A host of reasons — not least the cost of medical education — is driving students to foreign universities 

“Wuhan is a beautiful place, you know,” says Vinod*, over the phone, as we talk about the plight of Indian medical students forced to return home two years ago after the outbreak of the COVID-19 pandemic. His stammer and long pauses reflect the anxiety that students and their parents have grappled with for over 800 days now. Even today, there seems to be no end in sight.

Vinod, from Kerala, had left the country in 2017 to join Wuhan University in China and returned to India when the pandemic began. He was a good student through school. “Two of my cousins were already studying medicine in China when I cleared Class XII. My National Eligibility-cum-Entrance Test (NEET) ranking wasn’t good enough to get me a seat in a government college; and a good private college seat costs anywhere between ₹50 lakh and ₹70 lakh on paper. In China, I could finish the same course in under ₹35 lakh,” he says.

Like Vinod, thousands of students travel out of the country for a medical degree each year simply because it is more affordable. But now, a crisis is in the making. As the students waiting to return to China are joined by students returning home from war-hit Ukraine, one has been surprised by the sheer numbers. Prime Minister Narendra Modi even went on to urge students to study in India.

Strong driving factor

Of course, the phenomenon of travelling overseas for education is not new. Data submitted in Parliament by the Centre last year states that there are 2.19 lakh Indian students in the UAE, 2.16 lakh in Canada, 2.12 lakh in the U.S., 23,000 in China, 18,000 in Ukraine, 16,500 in Russia, 15,000 in the Philippines, 7,500 in Georgia, 5,300 in Kazakhstan, 5,200 in Bangladesh, and 2,200 in Nepal. These numbers are for all Indian students studying abroad, of which medical students account for a large proportion.

While travelling abroad for a coveted advanced degree in a specialisation of choice is well documented, what drives undergrad students? It cannot, after all, be easy to leave behind the comfort of homeland and family and spend years in a foreign country where everything from the weather and language to food and teaching are alien.

There must be a strong driving factor, which is partially revealed by the figures submitted by the health ministry in the Lok Sabha. As per data submitted in December 2021, there were 88,120 MBBS seats and 27,498 Bachelors of Dental Surgery seats available in India. Against these seats, the number of candidates who registered for NEET last year alone was 15-16 lakh. So what happens to all the aspirants who don’t get a seat for medicine?

This is where an MBBS programme in Ukraine, Russia, China or the Philippines comes in. A seat in a medical school in these countries is much cheaper than one in a private college in India, where courses cost close to ₹1.25 crore in a reasonably good institution. Moreover, the courses there are far less competitive than in India.

In February 2018, it was made mandatory to pass NEET to get an eligibility certificate to study MBBS in medical colleges abroad, besides the usual criterion of students getting at least 50% in Physics, Chemistry and Biology in Class XII. However, most countries that accept Indian students allow entry at low NEET scores.

NEET exams are set for a total score of 720 (360 for Botany + Zoology; 180 for Physics; and 180 for Chemistry). On an average, a general category student must score over 550 to get a shot at a seat in a good government medical college in India through the all-India or State quota. Whereas an aspirant planning to go abroad needs to score only the cut-off marks, which in 2021 for a general category seat was 138.

“While high scores in the NEET exam are not what eventually make a good doctor, the exam does give an insight into the ability of a student to get through a demanding course,” says Rajeev Jayadevan, senior consultant gastroenterologist and former president of the Indian Medical Association (IMA), Cochin.

Many pitfalls

The other issue that comes up is the intensive coaching required to get the high NEET scores that can procure a seat in a government college here. As Ravi Wankhedkar, former IMA president, says, the NEET exam favours those who can afford coaching and the investment needed to crack the paper, which leaves many students at a disadvantage. It is this that led the Tamil Nadu government to oppose NEET when it was made compulsory, stating that it went against the interests of its State board students. Many other State governments are now raising the same objections.

But studying abroad has its own pitfalls. For instance, the National Medical Commission (NMC) — a body of 33 members that regulates medical education and medical professionals and replaced the Medical Council of India in 2020 — advises students against enrolling in countries such as Kazakhstan that offer a bilingual course because NMC guidelines do not recognise bilingual courses in India. English is mandated as the sole medium of instruction. Additionally, the NMC in a notification earlier this year advised students against applying to universities in Kyrgyzstan because students were overlooking “the supervisory, regulatory and infrastructural issues in these institutions”.

Besides this, in the present crisis generated by the pandemic and the war in Ukraine, students who have returned are not sure how they will finish their graduation. NMC does not recognise any medical course that is conducted only online. Undergraduates are now looking at Egypt, Poland and Armenia as potential destinations to finish their course.

Also, as per the Indian Medical Council Act, 1956, students who get a medical degree from a foreign country need to clear the Foreign Medical Graduates’ Exam (FMGE) in order to register and practise in India. “The percentage of students who clear this exam hasn’t gone above 20%, which speaks to the quality of education that foreign graduates are exposed to,” says Dr. Wankhedkar. “Yet, with the cost of private medical colleges being so exorbitant, what can students do? The next logical step is for the Centre to step in and rationalise the fees. But we also cannot forget that these are business ventures.”

Status symbol

Dr. Wankhedkar points to the overwhelming desire, especially among middle-class families, to somehow see their children become doctors. There is a strong status symbol attached to it. “Taking advantage of this, there has been a mushrooming of colleges in many nations to offer medical degrees at a much lower cost than in India. The present crisis has only brought this issue to the forefront. While there is an urgent need to ‘rehabilitate’ these students, a long-term solution is the need of the hour.”

As of now, in a bid to cater to the large number of medical aspirants, India has been steadily adding seats to undergraduate courses across the country, but the demand continues to be far greater than supply. Undergraduate seats have increased by 72%, from 51,348 seats in 2014 to roughly 1.1 lakh now. The Prime Minister recently asked the private sector to step in to help expand health education infrastructure. But, as Maheshwar Peri, founder of Careers360, points out, when NEET was imposed by the Supreme Court, 90% of private colleges increased fees by at least 400% within a day.

Now, in a bid to regulate the fee structure in private medical colleges, the NMC has said that the fees for 50% of seats in private medical colleges and deemed universities should be kept at par with government medical colleges in the same State or Union Territory.

Perhaps the way ahead is to open the gates, set up eligibility criteria for infrastructure and teaching standards alone, and set a cap on fees. This could help cover the supply gap that is being exploited today. Only adequate, affordable and high-quality medical education will make students opt for India.

Meanwhile Vinod assures me that he hasn’t given up hope. “Today I got the news that students from Singapore and Pakistan are being allowed back into China. If it’s true then maybe we can also head back by September. Right now, all I want to do is get to college and finish my internship.”

“We carry the burden of our dreams, our parents’ aspirations. They have invested a lot in us,” he says. His parents have remained silent throughout. Only their hands on Vinod’s shoulder betray their anxiety.

(*Name changed.)