Estimates suggest that India loses ₹15,000–20,000 crore annually in foreign exchange as students and families spend on tuition and living expenses abroad for medical education. This is capital flight that could otherwise have strengthened domestic infrastructure — new medical colleges, upgraded district hospitals, or expanded faculty pipelines, writes former IAS officer V.S.Pandey
Every year, the National Eligibility-cum-Entrance Test (NEET) becomes one of the most competitive examinations in the world. Over 22 lakh students appear for it, chasing a limited number of medical seats. For many aspirants, the outcome is not just an academic result but a life-defining moment. Those who do not make it into an Indian medical college — despite clearing NEET — increasingly find themselves looking beyond India’s borders to pursue an MBBS degree.
This phenomenon is no longer marginal. It has become a structural feature of India’s medical education ecosystem and a reflection of long-standing policy inadequacies.
According to the Ministry of External Affairs (MEA), more than 18.8 lakh Indian students are currently studying abroad across school and higher education levels. While the government does not publish MBBS-specific country-wise figures, estimates based on National Medical Commission (NMC) data and Foreign Medical Graduate Examination (FMGE) applicants suggest that between 65,000 and 70,000 Indian students are enrolled in foreign medical colleges at any given time.
Russia, China, Georgia, Kyrgyzstan, Kazakhstan, the Philippines, Armenia, Poland and Uzbekistan to name a few, have emerged as major destinations. These are not countries traditionally associated with elite medical education, but they offer something Indian aspirants find increasingly scarce at home: affordable seats.
India’s medical seat deficit is stark. Against 22–24 lakh NEET aspirants annually, the country has roughly 1.1 lakh MBBS seats. Government medical colleges account for only about half of these. Private colleges fill the gap, but at a prohibitive cost — often between ₹70 lakh and ₹1.25 crore for the full course. Why we as a country have failed to grasp this reality for decades is a million dollar question. All pervasive corruption may be one of the main reasons for the inaction on the part of those running the system. Same was the situation in engineering education land scape in the year 2000 but well considered remedial actions were taken to resolve the issue and today there is no shortage of engineering seats in our country. Why we failed to do the same in medical education is the question which begs answers.
Due to the perineal shortages in medical seats, access to medical education is no longer determined by merit alone. Economic capacity plays a decisive role. Even students with respectable NEET ranks find themselves excluded simply because they cannot afford private fees.
In this context, studying medicine abroad becomes a rational choice rather than a desperate gamble. In several foreign universities, the total cost of an MBBS degree, including living expenses, ranges from ₹25 lakh to ₹40 lakh — substantially lower than private medical education in India.
Admission processes abroad are typically less complex. Once NEET qualification is secured — now mandatory for studying medicine overseas — entry into foreign medical colleges is relatively assured. This certainty contrasts sharply with the unpredictability of domestic counselling rounds.
However, this convenience comes with serious concerns. Medical education is not merely about classroom instruction; it hinges on clinical exposure. Many foreign institutions enrolling large numbers of Indian students operate in countries with small populations and limited hospital footfall. This constrains hands-on training.
The impact is visible in licensing outcomes. Historically, FMGE pass rates have hovered between 10 and 25 per cent. While pass rates alone do not tell the full story, they point to significant disparities in curriculum alignment, teaching standards and clinical preparedness.
The NMC has attempted to address this through tighter eligibility norms, mandatory internship and the proposed National Exit Test (NExT). Yet, regulation at the exit stage cannot fully compensate for gaps in training during formative years.
The issue is not merely academic. India’s healthcare system depends on the competence of its doctors, especially in underserved rural and semi-urban areas. Graduates who are inadequately trained, or who struggle to integrate into Indian clinical settings, pose long-term risks to patient safety and healthcare quality.
Paradoxically, this occurs in a country that still faces doctor shortages at the primary care level, despite producing large absolute numbers of medical graduates.
There is also a macroeconomic dimension. Estimates suggest that India loses ₹15,000–20,000 crore annually in foreign exchange as students and families spend on tuition and living expenses abroad for medical education. This is capital flight that could otherwise have strengthened domestic infrastructure — new medical colleges, upgraded district hospitals, or expanded faculty pipelines.
Instead, India effectively subsidizes foreign medical institutions while struggling to meet its own healthcare workforce needs.
It is important to avoid moralising the issue. Students who go abroad are responding rationally to constraints imposed by the system. Their decision reflects a failure of capacity planning, not a lack of commitment to the country.
Over the past decade, governments have taken steps to expand medical education, particularly by attaching new colleges to district hospitals. While these efforts are welcome, they remain insufficient relative to population size, disease burden and demographic trends.
India’s doctor-population ratio may meet global norms on paper, but regional imbalances and quality disparities persist.
It is my well considered view that what is needed is not piecemeal regulation but structural reform.
First, India must significantly expand public medical education capacity through a time-bound plan, with a focus on underserved districts.
Second, private medical education must be brought under meaningful fee regulation, balancing viability with social obligation.
Third, regulatory oversight should shift from rigid input norms to outcome-based accreditation, emphasising clinical competence.
Fourth, the government should enter into bilateral arrangements with countries hosting large numbers of Indian medical students to ensure minimum training standards and supervised transition into Indian practice.
Finally, transparency is essential. The MEA, Ministry of Health and NMC should jointly publish an annual, MBBS-specific report on Indian students abroad, disaggregated by country and institution.
India aspires to be a global healthcare leader and a net exporter of medical professionals. These ambitions sit uneasily with a system that forces tens of thousands of its own students to seek basic medical education outside its borders.
The continued outflow of medical aspirants is a mirror held up to policy choices made over decades. Whether India responds with decisive investment and reform, or continues to rely on foreign classrooms to train its future doctors, will shape the country’s healthcare outcomes for generations.
(Vijay Shankar Pandey is former Secretary Government of India)
