JUDGMENT : N. NAGARESH, J. 1. The petitioners in all these writ petitions are Indian students who pursued their Medical Degrees outside India. Indian citizens and Overseas Citizens of India who have obtained their primary medical qualifications from institutions outside India are required to pass the Foreign Medical Graduate Examination (FMGE) in order to get registration under the National Medical Commission (NMC) or any State Medical Council. They are required to obtain provisional registration under the State Medical Councils in order to apply for Compulsory Rotating Medical Internship (CRMI). The Foreign Medical Graduates are required to complete a 12 month CRMI on par with Indian Medical Graduates (IMGs) in order to become eligible to apply for permanent registration under the State Medical Councils. 2. The petitioners in these writ petitions completed their medical degree courses abroad, in countries like Russia, Bulgaria, Philippines and Guyana. On their return after education, they applied for CRMI and were allotted to various General Hospitals. The petitioners were required to pay an annual fee to complete their one year internship. The fee demanded was higher than the fees levied from Indian Medical Graduates. The petitioners impugn Government Orders fixing the fee for CRMI and seek to declare that they are entitled to do internship without paying any fee. 3. Sri. Abhilash K.N., counsel for the petitioners in W.P. (C) No.19369/2025, argued that no fee is to be charged from Foreign Medical Graduates doing CRMI in view of the Circular dated 19.05.2022 of the National Medical Commission. As per clarification issued under Circular dated 09.05.2023 of the NMC, the amount of stipend payable to the interns is to be decided by the appropriate authority applicable to the institution/University or State. However, the Government of Kerala issued GO dated 03.04.2025 ordering that the Foreign Medical Graduates have to pay Rs. 5,000/- per month as internship fee. They have to remit Rs. 60,000/- as fee for the whole year, even though they practice for only a few months. 4. The counsel for the petitioners pointed out that though the NMC has issued Circular dated 19.10.2022 leaving it up to the Institution/University/State to decide the amount of stipend payable to the interns, the discretion/power given under Circular dated 19.10.2022 is only with respect to the stipend payable to the interns. The NMC gives no option to the State to levy any amount as internship fee. 5. The NMC gives no option to the State to levy any amount as internship fee. 5. A Division Bench of this Court has held that it is clear from the Circular issued by the NMC that the policy of the Commission is that no fee shall be charged from the Foreign Medical Graduates for permitting them to do internship by the Medical Colleges. The Division Bench, in the judgment in W.P. (C) No.23663/2020 and connected cases, directed the Secretary, Department of Health and Family Welfare, Government of Kerala to consider the issue of fixation of fee for internship as per GO dated 16.10.2020 in the light of Circular dated 04.03.2022 of the NMC and take a decision. The decision taken thereupon as per GO dated 03.04.2025 goes against the policy of the NMC and the judgment rendered by the Division Bench of this Court. 6. Sri. T.K. Ananda Krishnan, counsel for the petitioner in W.P. (C) No.19908/2025, urged that in view of Section 10 of the National Medical Council Act, the power to make policy regarding the internship is exclusively vested with the NMC. The NMC has framed Regulations in this regard. The Government Order dated 03.04.2025 goes against the statute and hence is ultravires. 7. Sri. Sidharth O.K., counsel appearing for the petitioners in W.P. (C) No.20172/2025, submitted that after qualifying the FMGE and obtainining provisional registration, there cannot be any distinction between Indian Medical Graduates and Foreign Medical Graduates with respect to internship. There is no substantial difference between Indian Medical Graduates and Foreign Medical Graduates once the Foreign Medical Graduates clear FMGE and obtain provisional registration. 8. Mr. V.K. Sidhique, the counsel appearing for the petitioners in W.P. (C) No.19383/2025 and connected cases, pointed out that no additional infrastructure, training or stipend is provided in return of the internship fee. There is no corresponding benefit to the internship fee paid. The Government Order dated 03.04.2025 contradicts the Regulations of the NMC and the provisions of the NMC Act itself. It is the NMC and NMC alone which is empowered to lay down policies for maintaining quality and standards of medical education. The NMC has already ordered that no fee should be charged for doing CRMI. The Government Order dated 03.04.2025 is therefore liable to be set aside. 9. Ms. It is the NMC and NMC alone which is empowered to lay down policies for maintaining quality and standards of medical education. The NMC has already ordered that no fee should be charged for doing CRMI. The Government Order dated 03.04.2025 is therefore liable to be set aside. 