GLADSTONE D’COSTA
The NEET examination was established as a standard entrance ex amination nationwide for MBBS admissions after a very turbulent gestation period and SC intervention. The main purpose was to set up a lev el playing field and a uniform admission process. As on date, there are 816 medical colleges in India. Of these, roughly half are private; and a significant portion of these are owned or controlled by political fami lies and trusts. Though there are no official statistics, at the time of NEET introduction, there were about 80 parlia mentarians across party lines who had a significant direct or indirect stake in private medi cal colleges. Political interest revolves around numerous factors. Medical education is a highly lucrative business due to high tuition fees, capitation fees, and “management quota” seats, creating an estimated Rs 10,000 crore industry. Politi cians can strengthen their vot er base with a medical college which provides local employ ment and infrastructure. They are also able to manipulate and provide the large tracts of land required for a college. We have come a long way from the Ma caulay era debate of whether medical education should be in English or not. In the days gone by, the medical profession was an extremely attractive one for personal fulfilment, social sta tus, and increasing ones’ value in the marriage market. How ever, things have changed as a result of the stress of the job, litigation, violence, lack of se curity and other social issues. According to data from the Medical Counselling Committee (MCC), the number of vacant seats at all- India level, after the first round of counselling, has gone up from 11,629 in 2021 to 17,619 in 2025. Last year, in Chennai, at least 136 MBBS seats in the state, including 9 in AIIMS-Madurai, were vacant after three rounds of counsel ling. Students who were allotted seats did not join their respective institutions. Seats under quotas from Jain minorities, NRIs, and children/widows of armed forc es, went vacant every year. The implemented solution in previous years to slash the NEET cut-off. This was strongly objected to with a PIL in the SC on the grounds that this “com promised the integrity of the profession and threatens pub lic health”. During PG medical counselling in 2023, the cut-off percentile was reduced to zero for all categories, making the appearance for NEET a mere formality. The last OBC seat was allotted to a candidate who scored 5 marks in 2023. Critics argue that a disproportionate number of these vacancies ex ist in private medical colleg es, and that lowering cutoffs questions the competence of the candidate. Meritorious students are prevented from getting admission because they cannot afford the astronomical fees often collected under the table. In short, students who would otherwise not be con sidered for admission do so. Such views are not unfounded. The Economic Survey of 2021 suggested that, in 2018, though access to healthcare had im proved, about 1.6 million deaths in India occurred due to poor quality of care. Multiple stud ies report serious deficiencies in healthcare provider compe tence, with wrong diagnoses and incorrect or unnecessary diagnostic tests. Irrational pre scriptions and poor diagnostics shockingly account for two thirds of total out of pocket ex penditure with worse health outcomes. Irrational use of drugs is also fuelling resistance to an tibiotics. As a result, patients tend to flock to secondary and tertiary centres for even minor problems, or opt out of the pub lic system totally. The situation is worse for persons from lower social groups and rural areas. It gets worse. On 12th of Jan uary 2026, IMAHQ formally wrote to the Union Minister of Health and Family Welfare re questing lowering of NEET PG 2025 qualifying cutoff score as 18000 PG seats were vacant. The National Board of Examina tions on 13th January prompt ly, within 24 hours, notified a revised cutoff reducing the re quired percentage marks for a General Category student to be 12.88% or 7th percentile. A Re served category student would be eligible to join a postgradu ate medical program even if he scored minus 40 marks out of 800 or zero percentile (-5%). The immediate response, which under normal circumstances would take at least a week, to be referred to the National Board of examinations, suggests a far cical gaming of the system. One can’t help wondering whether the IMA was quietly primed to write such a letter to the gov ernment so that the latter could happily oblige and immediately satiate the appetite of the many members of parliament and senior politicians who own or are in managing positions of these colleges. A “decent” re turn on investment was there by assured. The IMA has not exactly covered itself in glory by being a party to this subter fuge. One wonders if the farce of MBBS as a prerequisite qual ification for Post graduation is better removed in view of the political inclination to create and fill more and more MBBS and PG medical seats for finan cial returns The proposed qualifying Na tional Exit Test (NExT) at the end of the course, consisting of an MCQ examination, followed by a practical, clinical assess ment could provide an alter native. Even a comprehensive framework as is followed in the West, where each phase of undergraduate training carries meaningful weight in the final assessment could be consid ered. A revalidation after every 5 years could be added to ei ther of these. Such an approach may help draw deserving stu dents back to classrooms. The situation is no better in nursing colleges. Seven private nursing colleges recorded zero admissions in Maharashtra for the academic year 2025-26. 33 private colleges reported less than 10 admissions each with some admitting one or two stu dents in spite of relaxation of eligibility criteria. Under these circumstances, it is difficult to fathom the ration ality of the budget 2026 pro viding for an increase of nearly 10,000 seats. If the standard of healthcare is to improve, admis sions can no longer be based on financial returns; and the whole structure of the profession has to be reviewed. (The author is the Past IMA Goa State President, founder member and Past President of VHAG, and a past member of the Central Executive Com mittee of VHAI)
