A decision by India’s apex medical regulator to impose a two-year internship on sections of foreign medical graduates will delay their postgraduate education and also force some working doctors back into internship, affected graduates have said.

The National Medical Commission (NMC) on October 19 stipulated an additional year over the standard one-year internship for foreign graduates who had any online classes during the Covid-19 pandemic.

Foreign medical graduates have also complained that many medical colleges are not paying them the stipends due under the NMC’s own guidelines. An extra year of unpaid internship, they say, will put some of them under severe financial stress.

The NMC has told state medical councils and state medical education directorates that foreign medical graduates who had any online classes should undergo two years’ compulsory internship after passing the foreign medical graduates exam (FMGE) to make up for the lack of physical clinical training during the pandemic.

The FMGE is a mandatory test all foreign medical graduates need to take in addition to other requirements before they can practise medicine in the country.

During internship, medical graduates rotate across clinical departments — from general medicine to general surgery to obstetrics and gynaecology, and so on, in no particular order. They spend periods ranging from a week to over four weeks in any particular department, watching, assisting and learning.

“Clinical and bedside training is critical to medical education. Many foreign medical graduates who had online classes during the pandemic have had no clinical training,” Shivkumar Shankar Utture, a former president of the Maharashtra Medical Council and an NMC member, told The Telegraph. “This was the rationale for the two-year internship.”

But some foreign medical graduates who have already obtained registration, or licence, to practise medicine after passing the FMGE and completing a one-year internship say the state medical councils, citing the NMC’s October 19 order, have asked them to give up their licence and return to internship.

“I’ve been asked to return my registration and do one more internship year,” said a doctor who had received the licence from the Delhi Medical Council in August 2022 after completing a year’s internship at a government hospital in New Delhi.

The doctor had worked at a private hospital in New Delhi for a few months before returning to his home state, Kerala, to study for the national entrance test for postgraduate medical courses.

The Punjab Medical Council, in a notice on October 31 this year, cited the NMC’s October 19 directive and said the registration of foreign medical graduates who had any online classes and had done one-year internships shall “stand revoked”.

The council has asked the candidates to surrender their registration certificates and complete an extra year’s internship.

“Why didn’t the NMC come up with the two-year internship rule last year — by October 2021? We could have continued in our internship positions,” said a doctor who had completed her one-year internship by March 2022.

She received her registration from the Punjab Medical Council and is currently a medical officer at a private hospital. “Now, they want it back — this will mean an additional year’s delay in my educational career and no stipend during the internship.”

Internships are, anyway, often difficult to find for foreign medical graduates.

An aspiring intern in Haryana who had earned her medical degree abroad said she had applied for internships to colleges in Haryana, Rajasthan and Uttar Pradesh but had not heard back from any. “The longer the wait for the internship, the longer I have to wait for the PG entrance test,” she said.

“Many of us had only three months of online classes — only theory subjects, nothing clinical. Yet the two-year internship is being applied to all students, those with three months’ online classes and those with online classes for a year.”

Guidelines released by the NMC on March 6 this year asked all medical colleges to allocate 7.5 per cent of internship seats for foreign medical graduates and to extend to them stipends and other facilities that Indian medical graduates receive at government medical colleges.

But several interns who graduated from foreign medical colleges said they had not received a single rupee.

“I need to think five times whether to buy even a cup of tea for ten rupees,” said a foreign medical graduate interning at the central government-run Ram Manohar Lohia Hospital, New Delhi, over the past six months. “This is the state of a doctor in the capital.”

Around 200 foreign medical graduates interning at Lohia Hospital and between 60 and 80 interning at Hindu Rao Hospital and Safdarjung Hospital — also in New Delhi — do not receive stipends, the intern said.

In contrast, graduates from Indian medical colleges receive, during internship, stipends ranging from Rs 17,000 a month to Rs 26,500 a month, two interns said. “Is this not discrimination? When we ask for stipends, we’re told to be thankful that we’ve got internships,” another Delhi intern said.

Utture, the NMC member who is a senior surgeon in Mumbai, said the NMC had “categorically asked” medical colleges to pay foreign medical graduates the same stipends as domestic students.

“Interns not receiving stipends should complain to the NMC, which can take it up with the colleges,” he said.