9. Ms. Farah Jyothi Pradeep, counsel appearing for the petitioners in W.P. (C) Nos.19454/2025 and 20259/2025, argued that the GO dated 03.04.2025 clearly offends Article 14 of the Constitution of India as there is no intelligible differentia in doing internship in Government Medical Colleges and Private Medical Colleges. Levy of any fee pre-supposes quid pro quo. There is no quid pro quo in the matter of internship being done by Foreign Medical Graduates. Not even library facility is provided by the Government to them. The Foreign Medical Graduates are working in frontline, in Hospitals. They are being denied even stipend. Levy of internship fee is exploitation of students. Internship fee imposed on Foreign Medical Graduates amounts to taxation which has no sanction of law. The levy is contrary to the policy decision and orders of NMC. The petitioners have a legitimate expectation to do CRMI without paying any internship fee and also to receive due stipend. 10. Sri. P.G. Pramod, Special Government Pleader representing the State of Kerala, resisted the writ petitions forcefully. The State derives power to prescribe stipend and internship fee for Indian and Foreign Medical Graduates, from Entry 25, List III of the Seventh Schedule to the Constitution of India. The powers of the NMC are as confined in Section 10 of the National Medical Commission Act, 2019. The Act gives power to the NMC to prescribe policy guidelines. The NMC cannot restrain the State Governments from levying a fee for internship from Indian or Foreign Medical Graduates. 11. The Government issued GO dated 16.10.2020 prescribing Rs. 10,000/- as internship fee for FMGs. The GO was issued on the basis of a decision taken in the meeting held under the Chairmanship of Minister for Health, on 03.03.2020. Consequently, internship fee was fixed as Rs. 10,000/- for FMGs. The internship fee for students of Self Financing Colleges was fixed as Rs. 5,000/- per month. W.P.(C) Nos.23663/2020 and 24610/2020 were filed contending that the differential treatment is discriminatory. 12. Consequently, internship fee was fixed as Rs. 10,000/- for FMGs. The internship fee for students of Self Financing Colleges was fixed as Rs. 5,000/- per month. W.P.(C) Nos.23663/2020 and 24610/2020 were filed contending that the differential treatment is discriminatory. 12. This Court disposed of the writ petitions directing the State Government to reconsider the fixation of fee for internship taking note of the Circulars of the NMC. The Government decided to levy internship fee from FMGs. By Circulars dated 04.03.2022 and 19.05.2022, the NMC had clarified that no amount/fees can be charged by the Medical Colleges from FMGs for permitting them to do their internship. Subsequently, as per letter dated 19.10.2022, the NMC clarified that the Circulars dated 04.03.2022 and 19.05.2022 issuing guidelines/instructions/advisory regarding payment of stipend, are solely at the discretion of the concerned State authorities. 13. Seats in Government Medical Colleges are limited. In order to complete the internship without delay, the Government have provided opportunity to FMGs to complete internship at District/General Hospitals in the State. Since the District/General Hospitals are not full fledged teaching institutions, additional infrastructure, library, manpower, security facilities, etc. are to be arranged for training the interns. The State bears huge amount of money to maintain a Hospital capable of being training centre for CRMI. During the internship period, the FMGs are availing onhand training in an excellent manner under competent and qualified Doctors. The fee charged from FMGs is not excessive. However, in view of the directions of the Division Bench of this Court, Government decided to refix the fee charged on FMGs for internship in District/General Hospitals at par with the fee charged to IMGs. Accordingly, the internship fee of FMGs was reduced from Rs. 10,000/- per month to Rs. 5,000/- per month. The nominal fee of Rs. 5,000/- is not excessive or on the higher side, urged the Special Government Pleader. 14. Sri. Prenjith Kumar, Standing Counsel for NMC, entered appearance and submitted that the power to regulate UG and PG Medical Education and internships mandated for the medical courses, is with the NMC. The NMC has taken a policy decision and has ordered that no internship fee shall be collected from students undergoing CRMI. The discretion left to the State authorities is confined to the amount and payment of stipend, payable to the IMGs and FMGs. 15. The NMC has taken a policy decision and has ordered that no internship fee shall be collected from students undergoing CRMI. The discretion left to the State authorities is confined to the amount and payment of stipend, payable to the IMGs and FMGs. 15. I have heard the learned counsel representing the petitioners, the learned Special Government Pleader representing the State of Kerala, the learned Standing Counsel appearing for the NMC and the learned Standing Counsel appearing for the Kerala State Medical Council. 16. The legal issue posed for decision is 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. There is no legislation, Central or State, governing internships in India. Internship is akin to apprenticeship. 17. Internships and apprenticeships are valuable ways to gain work experience and develop skills. While apprenticeships are typically longer-term, more structured and focused on developing specific vocational skills often leading to recognised qualifications, internships are generally shorter- terms, more focused on gaining overall exposure. Apprenticeships are mostly specified training program within a specific field. In India, apprenticeships are governed by the Apprentices Act, 1961. The Apprentices Act regulates and controls training of apprentices. Section 13 of the Apprentices Act, 1961 provides that an employer shall pay to every apprentice during the period of apprenticeship training such stipend at a rate not less than the prescribed minimum rate to the category of apprentices under which such apprentices fall. The Act, 1961 also contemplates entering into contracts of apprenticeship. There is no comparable independent legislation governing internships. 