Daybreak - India needs doctors. So why are foreign-trained ones working unpaid—or not at all?

Episode Date: September 2, 2025

A severe shortage of seats and difficult tests result in about 25,000 Indians flying abroad to get a medical degree. The problems begin afresh when they return. Instead of warm welcomes, graduates are met with screening tests with high failure rates, tedious registration procedures and even unpaid internships.But, the thing is: India needs these doctors, and badly. For every 1260 people, we have only 1 doctor–a stark departure from the WHO recommended 1:1000 ratio. However, bureaucratic mazes and a lack of infrastructural support put these young doctors in a difficult position.Tune in.Daybreak is produced from the newsroom of The Ken, India’s first subscriber-only business news platform. Subscribe for more exclusive, deeply-reported, and analytical business stories.

Hi, this is Rohan Dharma Kumar. If you've heard any of the Ken's podcasts, you've probably heard me, my interruptions, my analogies and my contrarian takes on most topics. And you might rightly be wondering why am I interrupting this episode too. It's for a special announcement. For the last few months, I and Sita Raman Ganeshan, my colleague and the Ken's deputy editor, have been working on an ambitious new podcast. It's called Intermission. We want to tell the secret sauce stories of India's greatest companies. Stories of how they were born, how they fought to survive, how they build their organizations and culture,

how they manage to innovate and thrive over decades, and most importantly, how they're poised today. To do that, Sita and I have been reading books, poring over reports, going through financial statements, digging up archives, and talking to dozens of people. And if that wasn't enough, we also decided to throw in video into the mix. Yes, you heard that right. Intermission has also had to find its footing in the world of multi-camera shoots in professional studios, laborious editing, and extensive post-production. Sita and I are still reeling from the intensity of our first studio recording. Intermission launches on March 23rd. To get an alert as soon as we release our first episode,

please follow intermission on Spotify and Apple Podcasts or subscribe to the Ken's YouTube channel. You can find all of the links at the ken.com slash I am. With that, back to your episode. Koshal is among 20 interns who work at a state-run urban health center in Gujarat. And for the last few months, most nights at the hospital have looked somewhat alike for them. Check patients vitals, assess injury, record observations and offer treatment. From patients with first degree burns

to factory workers with severed thumbs, Kossel and his fellow interns have seen a lot. And that too, on only a few hours of sleep and no pay. You heard that right. None of these medical interns are getting paid any money by the government. And you will never guess why. Turns out, they all got their primary medical degree

from outside India, and the system here is just not built to accommodate them. If you look at the proportion of students who are taking the exam, I think recently, I think 21 lakh students wrote the neat exam, something around that mark. And there are like, what, 1.17 lakh seats, medical seats in the country. So it's not enough, there are not enough seats to incorporate all the students. So unless the medical seats go up dramatically,

then there is nothing you can do students. So the issue is that students have two options. One is either go abroad and take degrees from these countries where it's fairly cheap and easy to get into. Or they need to repeat and in the hopes that they can clear the exam. That was Atul Krishna from the Ken. He's been reporting on education and ed tech for six years and this story had been on his radar for a while. Now, according to government estimates, about 25,000 students fly out to Russia, Ukraine, China, Georgia and Uzbekistan for their medical degree. But the hurdles only really begin after they complete the six-year course and come back here.

If you think foreign trained doctors who return to India have some kind of an advantage compared to the rest, it is in fact the opposite. These freshly minted medical professionals do not have it easy in their home country. Their degrees are often not recognized here. So when they come back, they are faced with screening tests with high failure rates and tedious registration procedures. The odds are really stacked against them. So for the last few years, the body that regulates medical education in India, the National Medical Commission or NMC, has been trying to fix this. In 2021, it asks states to provide graduates with extra internship seats and pay them stipends on par with the graduates from India. This July, the commission even proposed that foreign universities paid $10,000 each for every course they want India to recognize.

But NMC can only do so much. The ball is ultimately in the state medical council's court. The thing is, it's not that the country doesn't want these doctors. It actually needs them, badly. We barely have one doctor for every 1,300 people. So, Cautiel and his peers should be invaluable, right? Unfortunately though, as invaluable as they may be, the Indian medical system still prioritizes India-trained doctors. And that ends up leaving the likes of Cauchel in a rather precarious position.

Welcome to Daybreak, a business podcast from the Ken. I'm your new host, Rachel Virgheese, and every day of the week, my co-host, Niktha Sharma and I will bring you one new story that is worth understanding and worth your time. Today is Wednesday, the 3rd of September. So the thing is, the number of medical seats in India, has actually been on the rise. In 2016, our medical colleges could accommodate only about 65,000 students. But over the last decade, that number has thankfully doubled.

Unfortunately, though, it seems like this increase is not quite enough. Because the number of students taking the need or the national eligibility entrance test is far higher. Out of the 21 lakh students that appeared for the exam this year, over half of them scored the qualifying marks. So, like Atul mentioned earlier, if you're one of the students who doesn't end up with a seat, you have two choices. Retake the exam or seek a degree abroad. And it seems like a degree abroad has lately become the popular option.

Take the case of a student from Kerala, for instance. She had secured the qualifying marks in need, but unfortunately it wasn't good enough to get her a seat in India. And that is when a relative told her about Ukraine. She could go there and finish her MBBS degree. So she went for it. And just when she was close to the finish line, in her fourth year, the Russia-Ukraine war hit. That was in early 2022.

She had no choice but to return to India and take a semester online. Not long after, she had to return to the university and this time, because of poor flight connectivity, her travel included having to cross the Polish border in the West. When she finally returned to India after the hard one degree, she realized an uncomfortable truth. studying in a war zone felt easier compared to getting registered as a doctor in India, especially if you'd been trained abroad.

