Strange things are going on worldwide in the area of medical education. On the one hand, there appears to be a shortage of medical doctors, while at the same time governments, and in many cases also medical doctors themselves, oppose increased access to the study of medicine. As a result, there has been an increase in international mobility of medical students from high-, mid- and low-income countries. While once medical education was international, now it is nationally regulated, but at the same time becoming internationalised. Because of national and global health needs, it is worth examining this particular global medical environment.
No one knows how many international students are studying in medical schools outside their home countries, but a conservative estimate might put the number to be more than 2,00,000 — many of them in institutions and countries with questionable quality of medical preparation. To give an indication, Ukraine, before the Russian invasion, had 24,000 medical students from abroad, mainly, but not exclusively, from India.
The India crisis
India is an interesting example. The country has a severe shortage of doctors. The demand for places in medical colleges is considerable and, as a result, competition for places is intense. Annually, approximately 2.3 million students sit for the national medical school entry examination, but only one in around 22 successful candidates is able to enter the country’s 700-plus medical colleges.
The fierce competition for medical seats in India has compelled many students to explore opportunities abroad. It is estimated that more than 20,000 Indian medical students go abroad to study. With limited government medical seats and high tuition fees in private institutions, studying medicine abroad has emerged as an “affordable” and practical alternative for Indian aspirants. Countries such as Russia, pre-war Ukraine, Kazakhstan, the Philippines, China, Mauritius, and Nepal have become attractive destinations.
Interestingly, some of the institutions in foreign countries are controlled by Indians. One such institution is the Manipal College of Medical Sciences in neighbouring Nepal, the country’s first private medical college which was established in 1994. It is operated by the Manipal Education and Medical Group (MEMG), Bengaluru. The American University of Antigua (AUA) College of Medicine, a Caribbean medical school, is also a division of Manipal. This reflects a broader strategy of Indian education groups expanding their footprint overseas to meet the growing demand from Indian students.
However, studying medicine abroad comes with its own challenges, particularly for those who wish to practise in India. Indian students who complete their programmes from foreign institutions must clear the national licensing examination to qualify for medical practice in India. They are also required to complete a medical internship upon their return. Similarly, Indians wishing to practise medicine in other countries must satisfy licensing and other requirements of those countries — and one can find Indian doctors throughout the world. This illustrates that governments are aware of the varying standards of medical education around the world.
In a significant announcement during the Union Budget speech in February 2025, Finance Minister Nirmala Sitharaman highlighted the government’s achievements in medical education. She stated that the government had successfully added nearly 1.1 lakh undergraduate and postgraduate medical education seats over the past decade, an increase of 130%. She also revealed plans for further expansion in the medical education sector by announcing that an additional 10,000 seats would be introduced in medical colleges and hospitals in 2026. This initiative is part of a broader five-year goal to add 75,000 new seats, aimed at addressing the growing demand for qualified medical professionals.
Not just a Global South phenomenon
The case of medical education in India illustrates the problematic phenomenon of students leaving the Global South, in particular South Asia and Africa, to study medicine in other mid-income countries — and often to remain abroad. But the trend is broader.
For many years, students from western countries such as France, Germany, the Netherlands, and Norway, have been going to neighbouring countries for their medical studies, due to a lack of access at home. Romania, where medical study is provided in French, Hungary, and Poland are common host countries. Hungary and Poland also receive medical students from the United States. Thousands of U.S. students study medicine in these two countries, as well as in Ireland, the Caribbean, and the United Kingdom.
Medical programmes in central and eastern Europe, as well as in Central Asia, cater to diaspora students and teach in English. The Medical University of Warsaw, for instance, has medical study programmes in both Polish and English. Currently, due to a lack of national funding for places at their home universities, about 3,000 Norwegian medical students receive scholarships to study abroad, mainly in central and eastern Europe.
In other words, the phenomenon of foreign medical education is widespread, almost completely unknown, and unregulated. Where entire medical schools are devoted to international enrolments, they are almost exclusively for-profit institutions. Medical schools established in non-English speaking environments, such as Poland and Ukraine, offer English-medium medical curricula to attract high-fee-paying international students.
Balancing demand and quality concerns
As the recent Budget speech shows, the government is starting to see the problem, but solutions are expensive and meet opposition from inside the medical establishment, which fears a deterioration of their privileges and elite status. Yet, with an aging population, the need for quality medical doctors will only increase. The growing number of students looking for medical education abroad illustrates a potential, but there is an overall lack of quality control. More attention is needed on this key challenge.
Philip G. Altbach is Professor Emeritus and Distinguished Fellow at the Center for International Higher Education (CIHE), Boston College, U.S. Hans de Wit is Professor Emeritus and Distinguished Fellow at the Center for International Higher Education, Boston College, U.S. Eldho Mathews is Programme Officer (Internationalisation) at the Kerala State Higher Education Council, India
Published – February 14, 2025 12:16 am IST