18. In the field of medical education, however, the NMC, in exercise of the powers conferred by Section 67 read with Section 24(1) of the NMC Act, 2019, has made National Medical Commission (Compulsory Rotating Medical Internship) Regulations, 2021. The Regulation is silent on the issue of levy of fees on medical interns. 19. While considering the issue of levy of fees from medical interns, it is necessary to understand the context under which the National Medical Commission Act, 2019 was enacted. The Union of India felt that medical education is at the core of access to quality healthcare in the country and a flexible and well functioning legislative framework underlying medical education is essential for the well being of a nation. The Union of India felt that medical education is at the core of access to quality healthcare in the country and a flexible and well functioning legislative framework underlying medical education is essential for the well being of a nation. It was felt that the Indian Medical Council Act, 1956, which was enacted to provide a foundation for the growth of Medical Education, has not kept pace with time. The Department-Related Parliamentary Standing Committee on Health and Family Welfare in its 92 nd report has offered a critical assessment of medical education in India. The Standing Committee recommended for a decisive and exemplary action to restructure and revamp the regulatory system of medical education and medical practice and to reform the Medical Council of India in accordance with the regulatory structure suggested by the Group of Experts chaired by Dr. Renjith Roy Chowdary which was constituted by the Central Government. 20. In paragraph 5.36 of the 92 nd report of the Committee, the Committee observed that though the constitutionally designated fee rgulation committees of the respective State Governments fixes the fee to be charged by Private Medical Colleges, yet the yearly tuition fee and other expenses that have to be paid by a student through a year duration, work out in the range of Rs. 12-13 laks or even more which is certainly exorbitant and beyond the paying capacity of poor but meritorious students and the same, therefore, needs to be rationalised. As of now, the Union Health Ministry does not play any role in fixation of the tuition fee. The Committee was of the opinion that since the Ministry of Health and Family Welfare plays a critical role in supporting the regulation of medical education, it should be enabled to play a role in regulating fee structure in Private Medical Colleges so that the right quantum of tuition fees to be charged by Private Medical Colleges is ensured and there is uniformity in fees across the country amongst the public and private sector Medical Colleges / Institutions. The observations of the Committee would indicate that the Central Government was concerned about the higher rates of fees levied in the medical education sector. It is considering the report of the Department-Related Parliamentary Standing Committee on Health and Family Welfare also that the National Medical Commission Act, 2019 was enacted. 21. The observations of the Committee would indicate that the Central Government was concerned about the higher rates of fees levied in the medical education sector. It is considering the report of the Department-Related Parliamentary Standing Committee on Health and Family Welfare also that the National Medical Commission Act, 2019 was enacted. 21. The preamble to the Act, 2019 would indicate that the Act is intended to provide “affordable” medical education and to ensure availability of adequate and highly qualified medical professionals in all parts of the country in order to promote equitable and universal healthcare that encourages community health perspective and makes services of medical professionals accessible to all the citizens. Any fee prescribed by the State Governments, Universities and Medical Colleges including tuition fees and internship fees would therefore have an impact on access to quality and affordable medical education which is the purpose for which the National Medical Commission Act, 2019 has been enacted. 22. Coming to the statutory provisions and powers of the stakeholders, Section 10 of the Act, 2019 lays down the powers and functions of the NMC. Section 10 of the Act, 2019 reads as follows: 10. Powers and functions of Commission— (1) The Commission shall perform the following functions, namely:— (a) lay down policies for maintaining a high quality and high standards in medical education and make necessary regulations in this behalf; (b) lay down policies for regulating medical institutions, medical researches and medical professionals and make necessary regulations in this behalf; (c) assess the requirements in healthcare, including human resources for health and healthcare infrastructure and develop a road map for meeting such requirements; (d) promote, co-ordinate and frame guidelines and lay down policies by making necessary regulations for the proper functioning of the Commission, the Autonomous Boards and the State Medical Councils; (e) ensure co-ordination among the Autonomous Boards; (f) take such measures, as may be necessary, to