Why MBBS Abroad Graduates Struggle to Practice in India

Every year, thousands of Indian students complete MBBS degrees abroad and return expecting to practise medicine in India. A significant proportion cannot. The barrier is not always academic. It is often structural, rooted in a decision made before the first lecture: which institution to attend.

Choosing an institution that lacks NMC recognition, or failing to understand what the FMGE demands, can render years of medical education legally unusable in India. Both problems are preventable.

Why do MBBS graduates from foreign universities struggle to practice in India?

The two most common reasons are graduating from institutions not recognised by the National Medical Commission (NMC) and failing to clear the Foreign Medical Graduates Examination (FMGE). Without NMC-recognised credentials and a passing FMGE score, foreign medical graduates cannot obtain registration to practise medicine in India, regardless of their degree.

The NMC Recognition Requirement: Why It Is Non-Negotiable

The NMC Recognition Requirement: What it is and why it’s a must.

Foreign Medical Graduate (FMG) should get permanent registration from the NMC to practise medicine in India. This registration is subject to two conditions: passing out from an NMC recognised foreign institution and passing the FMGE (or its replacement, the National Exit Test, NEXT).

The NMC has a list of recognised foreign medical colleges available on its website at nmc.org.in. The institutions that do not have their names on the list are not authorised for Indian medical registration. A graduate of an unrecognised institution is not eligible for the FMGE. Under the NMC’s own rules, the student is solely responsible for disqualification.

Requirement	Mandatory
NMC Recognised University	Yes
English Medium	Yes
54-Month Course	Yes
12-Month Internship	Yes
FMGE/NEXT	Yes

The May 2025 Advisory: A Formal Warning

The NMC issued a formal advisory in May 2025 to alert students and parents to unauthorised institutions claiming to be recognised by the NMC but are not. The advisory warned against using websites, advertisements, and letters of recognition by the college which have not been verified by the NMC portal, and named specific institutes like Singhania University in Rajasthan, which is facing legal proceedings in the Rajasthan High Court for running MBBS courses without NMC approval.

The point that has been made in the advisory is quite clear: verify the institution with the NMC official list before paying the fee or enrolling. The NMC does not make direct admissions and cannot be held liable for students who join unrecognised institutions.

Red Flags Students Should Avoid

• Guaranteed admission without NEET
• Very low fees
• No official NMC listing
• Multiple campus transfers
• Internship in a different country
• Agents avoiding written confirmation

FMGE Performance Data: What the Numbers Reveal.

The pass percentage of FMGE 2015-2018 published by the National Board of Examinations (NBE) gives a clear idea of the difficulty level of the examination and the drastic difference in the outcome of the examination from country to country and institution to institution.

Country-Level Patterns

In all the major countries where Indian students go for MBBS, the pass rate was always low in the years 2015-2018:

• China had the highest number of FMGE candidates. The scale of enrolment and difficulty of graduates passing the screening test can be seen from institutions like Chongqing University of Medical Sciences (1,519 applicants, 10.80% pass rate), Wuhan University (1,167 applicants, 9.77%) and Zaporizhzhia State Medical University in Ukraine (1,740 applicants, 12.01%).
• The same was true of Russia. The number of applicants to Stavropol State Medical Academy was 1010, and the pass rate was 6.53%. The Tver Medical State Academy received 1,200 applications, with 9.50% of the total. Even at the well-known institutions, the pass rates were in the low double digits.
• The results were similar in Kyrgyzstan, a country that is becoming a popular choice for Indian students. International University of Kyrgyzstan received 2,645 applications, and 13.31% of them passed. Osh State Medical University received 933 applications, which is 4.39%.
• At Tbilisi State Medical University, the situation was a little better in Georgia. 1,600 applicants, 19.81%. But still less than half.
• Nepal, although close and culturally familiar, had mixed results. B.P. Koirala Institute of Health Sciences had one of the better results with 41.84% passing out of 239 applicants. The College of Medical Sciences, Bhartpur, was the top institute with 17.82% out of 836 applicants.
• The highest difference was observed in Bangladesh, ranging from 0% at some institutions to 83.33% at the University of Rajshahi (12 applicants) and 64.29% at Sir Salimullah Medical College (14 applicants). Institutions with small sample sizes tend to overestimate some of the figures, while institutions with larger numbers of applicants, like the University of Science and Technology Chittagong (414 applicants, 17.63%), represent more reliable patterns.

