Junior doctor or independent practitioner? The Georgia MBBS question dividing regulators

Indian students planning to pursue medical education in Georgia are facing uncertainty over whether their degrees will qualify them to practice medicine in India, as the National Medical Commission (NMC) has issued different responses to identical queries about foreign medical graduate eligibility.

The country's medical education regulator has reiterated its 2021 regulations in one response while stating in another that the independent licensing requirement is under examination by the competent authority and an expert committee. The differing explanations have raised concerns among aspiring doctors.

Legal experts have alleged that the NMC's unclear position on the matter is allowing education consultants, reportedly working with foreign medical colleges in exchange for hefty commissions, to make misleading claims about the validity of overseas MBBS degrees in India.

The issue concerns two aspiring doctors who approached the NMC through the PM Grievance Portal to clarify whether completing a six-year MBBS course in Georgia would make them eligible to appear for the Foreign Medical Graduate Examination (FMGE) in India and subsequently practice medicine.

In its first response, dated Sept 24, the NMC referred to the National Medical Commission (Foreign Medical Graduate Licentiate) Regulations, 2021. It clarified that a medical degree would be considered valid for appearing in the FMGE only if Georgia granted graduates an independent license to practice medicine after completing their MBBS course.

However, the regulator adopted a different position in its second response, dated October 13, to another candidate who had submitted an identical question. This time, the NMC stated that the provisions concerning the independent licensing system were being examined by the competent authority and an expert committee.

The difference between the two replies has raised questions about the regulator's position and the eligibility conditions applicable to Indian students graduating from Georgian medical institutions.

NMC's unclear position raises concerns over foreign MBBS admissions

Sachin Jain, a Delhi High Court lawyer who handles medical-related matters, alleged that education consultants receiving substantial commissions from foreign universities were using the NMC's second response to persuade students to pursue medical education in Georgia.

“Education consultants who allegedly receive hefty commissions from foreign universities are misleading students by citing the second response, which said that the matter is under examination,” Jain said.

He alleged that consultants were presenting the regulator's statement about the matter being under examination as an indication that the independent licensing requirement could eventually be removed or relaxed.

He added, “They are promising students that the ‘independent licence condition’ will be revoked or bypassed through various other mechanisms, enabling them to appear for the FMGE and practise medicine in India.

“This will jeopardise the careers of thousands of students, as the NMC can only recommend that the government amend the law. It cannot do anything else because the law was framed by Parliament,” he said.

The candidates also sought further clarification through the PM Grievance Portal, asking the NMC which of its two earlier responses should be treated as valid. However, the regulator did not directly resolve the discrepancy.

Instead, it reiterated the provisions of the National Medical Commission (Foreign Medical Graduate Licentiate) Regulations, 2021, without clarifying whether the independent licensing requirement was applicable to graduates of Georgian medical universities.

Georgia's medical education regulator adds to the confusion

The uncertainty has also drawn attention to the National Center for Educational Quality Enhancement (NCEQE), Georgia's education quality regulator, which has published frequently asked questions (FAQs) concerning the recognition of medical qualifications.

According to legal experts, the information published by the NCEQE presents another point of ambiguity for Indian students considering medical education in the country.

On one hand, the Georgian authority claims that Georgia fulfills the NMC's requirements for foreign medical graduates. On the other, its FAQ explains that graduates of medical doctor (MD) programs can be employed as junior doctors without appearing for additional examinations, irrespective of their citizenship.

The FAQ states, “Under the Law of Georgia on Medical Practice, graduates of the Medical Doctor (MD) programme are entitled, irrespective of their citizenship, to be employed as junior doctors without taking additional examinations.

A person appointed to this position performs a physician’s duties under the direction and responsibility of a person authorised to engage in independent medical practice.”

The distinction between working as a junior doctor under supervision and holding an independent license to practice medicine has become central to the dispute over FMGE eligibility.

Ajay Kumar Singh, Advocate on Record at the Supreme Court, questioned the Georgian authority's interpretation of the NMC requirements. He said that the FAQ's explanation of junior doctor employment did not establish that graduates were permitted to practice medicine independently.

“However, the FAQ says that medical graduates can work as junior doctors, but not independently. They must work under the direction and responsibility of a person authorized to engage in independent medical practice.

The NCEQE’s claim that Georgia fulfills the NMC’s conditions could mislead Indian students and benefit Georgian medical colleges,” Singh said.

Legal experts have also alleged that the Georgian regulator's FAQ could create an incorrect impression among Indian aspirants about the recognition of medical degrees obtained from universities in the country.

What do NMC's foreign medical graduate regulations require?

Under the National Medical Commission (Foreign Medical Graduate Licentiate) Regulations, 2021, a candidate must receive an independent license to practice medicine in the country where the medical qualification was obtained.

This requirement is central to determining whether graduates of foreign medical institutions can appear for the FMGE in India. The examination is a qualifying requirement for foreign medical graduates seeking registration to practice medicine in the country.

The concern raised by legal experts is that employment as a junior doctor under the supervision of an independently licensed practitioner may not satisfy the NMC's independent licensing condition.

Consequently, students completing medical education in Georgia could face difficulties if their qualifications do not meet the requirements prescribed under Indian regulations.

Lawyers seek list of NMC-approved foreign medical institutions

With uncertainty continuing over the interpretation of the licensing requirement, lawyers have urged the Union Health Ministry and the NMC to publish a list of countries and foreign medical universities that meet the eligibility conditions for appearing in the FMGE.

They believe an official list would help students verify the status of foreign medical qualifications before taking admission and making substantial financial commitments to medical colleges abroad.

The demand also comes against the backdrop of concerns over education consultants allegedly making assurances about the recognition of overseas medical degrees without adequately explaining the licensing conditions applicable in India.

Legal experts have warned that students who rely on such assurances could face financial losses, difficulties in obtaining medical registration and setbacks to their professional careers.

The proposed list, they argue, would provide greater clarity on the eligibility requirements and reduce the possibility of students being misled by conflicting interpretations of foreign medical licensing rules.

For now, the NMC's responses, the Georgian regulator's FAQ and the distinction between junior doctor employment and independent medical practice continue to leave aspiring Indian doctors seeking clarity before pursuing an MBBS degree in Georgia.