Ultimate Guide to Practicing Medicine in India

India, the land of diversity. One country holding several “countries” – where heterogeneity and wide disparity are the rule, not the exception. The same is true for practicing medicine. There is a wide variation of practice patterns, quality of care, physician training, infrastructure, and capacity for patients to pay.  As a physician who trained in the US and then returned to India, this experience provides a unique lens through which I appreciate the Indian Healthcare system. Here is a brief introduction to the Indian Healthcare system as well as a guide to help an American doctor practice abroad in India.

Importantly, the Medical Council of India was replaced by the National Medical Commission (NMC) on September 24, 2020. The National Medical Commission is now the governing body for the medical profession. We will outline the links on NMC website that have the information on recognition of American degrees and training in India. (NOTE: If you’re trying to access the NMC website from outside India, you may need to use a VPN)

 

Indian HealthCare System

The Indian constitution mandates the government provide all citizens with the “right to health” and each state is required to provide free universal access to healthcare. There are private and public health insurance schemes, though on the whole, the healthcare system is underfunded. Private health insurance accounts for approximately 4% of total healthcare expenditure and tends to be available in bigger cities, typically only covering inpatient expenses with minimal or no outpatient coverage. The majority of medical care is still paid out of pocket. The Central Government Health Scheme, ECHS (armed forces), and the Employees’ State Insurance scheme provide medical coverage for many government employees and factory workers, enabling access to health care at nominal costs. For low-income people, the government recently launched the tax-financed National Health Protection Scheme (Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana, or PM-JAY), which allows them to also get cashless secondary and tertiary care at private facilities. 

Indian cities are divided into three tiers based on population density. Tier 1 cities have the highest populations, higher cost of living, and more developed healthcare and education infrastructure, while Tier 3 cities have smaller populations and are less developed. Tier 1 cities – like New Delhi and Mumbai – have access to the latest medicines and technologies and provide care on par with global standards. Tier 1 and a few Tier 2 cities, like Goa and Agra, also have a thriving private sector. The Private sector ranges from small clinics (run by an individual doctor), “nursing homes” which are essentially 10-50 bed hospitals staffed by one or two doctors providing care in one or two specialties, to 100-500 bed corporate hospitals offering all diagnostic and therapeutic facilities, and access to a wide range of specialists. Complicated patients are referred to a higher level of care in the closest metropolitan area.

Premier institutions – like All India Institute of Medical Science, Post Graduate Institute of Medical Education and Research Chandigarh, or Sanjay Gandhi Post Graduate Institute Lucknow – provide quality tertiary clinical care to millions of patients while also advancing their academic missions. In contrast, most other government facilities are short-staffed with limited supplies. For example, in government facilities, an individual could wait several months to a year to obtain a MRI or schedule an elective surgery.

 

Medical Licensure/Registration

The Medical Council of India (MCI) was officially replaced by the National Medical Commission (NMC) on September 24, 2020. The NMC is now the central governing body for medical education, licensure, and ethics in India. It oversees medical education standards, grants Indian medical qualifications, determines the validity of foreign qualifications, and maintains the national physician register. The NMC comprises four autonomous boards: the Undergraduate Medical Education Board, Postgraduate Medical Education Board, Medical Assessment and Rating Board, and the Ethics and Medical Registration Board.

The NMC Act of 2019 (No. 30 of 2019) makes it clear that the Commission is the legal successor to the MCI. All educational standards and recognitions previously granted by the MCI continue to be valid unless officially changed. Section 61 of the Act explicitly states that previously recognized qualifications, such as those listed in the Second Schedule and Part II of the Third Schedule (page 7 of 18) of the Indian Medical Council Act, 1956—including many American Board certifications ( the American Board of Peds, Psychiatry & Neurology, Ortho, Derm, Radiology, Urology, OB/GYN, IM, Pathology, Opthalmology, ENT, Surgery, Anesthesiology, Plastic Surgery, Neuro Surgery, PM&R, Preventive Medicine,—remain recognized under the NMC.,

In practice, this means that American-trained doctors in most ABMS-recognized specialties do not need to take additional exams to be eligible for registration in India. This continuity is critical for physicians looking to return or relocate to India with American credentials.

 

Permanent Registration & Adding American Qualifications

If you completed medical school (MBBS) in India, you will already have permanent registration in the state you graduated from. You can renew your state registration and then add additional qualifications—including U.S.-based residency and subspecialty fellowships—without much hassle or cost.

Note, however, that non-ABIM or non-ACGME-accredited fellowships may not be added to your official registration. For instance, the Delhi and Haryana medical councils declined to list my kidney transplantation fellowship, as the American Society of Transplantation accredited it but not by ABIM or ACGME.

You can register either with your state’s medical council or directly with the national register. Many states now upload their data to the national NMC database, so you typically don’t need to do both. That said, some states like Haryana still require a separate state-level registration to practice locally. 

 

Finding a Job

You can find a job by making a list of all of the hospitals and/or clinics in the city of your choice and emailing or calling the human resources teams for openings in your specialty. You can search job boards like Foundit.in or Naukri.com and reach out to colleagues practicing in your desired locale. There are a small number of recruiting agencies that have recently appeared though it is tough to verify their authenticity. Organised job boards or website listings are still scarce. The Indian Medical Association has started such a portal in early 2025 but it is still in its infancy stages. 

