Kerala High Court Quashes State Govt's Imposition Of Mandatory Internship Fees For Foreign Medical Graduates

Background

The petitioners in the case were FMGs who had completed their medical degrees abroad in countries like Russia, Bulgaria, the Philippines, and Guyana. After passing the Foreign Medical Graduate Examination (FMGE) and obtaining provisional registration, they applied for internships in government hospitals in Kerala.

The Kerala Government, however, issued an order on April 3, 2025, requiring FMGs to pay ₹5,000 per month, totaling ₹60,000 for one year, to complete their internship. This fee was higher than what was charged from Indian Medical Graduates (IMGs).

The FMGs challenged this order, arguing that the NMC had already issued circulars stating that no fees should be charged for internships from FMGs.

Arguments

The petitioners argued that the NMC circular dated 19.05.2022 clearly prohibits any fee from being charged by medical colleges for internships from FMGs. Although the NMC's later circular dated 19.10.2022 allowed States to decide on the amount of stipend payable to interns, it did not permit the collection of internship fees. Once FMGs clear the FMGE and obtain provisional registration, there is no legal distinction between them and Indian Medical Graduates for the purposes of internship. The State Government's order violated Article 14 of the Constitution by discriminating against FMGs. They further emphasised that no additional training, infrastructure, or stipend was provided in return for the internship fee.

The State Government argued that it has the power, under the Constitution, to levy reasonable fees to cover administrative and training expenses incurred by hospitals. The Government justified the fee, citing the infrastructure and training facilities it provides to interns. The State initially charged ₹10,000 per month but later reduced it to ₹5,000 per month after the High Court's earlier directions. The Government maintained that the fee was nominal and necessary to maintain hospital services and training.

The NMC, represented in court, made it clear that it alone has the authority to regulate medical education, including internships. It stated that the NMC's policy prohibits any fee from being charged by medical colleges for allowing FMGs to complete their internship. The NMC clarified that States only have discretion to fix stipends, not internship fees.

Court's findings

The court considered whether the State Government is justified in demanding internship fee for undergoing medical internship regulated by the National Medical Commission (Compulsory Rotating Medical Internship) Regulations, 2021?

The High Court found that under the National Medical Commission Act, 2019, it is the NMC that has the sole authority to regulate medical education and internships. The Court said the State Government's order demanding fees from FMGs was against the NMC's guidelines, which clearly state that no fees should be charged from FMGs for their internships. The Court also pointed out that in an earlier case (W.P.(C) No.23663/2020), a Division Bench had already told the State to reconsider the fee based on the NMC's directions, but the new order dated April 3, 2025, ignored that. The Court made it clear that once FMGs pass the FMGE and get provisional registration, they are equal to Indian Medical Graduates when it comes to internships, so there's no reason to treat them differently. Additionally, the Court observed that the fee imposed by the State lacked any basis of quid pro quo, as there was no evidence of additional infrastructure or training being provided in exchange for the fee.

Court's Ruling

The court held that the NMC Act, 2019, has been enacted to provide for a medical education system that improves access to quality and affordable medical education for the citizens. When the NMC Act, 2019 mandates payment of stipend to medical interns for their service, the State will not be justified in levying an internship fee from the Medical Graduates. The GO(Rt) No.987/2025/H&FWD dated 03.04.2025 issued by the Additional Secretary, Government of Kerala, Health and Family Welfare (S) Department is therefore illegal and ultra vires. The Kerala High Court, therefore, quashed the Government Order dated April 3, 2025, and declared that no internship fee can be charged from FMGs by government medical colleges in Kerala.

This judgment brings clarity and uniformity in the regulation of medical internships for FMGs. It reinforces the authority of the NMC in setting standards for medical education and ensures that FMGs are not financially burdened during their compulsory internship period.

Case No: W.P.(C) Nos. 19369, 19383, 19776, 19908, 20000, 20045, 20172, 20195, and 20259 of 2025

Case Title: Sharooq Mohammed & Ors. v. State of Kerala & Ors & Other Connected Cases

Citation: 2025 LiveLaw (Ker) 318

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