The Harsh Realities of Pursuing Medicine Abroad for Foreign Medical Graduates

Series: Department of Podcast

Episode: 15

Guest: Dr. Akshit Srivastav

Host: Dr. Ankit Sharma

For many middle-class Indian students, the dream of becoming a doctor often collides with the fierce competition and prohibitive costs of private medical colleges. Studying medicine abroad in countries like China, Russia, or the Philippines can seem like the perfect solution—a direct path to an MBBS degree. But what happens after you return, degree in hand?

The journey of Dr. Akshit Srivastav, a Foreign Medical Graduate (FMG) who studied in China, reveals a gauntlet of surprising and often unspoken challenges. His story isn't just about earning a degree; it's a multi-year battle against a punishing exam, systemic biases, and a rapidly changing professional landscape. His experience distills the critical lessons every aspiring FMG needs to hear before they ever book a flight.

1. The Exam Isn't Just Pass/Fail—It's a Psychological Trap

Stuck at 148: The Nightmare of Being 'Almost' a Doctor

Before an FMG can practice medicine in India, they must pass the Foreign Medical Graduate Examination (FMGE). On paper, it’s a pass/fail exam with a cutoff of 150 marks. In reality, it can become a psychological abyss. Dr. Srivastav found himself stuck in a brutal loop of near-misses, with scores hovering just below the passing mark. His results read like a recurring nightmare: 146, 148, 147. It took him seven grueling attempts to finally clear it.

The trauma is not just about repeated failure. After his third attempt, Dr. Srivastav faced the ultimate humiliation: he had to “pack his bags, go back to China, and do his internship alongside his two-year juniors.” This turns a six-month exam cycle into a multi-year ordeal, inflicting immense mental trauma and putting lives on indefinite hold.

"FMG is something that if you clear it in the first or second attempt, it's well and good. If not, you'll just keep spinning in that whirlpool. It's very difficult... We are consistently studying, leaving everything else behind... and putting ourselves through a trauma."

2. The "Clinical Gap" Is Real—And It's How the Exam Defeats You

Why Your Foreign Textbooks Won't Prepare You for Indian Patients

FMGs often face a critical disadvantage: a lack of hands-on clinical experience compared to their Indian-trained peers. Studying abroad frequently involves less direct patient interaction, meaning students excel at theoretical subjects but crumble when faced with practical application. This “clinical gap” is precisely what the FMGE exploits.

The exam’s Paper 2 is dominated by applied clinical questions designed to test real-world knowledge. For many FMGs, this is where the dream dies. Dr. Srivastav perfectly explains the disconnect: “You only see things in 2D in a book... but you haven't seen it in 3D, you haven't imagined it, you haven't seen its use.” This is why questions that require practical experience can seem completely alien. To bridge this gap, he offers crucial advice: use your vacations to return to India and undertake “observer-ships” in various hospital specialties to gain invaluable exposure to the instruments and procedures you won’t find in a textbook.

3. Your Degree Might Be Equal, But Your Opportunities Aren't

A Cruel Game of Postcodes: The State-Level Bias They Don't Mention

One of the most shocking truths is that even after clearing the FMGE, graduates can face state-level discrimination during post-graduate (NEET-PG) counseling. This is a critical detail that admission agents almost never disclose. Dr. Srivastav, with an Uttar Pradesh (UP) domicile, discovered he could only participate in the All-India counseling round. In contrast, FMGs from states like West Bengal or Orissa can participate in both the All-India and their respective state counseling rounds. This gives them a significant advantage in securing a coveted PG seat. Prospective students are often completely unaware of this bias, which can severely limit their career options based solely on their home state.

4. There Are Lifelines If You're Stuck (And They're Not in a Hospital)

Your Lifeline Isn't in a Hospital

What happens if you can't clear the FMGE after multiple attempts? Without a license, an FMG is trapped and cannot practice medicine. However, Dr. Srivastav found that there are viable, non-clinical career paths that don't require an FMGE qualification. His search for stability led him to personally interview for a Drug Safety Physician role at a company called Parexel in Chandigarh. For graduates feeling stuck, these lifelines can provide financial stability and a new professional direction.

Key alternative careers include:

• Drug Safety Physician: Working within the pharmaceutical industry on drug monitoring and safety protocols.

• Medical Writer: Creating content for medical companies, journals, or healthcare publications.

• Masters in Hospital Administration (MHA): Transitioning into a management role within the healthcare system.

• Bioinformatics: A technology-focused field combining biology and computer science, noted as being less saturated than the popular Masters in Public Health (MPH).

5. The Financial Bleed Doesn't Stop After You Graduate

The Debt Spiral: Why the Financial Trauma Doesn't End at Graduation

The psychological pressure of the FMGE is compounded by relentless financial trauma. “Financial trauma is a major factor... especially for middle-class boys,” Dr. Srivastav states. Many students take out substantial education loans to study abroad, and the interest meter keeps running while they are stuck in the FMGE cycle. With no license, they are unemployable in the medical field. The crushing weight of being unable to earn, coupled with the family pressure of "Papa kab tak karenge?" (How long will Dad keep paying?), creates a desperate situation. This long-term financial servitude extends far beyond exam fees, trapping FMGs in a cycle of debt and dependency for years after they’ve technically "graduated."

6. The Medical Field Is Heading for a "B.Tech-Style" Saturation

The Coming Doctor Glut: An MBBS Is the New B.Tech

A forward-looking warning for all aspiring doctors: the Indian medical field is on the verge of a massive surplus. The huge influx of graduates from both Indian colleges and foreign universities is creating a scenario reminiscent of the engineering (B.Tech) boom years ago, where supply far outstripped demand. The consequences are already becoming apparent and will only intensify:

• Job saturation is increasing, especially in Tier-1 cities.

• Salaries are dropping. Fresh MBBS graduates in private Delhi hospitals, who once earned ₹80,000-₹1,00,000, are now being offered ₹55,000-₹65,000.

• Competition will worsen at every stage, from securing a PG seat to finding a stable job.

7. You're Not Just Competing With Peers—You're Competing With "Titans"

Welcome to the Arena: You're Not Just Competing with Peers—You're Competing with Titans

Even if you clear every exam and secure a PG seat, the final brutal truth awaits: you are entering an arena where the champions are already entrenched. Dr. Srivastav makes a devastating observation: “You are competing with the established 'Mahavirs' (titans/champions) of the medical field... You cannot replace them.” The top positions in desirable locations are already occupied by experts with decades of experience and established practices. He notes the harsh reality of a top-ranked radiologist from a premier Delhi hospital who, even after reaching the pinnacle of his training, is driving around in a van with an ultrasound machine to build a practice from scratch. This illustrates that even after conquering every academic hurdle, the struggle to establish yourself has only just begun.

Conclusion: Think 10 Years Ahead, Not Just About the Degree

The journey of a Foreign Medical Graduate is a roller coaster ride that demands immense resilience and strategic planning. The decision to study abroad is not a five-year commitment; it's the first step in a long, arduous, and perpetual race. As Dr. Srivastav warns, “this race will never end.” It continues through PG, job hunting, and the lifelong battle to establish a practice.

His core advice for prospective students is to think beyond the immediate goal. Don't just ask what happens in five years. Ask yourself, “How do you see India and Medicos after 10 years?” And, more importantly, “What is my backup plan if things don't work out?”

In a world with a growing surplus of doctors, is the long, uncertain struggle still worth the dream?