which will eventually be replaced by the NExT exam for all graduates, has historically seen very low pass rates. In the December 2025 session, only 23.95% of candidates cleared it, needing 150 out of 300 marks to qualify. The Economic Survey 2024тАУ25 cited similar past results as evidence that many foreign medical programsтАФespecially those with weak clinical trainingтАФfall short of Indian standards. Clearing the FMGE, however, is just the beginning. Indian citizens with an overseas MBBS must still complete a one-year compulsory rotating internship (CRMI) in India, even if theyтАЩve already done clinical training abroad. This has been in place for decades and was reinforced by the NMCтАЩs Foreign Medical Graduate Licentiate (FMGL) Regulations 2021, which require anyone who earned their degree after November 2021 to finish the full 12-month internship in India. As a result, a six-year medical program abroad can turn into an eight- to ten-year journey before a graduate can officially register as a doctor in India. The FMG pathway is best seen as a multi-stage pipeline, with each step often adding years to the overall process. Figure 1: The Long Return Pathway for FMGs in India In practice, the internship stage has become another major bottleneck for foreign medical graduates (FMGs). Internships are usually completed at teaching hospitals linked to medical colleges or at certain approved hospitals, but FMGs often struggled to secure vacant positions. State medical councils sometimes hesitated to accommodate them, citing limited capacity or lower stipends. In some cases, graduates had to wait for monthsтАФor even pay feesтАФto get an internship slot. The problem worsened after the Ukraine war and COVID-19 disruptions, which caused a surge of returnee students. The courts and the National Medical Commission (NMC) had to step in with temporary solutions, such as allowing some students to complete supervised training in non-teaching hospitals or directing states to increase the number of available slots. Pandemic closures and war left thousands of foreign medical graduates (FMGs), especially those in China and Ukraine, with disrupted clinical training and a complicated regulatory situation upon their return. The National Medical CommissionтАЩs (NMC) 6 March 2026 notice was later withdrawn and replaced with a clarificatory notice on 18 March 2026, after concerns from FMGs and other stakeholders. Under the revised rules, graduates who can prove that their online training was compensated by physical instruction abroad donтАЩt need extra clerkship in India. Those who cannot must still demonstrate equivalence. Even after clearing exams and meeting all requirements, FMGs often face unequal treatment. A notable example is internship stipends. In India, medical interns typically receive a modest stipend set by the state or institution (around тВ╣10,000тАУ50,000 per month in government hospitals). Yet in some places, FMG interns were paid lessтАФor sometimes nothingтАФcompared to Indian-educated interns. Protests and court cases followed, and in February 2026, the Supreme Court ruled that FMG interns must receive the same stipend as their Indian counterparts. These challenges create a widespread sense that the system is stacked against FMGs. While some caution about quality is understandable given the varying standards of global medical schools, the skepticism goes both ways. FMGs face higher hurdles for entry into practice, including a dedicated screening exam, even though
