Why an Exam Like NEET Does Not Work for a Country as Diverse as India

Written by Sakthirajan Ramanathan and Sundaresan Chellamuthu

Since it started about ten years ago, the National Eligibility cum Entrance Test (NEET) has been a hot topic in Tamil Nadu. Recently, it has become a national issue. NEET was created to ensure that students are selected for medical schools based on merit and to standardize the medical entrance process. It was also meant to stop private medical institutions from charging high capitation fees. But has NEET achieved these goals? Has it stopped the commercialization of medical education?

This year, over 24 lakh candidates took the NEET exam, paying application fees between Rs 1,000 and Rs 1,700. The application fees alone brought in about Rs 337 crore for the testing agency. Additionally, many candidates spend a few lakhs at coaching centers to prepare for the test.

The initial eligibility for qualification, which was 50 percentile, was reduced to 30 percentile in 2020 and further to zero percentile in 2023. The reason given was that many seats in private medical colleges were vacant. However, after the 60,000 seats in government medical colleges are filled, the ability to pay plays a big role in filling the remaining 50,000 seats in private colleges. This makes it nearly impossible for students from economically weak backgrounds to achieve their dream of becoming doctors, even if they score high marks in NEET. Nearly half of the MBBS seats end up being reserved for the wealthy, which goes against the goal of rewarding merit.

NEET is just one of several changes in the country’s medical education system in the past decade. Other changes include the dissolution of the Medical Council of India due to corruption charges, a reduction in the faculty-student ratio from 1:1 to 1:3, and a public-private partnership model 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 like the Ayushman Bharat insurance scheme, which allows people below the poverty line to access tertiary care, and renaming primary health centers as Ayushman Arogya Mandir with private partnership. Medical education and healthcare, which were once government services, have gradually become commodities with increased private participation.

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

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

Tamil Nadu has tried several methods for entrance to professional courses, starting with an interview system in the 1970s, entrance examinations in 1983, and giving 2/3rd weightage to marks in relevant 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 based on higher secondary marks. This method is still used for admissions to engineering institutes in the state. Even after NEET was introduced, the government ensured social equality and inclusivity to some extent by providing reservations for government school students as per the recommendations of the P Kalaiyarasan and AK Rajan committees.

Tamil Nadu’s experiences over five decades show that factors like infrastructure, faculty numbers, and the extent of patient care services determine the quality of young doctors. These factors play a much more decisive role compared to entrance examinations. The exam-based selection criteria are 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 students from different backgrounds in a country with many diversities is not a fair 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 consulted 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 has 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 reservations and quotas for government school students, will make the entrance process more inclusive. Limiting the number of repeaters to a fixed percentage and allocating 15 percent of seats for candidates from the rest of the country would be a fair system in a state. Allocating a small percentage of seats to allied health sciences candidates — like nursing — will create a lateral entry system, similar to engineering and polytechnic courses. Objective type questions can be added to high school board examinations, and the scores can be used to decide the best candidate in case of a tie.

The primary goal 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 also providing adequate support to students from marginalized communities. The aim should be to ensure that people from disadvantaged sections are adequately represented in the medical field and 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).