Nearly 44 percent of medical doctors with MBBS and BDS degrees who sat for licensing exams of the Nepal Medical Council have failed to get pass marks.

The council is the national regulatory body of medical doctors and dentists.

“Those who do not secure pass marks cannot practise medicine,” said Dr Bishwa Raj Dawadi, registrar at the council. “Medical graduates must pass a licensing test before they can begin practising.”

Of the total 2,028 doctors—1,737 holding MBBS and 285 with BDS degrees—who appeared in the licensing tests held between Tuesday and Friday, only 1,146 (972 MBBS doctors and 174 BDS doctors) secured pass marks.

This is not the first time such a large number of medical doctors failed to secure the minimum marks necessary to practise medicine in the country. Officials at the council said up to 70 percent of doctors would fail to secure pass marks in the licensing tests in the past.

In 2022, around 58 percent of MBBS and BDS degree holders who took the council’s licensing exams had failed.

In the past, the success rate of doctors who pursued medical degrees from foreign universities used to be low compared to those who graduated from national universities.

However, this time around, the council said that it refrained from disclosing the identities and other details of the examinees.

“Multiple factors might have been responsible for the poor result of doctors,” said Dr Bhagawan Koirala, former chairman of the council. “Some may have repeatedly appeared in exams. Those who cannot pass the test once have a high chance of failing again.”

The education quality of some universities could also have declined, according to doctors.

Experts, as well as academicians who have long been involved in medical practice, warned that licensing exams are not just about getting a certificate to practise medicine, but are broadly linked to the quality of the country’s healthcare.

To qualify as a medical practitioner, a doctor must secure at least 50 percent marks in the licensing exam.

Experts say the quality of medical education has been compromised with underachievers who do not deserve to practise medicine entering the medical profession.

“As far as I know, the council [NMC] does not compromise on the quality of doctors,” said Koirala.

The World Health Organisation said that in all countries there are inaccurate diagnosis, medical errors, inappropriate or unnecessary treatment, inadequate or unsafe clinical facilities and practices, and healthcare providers who lack adequate training and expertise.

But the situation is worse in low- and middle-income nations.

Doctors say it would be foolhardy not to start digging for the cause of the high failure rate in the medical licensing tests: potentially the health of 30 million Nepalis are on the line.

A large number of examinees can’t pass the test even after sitting the exams multiple times. According to the council, one doctor has failed 34 licensing tests in the past.

The WHO, the UN health agency, says low-quality health care is increasing the burden of illness and health costs globally.