You see, unlike MBBS graduates in India, foreign medical graduates can't just return and start practicing medicine. They need to clear the foreign medical graduate examination or FMGE first. This exam is very sort of notorious for its past percentage, where historically very few people passed the exam. Statistics was also quite remarkable in a way where if you take the neat exam, the past percentage is something like

something above 50%, which makes sense. But for this, it is quite low. Like only recently was the past percentage near 30%. Before that, it was even below. 20% as well. What's worse is that several students didn't even know that they had to give this test. In 2016, only 5,000 students took the test. Thankfully though, ever since, more and more students are taking the FMGE.

By 2024, the number of test takers had gone up to 45,000. And of course, more students taking the test meant that the number of students passing the test also went up. Now, one of the reasons for this is also because formal coaching for the exam, exam has slowly become normalized in India. But if you think it's all smooth sailing post this extremely difficult exam, well, you're wrong. When a student passes this test, they have to get themselves registered provisionally at their

regional medical council and only then does the unpaid internship begin. And only after that do they get a permanent registration post-which they can start practicing medicine. The same rules hold if they want to apply for postgraduate studies. Koshal, who we spoke about earlier, finished his graduation from Penza State University in Russia in 2022 and had to wait a couple of years to get permanent registration. And the Kerala student who studied in Russia? Well, she cleared the screening test in 2024 and is still waiting for her provisional registration.

Before her, her seniors had to wait for at least a year to get the same. This slow registration process isn't where it ends. We spoke to Apur Dalvi, National Convener of the Foreign and. wing of all India Medical Students Association. He told us that in states which have fewer medical seats like Rajasthan, Gujarat and Delhi, getting internships is super challenging, even after clearing the FMGEE. Now, the wing acts as an intermediary between authorities and Indian students pursuing medical education abroad. So what's being done to address the seat shortage? Well, the NMC in late 2021, asked states to provide nearly 8% more internship seats in medical colleges along with their

existing ones. But the issue of money still remains. If you're spending several lakhs on your education, you would expect to get paid for your practice. Internship or not? Turns out, stipends are scarce, if not entirely non-existent. In Koshal's case, without stipends, he has been accruing interest on the 15-lack-rupes education loan he had taken. To make things worse, some medical colleges even ask foreign medical graduates to pay an internship fee to accommodate them. A foreign graduate claimed that instead of the hospital paying students, the students are asked to pay anywhere between $20,000 and $1,000 to allow them to intern. The situation was so bad that in In 2022, NMC put out a circular prohibiting this internship fee.

Some states, such as Kanataka, are quite quick in providing the provisional registration. Foreign graduates typically get it within a month of passing the FMGE. But other states like Maharashtra take anywhere between six months to over a year. More on this in the next segment. Alifia, another MBBA's graduate, found out the hard way just how long it takes to get provisional registration in Maharashtra. She had cleared the test in 22 and then had to wait for almost a year before the registration was provided. Even after the wait, another roadblock came up.

After registering provisionally, Alifia was allotted a non-teaching institution that did not have two of the nine departments necessary to complete her compulsory one-year internship. So what happened with this student is that she got allowed to a place where they didn't have two of the necessary departments, one of which was the compulsory rural work that they have to do. So then she had to do that separately.

And the reason why this was allocated is because when usually when FMG students are given internships, they're not given the priority because the government's priority would be the students that have studied in government colleges and in like that. colleges in India. So that's probably why the allegation happened in that sense. And this is a common story where FMG students get internships in places where it's not ideal. Even if it's ideal, probably the hospitals treat like they don't need them there. So they already have to do an internship abroad.

That is necessary. So in most countries, they have a six-year degree and it involves at least one year of compulsory internship, the government deems it not satisfactory because of how they view the quality of education in these countries. So that's why even if a student complete six years, including internship, they have to come to India, clear the FMG exam and then do one year of internship again. The thing is, some state councils argue that the delay is, the delay is, providing provisional registration is because they are following the due procedure. A member of the Kerala State Medical Council told us that they have to check whether the graduate

certificates are genuine. For that, they need to check with the university abroad and the embassy. And when they do that for more than 1,000 students like they had to in Kerala this year, naturally the weight gets longer. The member added that sometimes the universities don't respond and it delays the process. But when you're trying to do it faster, it is assumed that you're not following due procedure. Then there are other factors that these councils have to consider. For instance, many students faced academic delays due to the COVID-19 pandemic and the war,

like the Kerala student. In this situation, the councils had to check their passport details and see if the students were in India when they were supposed to have been undergoing the internship. But even with these stipulations, there are ways to screen students faster. A member from the Karnataka Medical Council told us that if they have already reviewed a university, the previous year, they can just go by that list. They don't have to go through the review process again. The process is expected to get even simpler soon. The NMC in 2021, directed that the students pursuing their medical degree abroad

should register themselves as doctors in that country before they return to India. This makes the lives of the medical councils much easier. Essentially, if a student is recognized by the country where they studied, the state councils in India need to only verify if the university follows. follows NMC stipulations. De-late registrations may be fixable. But fixing the problem of unpaid internships could help doctors like Koshel.

And that in turn could really help fix India's shortage of doctors. Daybreak is produced from the newsroom of the Ken, India's first subscriber-focused business news platform. What you're listening to is just a small sample of our subscriber-only offerings. A full subscription offers daily long-form feature stories, newsletters and a whole bunch of premium potter. To subscribe, head to the ken.com and click on the red subscribe button on the top of the Ken website. Today's episode was hosted and produced by my colleague Rachel Vargis and edited by Rajiv Sien.