Here's the reality that no admission agent will tell you: The Pakistan Medical and Dental Council (PMDC) requires all foreign medical graduates (FMGs) to pass the National Registration Examination (NRE) before they can practice in Pakistan. The exam is conducted twice a year by the National University of Medical Sciences (NUMS)[reference:0][reference:1]. And the pass rates are devastating.
In the December 2025 NRE Step-1, out of 7,076 candidates who appeared, only 1,473 passed — an overall pass rate of 20.8%[reference:2][reference:3]. Medical graduates had a pass rate of 21.17%, while dental graduates had just 7.23%[reference:4][reference:5]. Nearly 4 out of 5 foreign medical graduates fail on their first attempt.
The math of despair: If 100 Pakistani students go abroad for MBBS, only about 20 of them will pass the NRE Step-1 on their first attempt. The other 80 will have to retake the exam — and there's no guarantee they'll pass the second time either. Families spend millions on tuition and living expenses, only to see their children fail the licensing exam that's required to practice in Pakistan.
Country-by-Country NRE Performance
The NRE results reveal a clear pattern: graduates from certain countries perform drastically worse than others. Here's the breakdown from the December 2025 exam[reference:6][reference:7][reference:8]:
| Country | Candidates | Passed | Pass Rate |
|---|---|---|---|
| Kyrgyzstan | 4,256 | 951 | ~22% |
| China | 2,154 | 333 | ~15.5% |
| Kazakhstan | 174 | 54 | ~31% |
| Uzbekistan | 116 | 35 | ~30% |
| Tajikistan | 91 | 30 | ~33% |
| Russia | 16 | 2 | ~12.5% |
| Afghanistan | 160 | 18 | ~11% |
| Ukraine | 14 | 2 | ~14% |
| Malaysia | 1+ | 1 | ~100% |
Zero pass rate from 8 countries: Not a single candidate from Barbados, Cuba, Cyprus, the Dominican Republic, Georgia, the Philippines, Saint Lucia, or Sudan passed the NRE Step-1[reference:9][reference:10][reference:11]. Officials described these results as "alarming" and pointed to "systemic academic shortcomings rather than isolated individual failures"[reference:12].
In contrast, countries with very small numbers of candidates achieved high success rates — but officials described these results as "statistically insignificant"[reference:13][reference:14]. For example, Bangladesh had 10 passes out of 11 candidates, Iran had 20 out of 39, and Bahrain, Saudi Arabia, Hungary, Poland, Romania, the UK, and the UAE each achieved a 100% pass rate with 1-3 candidates appearing[reference:15][reference:16].
The 60% Passing Threshold — and What It Actually Means
Candidates are required to secure 60% marks to pass the NRE[reference:17][reference:18]. There is no negative marking[reference:19]. The exam is based on a syllabus that is "equivalent to the MBBS and BDS programmes in Pakistan"[reference:20].
This means foreign graduates are being tested on the same curriculum as Pakistani medical students — but they've spent 5-6 years studying in a different system, with different teaching methods, different clinical exposure, and often a different language of instruction.
Key insight: The 60% threshold isn't arbitrary. It's the minimum competency standard required to ensure patient safety in Pakistan's healthcare system[reference:21]. PMDC has stated that "allowing inadequately trained doctors to enter Pakistan's healthcare system would pose a serious health security risk"[reference:22].
The Curriculum Gap: Why Chinese and Russian MBBS Fails to Prepare Students
Health regulators say the primary reason behind the consistently low pass rate is poor academic and clinical training at substandard or unrecognised medical and dental colleges abroad, particularly in countries where regulatory oversight is weak and admission standards are low[reference:23].
Here are the specific gaps that make it so difficult for foreign graduates to pass the NRE:
The PMDC warning: "Parents are urged to recognise that choosing unrecognised or low-standard institutions not only places their children's professional future at risk but also results in the waste of hard-earned financial resources and the irretrievable loss of their children's precious time and years of effort"[reference:32].
The Two-Step NRE Process
The NRE is a two-step examination held at least twice a year under an Act of Parliament[reference:33]:
- Step-1 (Theoretical): Tests basic medical sciences and theoretical knowledge. This is the exam where the pass rate is just 20.8%.
- Step-2 (Clinical): Tests clinical skills, clinical reasoning, and patient management[reference:34]. Officials have warned that Step-2 "could see even higher failure rates, with many candidates struggling in basic medical concepts, clinical reasoning, and patient management"[reference:35].
Candidates must pass both steps to receive provisional registration certificates from PMDC[reference:36][reference:37]. The dates for the NRE Step-II Clinical Examination are announced shortly after Step-1 results[reference:38].