ensure compliance by the State Medical Councils of the guidelines framed and regulations made under this Act for their effective functioning under this Act; (g) exercise appellate jurisdiction with respect to the decisions of the Autonomous Boards; (h) lay down policies and codes to ensure observance of professional ethics in medical profession and to promote ethical conduct during the provision of care by medical practitioners; (i) frame guidelines for determination of fees and all other charges in respect of fifty per cent. of seats in private medical institutions and deemed to be universities which are governed under the provisions of this Act; (j) exercise such other powers and perform such other functions as may be prescribed. (2) All orders and decisions of the Commission shall be authenticated by the signature of the Secretary. (3) The Commission may delegate such of its powers of administrative and financial matters, as it deems fit, to the Secretary. (4) The Commission may constitute sub-committees and delegate such of its powers to such sub- committees as may be necessary to enable them to accomplish specific tasks. 23. The National Medical Commission therefore has the power to lay down policies for maintaining a high quality and high standards in medical education and make necessary regulations in this behalf. Sub-section (i) of Section 10(1) empowers the NMC to frame guidelines for determination of fees and all other charges in respect of 50% of seats in private medical institutions and deemed to be Universities which are governed under the provisions of the Act. Section 10(1)(b) empowers the Commission to lay down policies for regulating medical institutions, medical researches and medical professionals and make necessary regulations in this behalf. When the NMC frames regulations and guidelines in exercise of the powers under Section 10 of the Act, 2019, such regulations and guidelines would indeed have a statutory flavour, which cannot be ignored or departed from by the State, Universities or Medical Institutions. 24. On the subject of internship, the NMC has issued Circular No.U.15024/01/2022-UGMEB dated 19.05.2022. The Circular comes with the subject “illegal charge of internship fee and non-payment of stipend to interns”. Taking note of the requirement of Doctors in India including those who have completed their medical education abroad, the NMC ordered that Medical Colleges or Institutions may allow up to 7.5% of their permitted quota of interns to accommodate internship by Foreign Medical Graduates. The Circular dated 19.05.2022 pointed out that the NMC as per Circular dated 04.03.2022, had clarified that no amount/fee is charged by the Medical Colleges from FMGs for permitting them to do their internship. The stipend and other facilities to FMGs should be extended equivalent to India Medical Graduates being trained at Government Medical Colleges as fixed by the appropriate authority applicable to the Institution/University or State. 25. The stipend and other facilities to FMGs should be extended equivalent to India Medical Graduates being trained at Government Medical Colleges as fixed by the appropriate authority applicable to the Institution/University or State. 25. The Circular dated 19.05.2022 directed all State Medical Councils and Directorates of Medical Education to ensure that no internship fee is charged by the Medical Colleges / Institutes from the interns, Indian and Foreign Medical Graduates, and stipend including other facilities is being provided to FMGs as equivalent to Indian Medical Graduates in the States/UTs. 26. The NMC received a number of representations/queries from various stakeholders seeking clarifications on different issues regarding mode and method of conducting medical internship for Foreign Medical Graduates in India. On the question of payment of stipend to FMGs, considering the requests/representations from various State Governments / UTs / Medical Colleges wherein it was intimated that there has been no budgetary provision in their allocation of annual budget to provide stipend to Foreign Medical Graduates, the NMC clarified that the amount of stipend to be paid to the interns is to be decided/fixed by the appropriate authority applicable to the Institution/University or State. The implementation of these guidelines / instructions/advisory is solely at the discretion of the concerned State authorities under which the Medical College / Institute is located. 27. The Special Government Pleader would urge that by Circular dated 09.05.2023, the NMC has given discretion to the Institutions/Universities or States in the matter of not only the stipend payable to FMGs but also the internship fees that can be levied from them. This Court cannot agree to that proposition for the reason that in the Circular dated 09.05.2023, the clarification giving discretion to the State is coming under the head “payment of stipend to FMGs”. The Circular dated 09.05.2023 does not specifically give discretion to the States to levy internship fee. 28. The NMC thereafter issued a Circular with E File No.U-15024/44/2022-UGMEB dated 19.10.2022 again giving clarification on the references received from State Medical Councils regarding CRMI of FMGs. Paragraph 5 of the said Circular dated 19.10.2022 reads as follows: 5. Further, vide Circulars dated 04.03.2022 and 19.05.2022, NMC has also issued guidelines/instruction/advisory to all the concerned authorities regarding payment of stipend to all interns for their consideration