Country	Average FMGE Performance Trend
China	Low
Russia	Low
Kyrgyzstan	Very Low
Georgia	Moderate
Nepal	Better
Bangladesh	Mixed

What do low pass rates indicate?

Low FMGE pass percentage does not necessarily mean poor teaching. They also highlight curriculum mismatch with medical standards in India, lack of clinical exposure, language barriers in teaching and in some instances, admission to institutions that are more about providing a place to stay and awarding a degree than about providing a strong medical education.

The NMC’s FMGL Regulations 2021 have been framed with the very purpose of addressing this issue: that is, a minimum of 54 months of study in one institution, a 12-month internship at the same foreign university, clinical training to be completed at one university, English as the medium of instruction, and completion of all subjects as specified in Schedule I of the Regulations.

Even if a graduate was enrolled in a college that was listed on NMC at the time of enrollment, their qualifications might be called into question at the time of registration.

Common Reasons for FMGE Failure

• Language barriers
• Lack of clinical exposure
• Memorisation-based learning
• Different syllabus structure
• Poor internship quality
• Weak practical training

What the NMC Recognition actually expects from the Institution

NMC recognition is not a listing. It indicates that the institution is fulfilling the standards that are expected of an Indian medical college, such as having qualified faculty, sufficient clinical infrastructure, teaching in the English language and a curriculum that includes the subjects mentioned in NMC’s Schedule I.

Graduates from recognised institutions in major destinations such as Russia, Ukraine, China, the Philippines, Georgia, Kyrgyzstan, Kazakhstan, Nepal, Bangladesh and others are given legal standing to sit the FMGE. Academic achievement is not the solution to the registration barrier without this standing.

The NMC also mandates foreign graduates to do a supervised internship in India for at least one year after returning to the country for permanent registration. This includes those who have graduated from institutions recognised by NMC.

Documents Students Should Verify Before Admission

• NMC recognition status
• University accreditation
• Internship policy
• Medium of instruction letter
• Course duration proof
• Clinical training details

Why students end up at non-recognised institutions

Several patterns recur. Some students take up offers from institutions that don’t have to be recognised, but the students believe that they do. Some students attend universities that were recognised at the time of their admission but lost their recognition before graduation, which can be a risk and needs to be re-verified from time to time. Others are misled by agents and/or consultants who have commercial relationships with particular institutions, whether recognised or not.

The NMC’s advisory makes it clear that no college is able to guarantee admission without going through the official NEET-based admission process and that any college that offers direct admission or guaranteed seats should be considered a red flag.

The Path Forward: What Students Must Verify Before Enrolling

• Step 1 — Check the NMC list directly. The college search tool at nmc.org.in is the only authoritative source. If the institution does not appear there, it is not recognised.
• Step 2 — Confirm the medium of instruction. The NMC considers only degrees taught in English as valid for FMGE eligibility. Programmes delivered primarily in the local language disqualify graduates regardless of institution status.
• Step 3 — Verify the internship structure. The 12-month internship must be completed at the same foreign university, not transferred to another institution or country. Split clinical training is a disqualifying condition under FMGL Regulations 2021.
• Step 4 — Review FMGE pass rate data by institution. The NBE publishes country and institution-level FMGE performance data. Examining pass rates for the specific institution — not just the country average — provides an evidence-based signal of how well the curriculum prepares students for the Indian screening examination.
• Step 5 — Contact NMC directly for verification. Email: ug@nmc.org.in. If any doubt exists about an institution’s recognition status, direct verification is the only reliable confirmation.

Conclusion

MBBS abroad can be a valuable opportunity for Indian students, but only when the university follows NMC regulations and prepares students properly for FMGE/NEXT. Choosing the wrong institution can lead to serious career challenges in India. Proper research, verification, and planning are essential before taking admission abroad.

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