Kerala HC Quashes Mandatory Internship Fee for FMGs

Ernakulam: Granting major relief, the Kerala High Court recently quashed the State Government's order imposing internship fees on the Foreign Medical Graduates (FMGs).

While considering a batch of pleas challenging the State policy of imposing an internship fee for the FMGs to complete their mandatory internship programme in government hospitals, the HC bench comprising Justice N Nagaresh emphasised that only the National Medical Commission (NMC) had the power to regulate internships.

Further, the HC bench also opined that the State Government's action of imposing an internship fee was contrary to the Apex Medical Commission's guidelines.

The pleas before the High Court were filed by foreign medical graduates who completed their medical degrees in countries like Russia, Bulgaria, the Philippines, and Guyana. After passing the screening test i.e. Foreign Medical Graduates Examination (FMGE) and obtaining provisional registration, these students applied for internships in government hospitals in Kerala.

Also Read: Take strict action on medical colleges charging MBBS internship fee, and not paying stipend to FMGs: NMC orders state counterparts

However, the Kerala Government issued an order on April 3, 2024, which required the FMGs to pay Rs 5000 per month, totalling Rs 60,000 for one year, to complete their internship. The fee charged from the FMGs was higher than what was charged from the Indian Medical Graduates (IMGs).

Therefore, challenging the State Government's order, the FMGs filed a plea before the Kerala High Court. They contended that the Apex Medical Commission, NMC, had already ordered the authorities not to charge any internship fee from the FMGs.

It was argued by the petitioner that NMC in its circular dated 19.05.2022, clearly prohibited any fee from being charged by medical graduates for internships from the FMGs. Even though the Commission, in a later circular dated 19.10.2022, allowed the States to decide on the amount of stipend allowed to the FMGs, it did not allow them to collect internship fees.

They contended that after clearing the FMGE screening test and obtaining the provisional registration, there is no legal distinction between the medical graduates from abroad and the Indian Medical Graduates to enroll into the internship programme. Therefore, the students argued that the Kerala Government's order violated Article 14 of the Constitution by discriminating against the FMGs. They also pointed out that while the FMGs had to pay internship fee, they did not get any additional training, infrastructure, or stipend.

On the other hand, the State Government argued that the Constitution provides it power to levy reasonable fees to cover administrative and training expenses incurred by the hospitals. Citing infrastructure and training facilities the State provides to the interns, the Government justified the fee. It was further submitted that while initially the State charged Rs 10,000 per month, later it reduced the fee to Rs 5000 per month after the earlier directions issued by the High Court. According to the Government, the fee charged from the FMGs was nominal and necessary to maintain hospital services and training.

However, while appearing before the Court, the National Medical Commission clarified that it alone had the authority to regulate medical education, including internships. Further, the Commission informed the Court that NMC's policy prohibited any fee from being charged by medical colleges for allowing FMGs to complete their internship. The Commission clarified that the States only had discretion to fix stipends, not internship fees.

While considering the question of whether the State was justified to demand internship fee for undergoing medical internship regulated by the National Medical Commission (Compulsory Rotating Medical Internship) Regulations, 2021, the HC bench found that under the NMC Act, 2019, only NMC has the sole authority to regulate medical education and internships. 

The Court further observed that the State's order demanding internship fees from the medical graduates from abroad was against the NMC's guidelines, which clearly stated that no fees should be charged from the FMGs for their internships. 

Further, the HC bench also pointed out that in an earlier case, a Division Bench had already told the State to reconsider the fee based on the directions from NMC, but the new order dated April 3, 2025 ignored that ruling. Apart from this, the HC bench also clarified that once the FMGs clear the screening test and obtain provisional registrations, they are equal to the IMGs when it comes to internships and therefore, there is no reason to treat them differently.

"It is when the levy of internship fee in any manner is prohibited by the NMC and when a Division Bench of this Court has made it clear that a decision shall be taken by the State Government taking note of the Circular dated 04.03.2022 issued by the NMC that the Government of Kerala has come up with GO(Rt) No.987/2025/H&FWD dated 03.04.2025. The GO dated 03.04.2025 took a stand that the NMC had clarified that the Circulars dated 04.03.2022 and 19.05.2022, issuing guidelines/ instructions / advisory to all concerned authorities regarding payment of stipend are solely at the discretion of the concerned State authorities under which the Medical College / Institute is located," observed the Court.

"In GO dated 03.04.2025, the Government stated that Government Medical Colleges do not charge any fee for internship from any student whether they are FMGs or not. The seats available in Medical Colleges are limited. The FMGs are therefore provided opportunity to complete internship at District/General Hospitals. Since the District/General Hospitals are not full fledged teaching institutions, additional infrastructure, library, manpower, security facilities, etc. need to be arranged for training the FMGs interns. On these premises, the Government reduced the internship fees charged to the FMGs ...As the NMC Circular dated 19.05.2022 unequivocally prohibits levy of internship fee and describes the levy of any internship fee as illegal, the GO dated 03.04.2025 is legally unsustainable," it further noted.

Further, the Court held that there was another reason to hold against the levy of any fee from the interns. It observed that

"The interns are deployed to the Medical Colleges / Government Hospitals to discharge the duties of Doctors. They are so deployed only after obtaining Certificate of Provisional Registration from the State Medical Council. The Certificate of provisional registration makes it clear that the Certificate is valid only for employment in a resident medical capacity in any approved institution or in the medical service of the armed forces of the Union as mentioned in Section 25 of the Indian Medical Council Act, 1956 as amended...From the Provisional Registration granted by the State Medical Councils, it is evident that medical graduates who obtained provisional registration and deployed as interns would be working in a resident medical capacity and such engagement amounts to employment. The interns are not deployed to Medical Colleges / General Hospitals for training simplicitor. The medical interns are getting experience as Doctors while working in a resident medical capacity. Such interns are often deployed to examine the patients, prescribe medicines and may even be directed to conduct minor surgical procedures. The Medical Colleges / General Hospitals are therefore getting benefits of their service, which is in the nature of employment."

"The NMC Act, 2019 has been enacted to provide for a medical education system that improves access to quality and medical education affordable to the citizens. When the NMC Act, 2019 mandates payment of stipend to medical interns for their service, the State will not be justified in levying internship fee from the Medical Graduates. The GO(Rt) No.987/2025/H&FWD dated 03.04.2025 issued by the Additional Secretary, Government of Kerala, Health and Family Welfare (S) Department is therefore illegal and ultravires. Consequently, the GO dated 03.04.2025 is set aside," observed the Court, while keeping the issue of payment of stipend to the FMGs open.

To view the order, click on the link below:

https://medicaldialogues.in/pdf_upload/kerala-hc-289856.pdf

Also Read: Allow Foreign Medical Graduates to continue internship without insisting on payment of internship fee: Kerala HC