As a medical degree authorizes a person to treat a life at risk, if such a degree remains unrecognized by the statutory body, the functioning of the system is likely to be in error. This problem is prevailing in many States of India like Jammu & Kashmir, Himachal Pradesh, Punjab, Haryana, Uttar Pradesh, Bihar, Tamil Nadu, Delhi and Maharashtra [1]. Any such training institution aspiring for recognition should be provided with necessary aid and guidance to fulfill the requirements for recognition.

We have strict regulations, for doctors trained in other countries, to practice in India. Less than 25% of the foreign medical graduates clear Foreign Medical Graduate Examination (FMGE) screening test conducted by the National Board of Examinations (NBE) [2]. The plight of medical students is at stake as they fall in to pressure to choose an unrecognized medical degree after overcoming a tough competitive examination, hoping that the recognition would occur during their training period. The other area to discuss is attempts by certain governments to allow non-medical persons to become faculties and getting promoted, quoting acute shortage of medical faculty.

NBE and Medical Council of India (MCI) are the two bodies that provide recognized postgraduate degrees in India under Indian Medical Council Act (Table I). NBE was established in 1982 with objectives to elevate the standards of postgraduate medical education in modern medicine and conducting examinations of high standard on all India basis. NBE conducts examinations in 72 disciplines and subspecialties of modern medicine, which includes DNB program in 29 broad- and 25 super-specialties. NBE has accredited 469 institutions/ hospitals in public- and private-sector, all over the country. On the other hand, MCI was established under the Indian Medical Council Act, 1933 with the main function of establishing uniform standards of higher qualifications in medicine, and recognition of medical qualifications in India and abroad. Under MCI, there are 462 medical colleges, which annually admit 63,535 MBBS students and nearly half the numbers of postgraduate students.

TABLE I	Total Number of Postgraduate Seats Provided by National Board of Examinations and Medical Council of India

The Supreme Court of India once observed "It is the Medical Council/Dental Council which can prescribe the number of students to be admitted in medical courses/ dental courses in a medical college or institution. It is the Central Government alone, which can direct increase in the number of admissions, but only on the recommendation of the MCI. Universities and State Governments had no authority to allow increase in the number of admissions in the medical colleges in the State. No medical college can admit any student in excess of its admission capacity fixed by the MCI subject to any increase thereof as approved by the Central Government, and that Sections 10-A, 10-B and 10-C will prevail over Section 53(10) of the State Universities Act and Section 41(b) of the State Government Capitation Fee Act."

Medical education is still in infancy in India. The recognition of medical degrees/diplomas is an important issue in almost all the States of India, and in most of the medical specialties. Few examples of various unrecognized medical degrees in India are University of Seychelles - American Institute of Medicine (USAIM), College of Physicians and Surgeons, Bombay [(L.C.P.S. (Bom), F.C.P.S. (Mid. and Gyne.), F.C.P.S. (Ophthal.), D.G.O. (Dip. in Gyn. & Obst.), D.C.H. (Dip. in Child Health)]. The membership examinations offered by the Royal Colleges of Paediatrics and Child Health, London; Royal College of Physicians, London; Royal College of Emergency Medicine in India are also not recognized as additional qualifications for practice of the respective disciplines. Many foreign universities such as George Washington University are offering the Masters in Emergency Medicine Courses (MEM) without being even on the edge of recognition by any regulatory process or Government of India.

There had also been protests by medical students and doctors in various parts of country to solve the issue of existing unrecognized medical degrees in India. The resultant reduction in number of postgraduate seats would also affect the medical fraternity, as it is well known that already there are inadequate postgraduate seats in comparison to undergraduate seats. Also, MBBS (without a post graduation) is becoming insufficient in current era of specialization-based practice.

The public authorities should take responsibility so as medical institutions do not admit students and foster them a medical degree/qualification at the end of training which by itself goes invalid and deficient. The perpetuation of this practice puts the public as well as the inadequately qualified doctors at risk. Some medical institutions do fill these unrecognized seats with a written undertaking from the students regarding the awareness of the consequences of having an unrecognized medical degree, if the degree remains unrecognized. Such a practice reflects negligent attitude of the stakeholders. Students do not have role in any of the processes of getting a medical degree recognized. It is the responsibility of the medical college/University, State and Central Governments, and/or the MCI. However, for no reasons, the students suffer ultimately. Consequences of possessing unrecognized degrees/ diploma include denial of right to practice; termination of services; demotion form senior post; denial of registration of degree in Concerned State Medical Council/ MCI; denial of employment/ promotion; not being counted as faculty members, especially for starting postgraduate courses; humiliation for holding unrecognized degree; no right to write unrecognized degree as suffix with name; framing of criminal cases and civil cases of negligence; and impact on patients’ rights.

Despite the availability of all the written regulations in place, sincere efforts in action are inadequate, and urgent remedial measures need to be implemented. The authorities in power should be made to realize the recent rules and regulations, their duties, and the hazards of unrecognized medical degrees, through structured training programs. They should also be made accountable in case of failure to implement the rules. Awareness among common men and aspiring students has to be created regarding the existence of unrecognized medical degrees and their hazards. Public awareness has to be created regarding the laws to protect medical students and patients affected by this problem. Central and State Governments should strictly adhere to withhold admissions for degrees without prescribed recognition. The trials in Court pertaining to this matter should be processed in a speedy manner to curb further batches of students being affected.

Stakeholders should ask oneself as why a student who worked hard and succeeded a tough competition has to undergo training in an unrecognized course, and after completing the course successfully, had to linger around the court at the cost of his time, money and career at stake, for things for which he/ she is not responsible. It is a very important issue of public interest related to violation of Article 21, 14, 16 of the Indian Constitution and other statutory provisions. It is also in violation of the Indian Medical Degree Act, 1916 and provisions of the Indian Medical Council Act, 1956 [1].

1. Yadav M. Problem of unrecognized medical degree/diploma who is at fault. Journal of Indian Academy of Forensic Medicine. 2007;29;1-6.