and compliance. Paragraph 5 of the said Circular dated 19.10.2022 reads as follows: 5. Further, vide Circulars dated 04.03.2022 and 19.05.2022, NMC has also issued guidelines/instruction/advisory to all the concerned authorities regarding payment of stipend to all interns for their consideration and compliance. However, the amount of stipend to be paid to the interns is to be decided/fixed by the appropriate authority applicable to the institution/University or State. The implementation of these guidelines/instruction/advisory is solely at the discretion of the concerned State authorities under which the Medical College / Institute is located. A reading of Circular dated 19.10.2022 would make it clear that the discretion granted by the NMC to the State authorities is confined to payment of stipend to the FMGs. 29. A Division Bench of this Court also considered the matter in W.P.(C) No.23663/2021 and connected cases. This Court observed that it is clear from the Circular issued by the NMC that the policy of the Commission is that no fee shall be charged from the Foreign Medical Graduates for permitting them to do the internship, by the Medical Colleges. The Division Bench was of the view that the State Government shall take note of the Circular dated 04.03.2022 issued by the NMC and take a fresh decision in the matter of charging fee for internship from Foreign Medical Graduates as the same reflects the policy of the apex body in the field of medical education. 30. It is when the levy of internship fee in any manner is prohibited by the NMC and when a Division Bench of this Court has made it clear that a decision shall be taken by the State Government taking note of the Circular dated 04.03.2022 issued by the NMC that the Government of Kerala has come up with GO(Rt) No.987/2025/H&FWD dated 03.04.2025. The GO dated 03.04.2025 took a stand that the NMC had clarified that the Circulars dated 04.03.2022 and 19.05.2022, issuing guidelines/ instructions / advisory to all concerned authorities regarding payment of stipend are solely at the discretion of the concerned State authorities under which the Medical College / Institute is located. 31. In GO dated 03.04.2025, the Government stated that Government Medical Colleges do not charge any fee for internship from any student whether they are FMGs or not. The seats available in Medical Colleges are limited. The FMGs are therefore provided opportunity to complete internship at District/General Hospitals. 31. In GO dated 03.04.2025, the Government stated that Government Medical Colleges do not charge any fee for internship from any student whether they are FMGs or not. The seats available in Medical Colleges are limited. The FMGs are therefore provided opportunity to complete internship at District/General Hospitals. Since the District/General Hospitals are not full fledged teaching institutions, additional infrastructure, library, manpower, security facilities, etc. need to be arranged for training the FMGs interns. On these premises, the Government reduced the internship fees charged to the FMGs from Rs. 10,000/- to Rs. 5,000/- per month at par with Indian Medical Students. It has been ordered that the FMGs have to remit Rs. 60,000/- as fee for the whole year, even though they practised for few months only. As the NMC Circular dated 19.05.2022 unequivocally prohibits levy of internship fee and describes the levy of any internship fee as illegal, the GO dated 03.04.2025 is legally unsustainable. 32. There is a further reason to hold against levy of any fee from the interns. The interns are deployed to the Medical Colleges / Government Hospitals to discharge the duties of Doctors. They are so deployed only after obtaining Certificate of Provisional Registration from the State Medical Council. The Certificate of provisional registration makes it clear that the Certificate is valid only for employment in a resident medical capacity in any approved institution or in the medical service of the armed forces of the Union as mentioned in Section 25 of the Indian Medical Council Act, 1956 as amended. 33. From the Provisional Registration granted by the State Medical Councils, it is evident that medical graduates who obtained provisional registration and deployed as interns would be working in a resident medical capacity and such engagement amounts to employment. The interns are not deployed to Medical Colleges/General Hospitals for training simplicitor. The medical interns are getting experience as Doctors while working in a resident medical capacity. Such interns are often deployed to examine the patients, prescribe medicines and may even be directed to conduct minor surgical procedures. The Medical Colleges/General Hospitals are therefore getting benefits of their service, which is in the nature of employment. 34. The NMC Act, 2019 has been enacted to provide for a medical education system that improves access to quality and medical education affordable to the citizens. The Medical Colleges/General Hospitals are therefore getting benefits of their service, which is in the nature of employment. 34. The NMC Act, 2019 has been enacted to provide for a medical education system that improves access to quality and medical education affordable to 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 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 ultravires. Consequently, the GO dated 03.04.2025 is set aside. The issue of payment of stipend to the FMGs is left open. 35. The writ petitions are disposed of as above.