India needs doctors, but foreign graduates face tough clinical test

Low pass rate brings overseas medical training under scrutiny

India faces an acute shortage of doctors, particularly specialists in rural areas, yet thousands of foreign-trained medical graduates remain unable to enter its healthcare workforce, with only 12.77 per cent clearing the latest mandatory screening test. Of the 37,448 candidates registered for the Foreign Medical Graduate Examination (FMGE) in June, 36,288 appeared and 4,635 qualified, according to the National Board of Examinations in Medical Sciences (NBEMS). 

The result comes as India faces shortages and an uneven distribution of doctors, raising questions about the quality of some overseas medical programmes and the ability of foreign-trained graduates to meet Indian clinical requirements. 

According to the Health Dynamics of India report, rural community health centres had 4,413 specialist doctors as of March 2023, against a requirement of 21,964 — a shortfall of nearly 80 per cent. 

“The demand for doctors is real, but the unaffordability of domestic medical education forces thousands of Indian students to go abroad for their Bachelor of Medicine, Bachelor of Surgery (MBBS),” a resident doctor at the All India Institute of Medical Sciences (AIIMS), New Delhi, said. 

More than 2.2 million students appear for the National Eligibility-cum-Entrance Test-Undergraduate annually, while India has around 130,000 undergraduate medical seats, according to the 2026 seat matrix. “Only around 63,700 seats are in government medical colleges, where fees are substantially lower than in private and deemed universities,” said Aman Singh, cofounder of foreign education consultancy GradRight. 

Private medical education can cost between ₹80 lakh and ₹1 crore, placing it beyond the reach of many middle-class households, he added. 

Education consultants estimate that 25,000–30,000 Indian students go abroad for medical education annually, though some estimates place the number closer to 50,000. Russia, the Philippines, Georgia, Bangladesh, Kazakhstan, and Kyrgyzstan are among the preferred destinations because of their lower costs and, in several cases, English-medium instruction.  

The Russia-Ukraine conflict disrupted this migration, with more than 18,000 Indian students in Ukraine when the conflict began in 2022. Central Asian countries subsequently gained popularity, with programmes costing between ₹15 lakh and ₹30 lakh, Singh said. 

Where classroom meets clinic 

Nearly 88 per cent of candidates appearing for the June FMGE were repeaters, according to government data. While 35.74 per cent of first-time candidates qualified, the pass rate was only 3.29 per cent among those who had made more than five attempts. 

In December 2025, 47.53 per cent of first-time candidates qualified, compared with 5.58 per cent among those with more than five attempts, an NBEMS official said. 

The figures suggest that the low overall pass rate is influenced considerably by repeat candidates. Experts, however, say persistent poor performance cannot be credited solely to the examination’s difficulty. 

The Economic Survey 2024 has linked low FMGE pass rates to concerns about the quality of medical education abroad, including inadequate clinical training. Abizer Manked, consultant physician and diabetologist at Mumbai’s Saifee Hospital, said inadequate clinical exposure was among the principal reasons for low pass rates.Unlike Indian medical colleges, where students may encounter large patient volumes, students at some overseas institutions have limited opportunities to interact directly with patients, the AIIMS resident doctor said. Language barriers can further restrict their participation in taking patient histories and conducting clinical rounds. 

FMGE covers 19 subjects and increasingly contains case- and image-based questions that require candidates to interpret clinical findings and reach a diagnosis, Manked said. Students trained overseas may also have less exposure to diseases frequently encountered in India, including malaria, dengue and other tropical infections. However, experts cautioned that the quality of medical education varies widely across institutions and countries.

 

More seats, same standards 

India’s doctor-to-population ratio is estimated at 1:811 when practitioners of modern medicine and ayurveda, yoga and naturopathy, unani, siddha and homoeopathy are counted together. The ratio, however, masks sharp geographical disparities, with doctors concentrated in urban areas. 

The NBEMS has resisted calls to lower the qualifying standard. A senior official said FMGE was a screening test, not a competitive examination, and that its minimum standard was necessary because doctors must be equipped to handle life-threatening emergencies. 

Some experts have proposed structured clinical training in Indian hospitals for candidates who narrowly miss the qualifying mark, followed by reassessment. Others caution that such a route should not circumvent licensing standards.“The solution to India’s doctor shortage is not to dilute the licensing examination but to significantly expand domestic medical education capacity,” Manked said. 

A three-member committee reviewing FMGE reforms has recommended holding the examination three times a year, upgrading examination-centre infrastructure, and reviewing fees and question banks. 

FMGE is eventually expected to be replaced by the National Exit Test, or NExT, which is intended to provide a common licensing benchmark for Indian and foreign medical graduates. Its implementation has been deferred, leaving FMGE as the operative test for foreign graduates. 

The longer-term answer, experts said, lies in expanding affordable, high-quality medical education in India while ensuring that Indians studying overseas receive adequate clinical training. Until then, many will continue to seek medical degrees abroad, while a substantial share of returning graduates remains outside India’s medical workforce after failing the licensing examination.