The Indian job market typically does not provide advanced job contracts such as signing up for a position 6 months prior to arriving in India. Instead, the on-boarding process for most hospitals is relatively simple and quick – “we have an opening – you can join tomorrow”.  Similarly, you can resign from a position by giving one to two month’s notice. 

Consider connecting with local colleagues 5-6 months in advance to see if there’s an opening, and consider making a trip to meet as many people as you can in person to assess the job market and to look for a home. That being said, your job will likely only get finalized when you are physically in India, so don’t get too stressed with planning and organization before your move. If you are super motivated to do this, take that leap of faith and make the plunge!

 

Salary & Work Culture

The pay is much lower than what you would get in the US (don’t even try comparing!), and it takes a lot of hard work to achieve the standard of living that you become accustomed to in the US. Expect full working days on Saturdays and even half-days on some Sundays if you would like to earn a “decent” salary.

There is fierce competition in Tier 1 and Tier 2 cities. It will take a long time, perhaps 5-10 years, to establish yourself and be known professionally. In a tier 2 or tier 3 city, you can be known professionally and be more successful within 2-3 years. 

Every other day here, you will be reminded that one can’t get everything in life! While settling down in a tier 2 or tier 3 city might catapult you to fame and recognition sooner, it will come with its share of problems. (Read – mindset of patients, nonaffordability of higher expense treatments, less severe or intellectually stimulating case mix, educational opportunities for your kids, quality of life with avenues, lifestyle, etc)

Be open and prepared to update your knowledge and skill set when moving. For example, many medications have different names and combination formulations – it will likely take a couple of months to get up to speed. As overwhelming as it may sound, many smartphone apps or a simple Google search can help you navigate this.

Consider doing as much additional (subspecialty) training in the US as possible before returning. Procedural subspecialties like cardiology, GI, nephrology, and even non-procedural subspecialties like endocrinology and rheumatology are in demand.

I strongly recommend working in a team in a bigger corporate hospital for 6-12 months after returning. You will have to learn a lot about navigating the Indian system of hospitals, patients, staff, work culture, etc.

Bigger hospitals in tier 1 cities are almost at par with any other country in the world in terms of services, drugs, or procedures they offer. So you will practice the same as what you did and learnt in the US.   

PS – do not feel “entitled” in any way that you are returning home with an “American degree”. Despite the colonial hangover that still exists in general, you will be treated in the same way professionally (post/ position, seniority, reimbursements, etc) as any other Indian doctor with similar qualifications in that field. If anything, your visiting card will read longer degree names as you are legally not allowed to use titles like MD or DM unless you have one. Certain instances may arise where you face a challenge explaining your degree/title to some people. 

 

Social Life

Life outside the hospital will remain fast-paced if you settle in a Tier 1 city! We are getting “westernised / modern” faster than you could think or imagine – for BOTH good and bad. Try moving closer to be with family; kids will have a very different upbringing compared to the US. Eventually, you won’t get too annoyed when people invade your personal space. 

Since this comes up on almost every call I have with NRIs, I’ll mention it here—having domestic help can truly make day-to-day life much easier. That said, managing and working with help is a skill in itself and takes a little getting used to.

The cost of living is not too high, even in the best cities, unless you want to lead a page 3 lifestyle. So even if you don’t make “too much,” it’s ok. You don’t need much money to lead a decent, comfortable lifestyle here. Do not compare it with the numbers in the US. It’s a different economic ecosystem. 

But do keep this in mind – you will not be able to enjoy the same work-life balance that you can in the US. You will work more hours and probably have fewer vacations; the output is directly proportional to the number of hours you can and want to put in.

Immigration

Indian Citizens and Overseas Citizens of India (OCI) can practice medicine in India on a permanent, long-term basis. Non-Indian citizens and Non-OCIs do get an opportunity to practice temporarily in India, though getting a temporary license can be quite an uphill task, depending on your current visa status and country of origin.

 

Bottom Line

The Indian healthcare system is not easy to adjust to. There is no standardization of work, pay, or turf. Don’t expect a red-carpet welcome as an “American-trained” doctor practicing in India. You may face a bit of hostility since you haven’t been in the trenches of the Indian healthcare system. As mentioned before, many people don’t understand the meaning of “Board Certified” – all they understand is MD/DM/MCH.

Be clear on your reason for moving to India. You will need to hold on to these reasons when you breathe in the pollution, drive through the potholes, and work long hours. If you move to India just to give it a try, chances are things will not work out. The beginning is tough; the best parts come after a long slog. 

I know many physicians who returned for various reasons and then returned to the US.

Despite the struggles, the community of American doctors practicing abroad in India is growing rapidly. Those who are determined will pave their own path – where there’s a will, there’s a way!

It has been close to eight years since I returned to India and knowing what I know now, I would still make this decision to return again. My six-year stay in the US, spanning internal medicine residency, nephrology fellowship, and kidney transplant fellowship, was very satisfying and gave me a lifetime of skills, knowledge, memories, and friends.

 

Dr. Sagar Gupta is an American-trained nephrologist currently practicing in India. He completed his MBBS at Maulana Azad Medical College, New Delhi, followed by internal medicine residency and nephrology and kidney transplant fellowships in the US. In 2017, he returned to India and now serves as Consultant and Head of the Department of Nephrology & Kidney Transplantation at Metro Hospital, Faridabad.

Thinking about moving to India? You can book a one-on-one session with Dr. Gupta through our Guidance Service to get honest, personalized advice from someone who’s walked the path. Click here to learn more. 

 

Updated May 20, 2025

Originally Published Jan 13, 2021