The 12-Month House Job Requirement
Passing the NRE is just the first hurdle. After clearing both steps, candidates are issued provisional registration certificates by PMDC, enabling them to undertake house jobs (internships) either in Pakistan or abroad[reference:39][reference:40][reference:41].
The house job is a mandatory 12-month internship required for full registration and independent medical practice[reference:42]. According to PMDC law, two NRE examinations are conducted annually for foreign medical graduates[reference:43].
Pro tip: The house job is unpaid in many government hospitals — or pays a nominal stipend. You've already spent 5-6 years abroad, paid millions in tuition, and now you're facing an additional year of unpaid work before you can start earning. This is a cost that most families don't factor into their decision.
What Happens If You Fail the NRE?
- You can retake the exam. The NRE is conducted twice a year, so you have multiple opportunities[reference:44][reference:45].
- But there's no guarantee of passing. Many graduates take the exam multiple times without success. Some eventually give up and pursue other careers.
- You cannot practice in Pakistan. Without passing the NRE, you cannot get registered with PMDC, which means you cannot legally practice medicine in Pakistan[reference:46].
- You cannot get a house job. Provisional registration is required before you can start your house job[reference:47].
- Your degree becomes worthless in Pakistan. If you can't pass the NRE, your foreign MBBS degree is essentially useless for practicing in Pakistan.
The hidden cost: "Pakistani families spend millions of dollars annually on medical education abroad, only to see many graduates fail to meet minimum professional standards"[reference:48]. The financial loss is devastating — and the career loss is permanent for those who never pass.
Why the NRE Exists — and Why It's Not Going Away
PMDC has defended the NRE as a "transparent, standardised and legally mandated screening mechanism"[reference:49]. The council has stated that the NRE is "a mandatory requirement under an Act of Parliament, aimed at ensuring transparency, standardisation, and quality in medical and dental education and professional practice in Pakistan"[reference:50].
Despite protests from foreign medical graduates[reference:51], PMDC has made it clear that "there would be no compromise on merit or patient safety" and that "there would be no dilution of standards under pressure"[reference:52][reference:53].
The bottom line: The NRE is not a conspiracy against foreign graduates. It's a quality control mechanism designed to protect patients from inadequately trained doctors[reference:54]. The low pass rate reflects real gaps in foreign medical education — not flaws in the exam itself.
Frequently Asked Questions
What is the NRE exam and who has to take it?
The National Registration Examination (NRE) is a mandatory licensing exam for all foreign medical and dental graduates (FMGs) seeking registration to practice in Pakistan. It is conducted twice a year by the National University of Medical Sciences (NUMS) under PMDC regulations[reference:55][reference:56].
What is the passing rate for the NRE Step-1 exam?
In the December 2025 NRE Step-1, out of 7,076 candidates who appeared, only 1,473 passed — an overall pass rate of 20.8%[reference:57][reference:58]. Medical graduates had a 21.17% pass rate, while dental graduates had just 7.23%[reference:59]. Nearly 4 out of 5 foreign medical graduates fail on their first attempt.
What is the pass rate for graduates from China and Russia?
China: 333 out of 2,154 candidates passed — a pass rate of 15.5%, the lowest among major countries[reference:60][reference:61]. Russia: only 2 out of 16 candidates passed — 12.5%[reference:62][reference:63]. Kyrgyzstan: 951 out of 4,256 — 22%[reference:64][reference:65].
What is the passing score for the NRE exam?
Candidates are required to secure 60% marks to pass the NRE[reference:66][reference:67]. There is no negative marking[reference:68]. The exam is based on a syllabus equivalent to the MBBS and BDS curriculum taught in Pakistan[reference:69].
What is the house job requirement after passing the NRE?
After passing both NRE Step-1 and Step-2, candidates are issued provisional registration certificates by PMDC, enabling them to undertake a mandatory 12-month house job (internship) either in Pakistan or abroad[reference:70][reference:71][reference:72]. House job is required for full registration and independent medical practice[reference:73].
Can I retake the NRE if I fail?
Yes. The NRE is conducted twice a year[reference:74][reference:75], so you have multiple opportunities to retake the exam. However, many graduates take the exam multiple times without success, and there's no guarantee of passing on subsequent attempts.
Is it worth going abroad for MBBS given these pass rates?
This is the question every family must answer for themselves. The financial cost is enormous (millions of rupees). The emotional cost is even higher. And the statistical reality is that 4 out of 5 foreign graduates fail the licensing exam. PMDC has warned that "enrollment in substandard or unrecognized colleges jeopardizes students' professional futures, wastes financial resources, and leads to the loss of valuable time and effort"[reference:76].