Setback to MBBS Abroad candidates: SC upholds new NMC norms on FMG, CRMI

New Delhi: Foreign Medical Graduates who had been looking for leniency in NMC norms for Foreign Medical Graduate Licentiate Regulations and Compulsory Rotating Medical Internship (CRMI) have faced a setback as the Supreme Court has upheld the criteria. 

"It is true that the country needs more doctors, but it needs really qualified doctors and not persons trained by institutions abroad, to test their skills only in their mother land", the top court bench comprising of Justices Hemant Gupta and V. Ramasubramanian stated while upholding the validity of Regulations 4(a)(i), 4(a)(ii), 4(b) & 4(c) of the Foreign Medical Graduate Licentiate Regulations 2021, Schedule ­II 2(a) and 2(c)(i) of the Compulsory Rotating Medical Internship Regulations, 2021 of the National Medical Commission (NMC).

The Bench clarified that the NMC, the apex medical education regulatory body has the authority to frame the regulations for Foreign Medical Graduates.

Medical Dialogues had earlier reported the regulations released last year and what they meant for foreign MBBS medicos. According to the rules, No foreign medical graduate shall be granted permanent registration, unless he has undergone a course leading to foreign medical degree with minimum duration of fifty-four months, but there are many foreign institutions and countries where the course duration is less than 54 months or 4 1/2 years as well as many of the foreign medical colleges that have teaching facilities but not training facilities.

The CRMI regulations further add that Foreign medical graduates who require to complete a period of internship shall do so only in Medical Colleges/ Institutions approved for providing Compulsory Rotating Internship to Indian Medical Graduates. The guidelines also add that Foreign Medical Graduates may be posted to different Medical Colleges/Institutions through a counselling/ seat allocation process based on the merit or by any other scheme/method as may be notified by the National Medical Commission or any other authority as applicable

Now with the matter reaching the top court, the bench was considering a plea seeking a declaration and the earlier mentioned Regulations both published on 18.11.2021, were violative of Articles 14, 19(1)(g) and 21 of the Constitution. After the Madras High Court dismissed the appeal, the petitioner approached the Supreme Court with the same prayers.

The concerned petitioner student wished to join an Under Graduate Medical Course in Anna Medical College, Mauritius. However, he was unable to join the said course because of the pandemic and in the meantime, the NMC brought the Licentiate and CRMI Regulations, imposing heavy and arbitrary burden upon students who want to pursue medical education abroad. Thereafter, the student approached the court.

However, the Madras High Court had opined that the impugned Regulations were issued with a view to ensure minimum standards and that they are in no way ultra vires the Act or the Constitution. 

As per the NMC (FMGL) Regulations, 2021, "No foreign medical graduate shall be granted permanent registration, unless he has–

(a) (i) undergone a course leading to foreign medical degree with minimum duration of fifty ­four months; (ii) undergone an internship for a minimum duration of twelve months in the same foreign medical institution;

(b) registered with the respective professional regulatory body or otherwise, competent to grant license to practice medicine in their respective jurisdiction of the country in which the medical degree is awarded and at par with the license to practice medicine given to citizen of that country.

(c) undergone supervised internship in India for a minimum of twelve months, after applying for the same to the Commission;"

On the other hand, NMC (CRMI) Regulations, 2021 clarify that

"(a) All Foreign Medical Graduates, as regulated by the National Medical Commission (Foreign Medical Graduate Licentiate) Regulations, 2021, are required to undergo internship at par with Indian Medical Graduates if they desire to seek permanent registration to practice Medicine in India.

(i) All Foreign Medical Graduates, unless otherwise notified shall be required to undergo CRMI at par with Indian Medical Graduates after the National Exit Test Step-­I after NExT becomes operational.

(b)...

(c) Foreign Medical Graduates who require to complete a period of Internship shall do so only in medical colleges or institutions approved for providing CRMI to Indian Medical Graduates:

(i) Foreign Medical Graduates may be posted first in colleges which have been newly opened and have yet to be recognised."

It was the contention of the student that these regulations these Regulations were violative of Article 21, he questioned the requirement regarding the duration of Foreign Medical Courses, and alleged that these rules caused undue hardships to the FMGs as they were asked to undergo two internships. He also claimed that these unreasonable regulations will ultimately lead to brain drain and argued that since the the system of Modern Medicine or Allopathy was the same throughout the world and since it cannot differ from country to country, the classification of students into two categories namely those who study in India and those who study abroad, is violative of Article 14.

However, the top court bench opined that, "we do not think that any of the above grounds of challenge are sustainable in law. The Regulations impugned by the appellant may appear superficially to be rigorous or tough. But these Regulations are a product of, (i) past experience; and (ii) necessity of times. Experts in the field of education believe (and justifiably so) that over ambitious parents, hapless children, exploitative and unscrupulous (and sometimes unlettered) founders of infrastructure­deficient educational institutions, paralysed regulatory bodies and courts with misplaced sympathy, have all contributed (not necessarily in the same order) to the commercialisation of education and the decline of standards in the field of education, in general and medical education, in particular. We may be able to appreciate this, if we have a look at the history of evolution of statutory measures taken to regulate the recognition and registration of foreign medical degrees in India."

Holding that the problem of unrecognised institutions offering diplomas/ degrees in medicine and untrained individuals practising medicine was not new the bench referred to Indian Medical Degrees Act, 1916, Indian Medical Council Act, 1933 and e Indian Medical Council Act, 1956 to show how the regulations changed gradually. The bench also pointed out the problems associated with the integration of foreign medical institutes and the litigations that followed.