Since its inception about a decade ago, the National Eligibility cum Entrance Test (NEET) has been a politically contentious issue in Tamil Nadu. The recent turn of events has made it a national issue. NEET was originally conceptualized to ensure merit-based selection to medical schools and standardize the medical entrance process. It was seen as a solution to the problem of high capitation fees being charged by private medical institutions. Has the examination achieved its intended goal? Has NEET curbed the commercialization of medical education?

This year, more than 24 lakh candidates sat for the NEET after paying application fees ranging between Rs 1,000 to Rs 1,700. The application charges alone give a revenue of about Rs 337 crore to the testing agency. Moreover an individual candidate spends a few lakhs at coaching centers to prepare for the test.

The initial eligibility for qualification, 50 percentile, was diluted to 30 percentile in 2020 and further to zero percentile in 2023. The reason cited was that several seats are vacant in private medical colleges. However, after the 60,000 seats in government medical colleges are filled up, people’s paying capacity plays a big role in filling up the remaining 50,000 seats in private colleges. This makes the MBBS dream virtually unattainable for students of the economically weak strata, despite scoring high marks in NEET. Nearly half of the MBBS seats become a virtual preserve of the wealthy, making a mockery of the objective of rewarding merit.

NEET is one of the several alterations in the country’s medical education ecosystem in the past decade. The other changes include the dissolution of the Medical Council of India, after the agency faced corruption charges, a reduction in the faculty student ratio from 1:1 to 1:3 and public private partnership model (PPP) for developing medical colleges in each district. with the entire district hospital being handed over to a private player. The medical sector has also seen reforms, including the Ayushman Bharat insurance scheme that allows people below the poverty line to access tertiary care and renaming the primary health centers as Ayushman Arogya Mandir with private partnership. Medical education, and healthcare in general, which was a service sector in the hands of the government, has gradually changed to a commodity with the increased participation of private players.

Festive offer

How does NEET compare with exams like the UCAT in the UK and MCAT in the US? These tests allow only students with excellent grades in higher secondary education to take the exams. In contrast, a NEET applicant only requires to pass the higher secondary school.

This low entry requirement can undermine the importance of excelling in high school. This, in turn, lowers the standard of school education. The state government and their education ministries do not have any say in the selection process of future doctors in their states. Finally, incidents such as paper leaks and allocation of grace marks, without formal approval of a competent committee, have eroded trust in NEET and the National Testing Agency (NTA).

Tamil Nadu has conducted several experiments in the entrance system to professional courses, starting from an interview system in the 1970s to the entrance examinations in 1983 along with 2/3rd weightage to marks in concerned subjects in the higher secondary education exam.

Following recommendations from the Anandakrishnan Committee, the state abolished entrance exams and conducted admissions to medical and engineering colleges solely on the basis of higher secondary marks. This method is still followed in admissions to engineering institutes in the state. Even after the introduction of NEET, the government ensured social equality and inclusivity, to an extent, by providing reservation to government school students as per the recommendations of P Kalaiyarasan and AK Rajan committees.

Tamil Nadu’s experiences over five decades demonstrate that factors such as infrastructure, faculty numbers and the extent of patient care services determine the quality of young doctors. These factors play a far more decisive role compared to entrance examinations. The exam-based selection criteria is merely a gate-pass. Moreover, as American educationists William Sedlacek and Sue H Kim note, “If different people have different cultural and racial experiences and present their abilities differently, it is unlikely that a single measure could be developed that would work equally well for all”. Testing the faculties of students who come from different backgrounds in a country with myriad diversities is not a justifiable method.

NEET needs to be reevaluated. Public health is a state subject and education is part of the concurrent list. All states need to be taken into confidence, before framing the admissions processes, especially in institutions controlled by the state government. The debate on NEET touches on broader issues such as educational equity and federalism. The debate on the examination is not just an academic issue but a deeply political one.

If NEET is riddled with problems, what are the alternatives? Instead of a single cross-sectional assessment, a summative assessment over two to three years of performance in school education along with a general aptitude test might improve the selection process. This along with existing caste-based reservation and quotas for government school students will make the entrance process more inclusive. Keeping the number of repeaters to a fixed percentage and allocating 15 percent seats for candidates from the rest of the country would be a fair system in a state. Allocation of a small percentage of seats to allied health sciences candidates — nursing, for instance — will create a lateral entry system, similar to engineering and polytechnic courses. Objective type questions can be added in the high school board examinations, the scores of which can be used to decide the best candidate in case of a tie between candidates.

The primary objective of refining the medical entrance process is to ensure that students with high average marks gain admission not only to government-run medical colleges but also that the admission criteria of private institutions are safeguarded to admit only those with significantly higher scores, while simultaneously providing adequate support to students from marginalized communities. The goal should be to ensure that people from disadvantaged sections are adequately represented in the medical field and they can contribute to making healthcare accessible to their communities.

Ramanathan is Assistant Professor of Nephrology, Madras Medical College and Chellamuthu is Associate Professor of Radiation Oncology, Madras Medical College and State President, Government All Doctors Association (GADA).