The contentious exam deciding the fate of India’s doctors

When India’s Education Minister Dharmendra Pradhan took oath in the new session of parliament, many opposition MPs chanted “NEET” and “shame”.

The MPs were protesting against a recent controversy that has engulfed a key national exam overseen by Mr Pradhan’s ministry.

Every year, hundreds of thousands of aspiring doctors write the National Eligibility Cum Entrance Test (Undergraduate), or NEET-UG, whose score decides who gets admitted to medical colleges.

The exam has seen fierce opposition and protests since its inception, but snowballed into a particularly huge scandal this year after thousands of students got abnormally high marks when results were declared – making it hard for even high scorers to get seats in good colleges.

Since then, a host of problems have been raised with the way the exam was held, and allegations of paper leaks and large-scale cheating have left many students dejected.

One of them is Komal, an 18-year-old from the northern state of Haryana, who had taken a gap year to study for NEET and got what would normally be considered a “decent” score. But worried that she won’t get a seat, she has joined a BSc degree course as a back-up option.

“I have decided to take the exam next year again, but I’m scared that this controversy can repeat,” she says.

Protesters have demanded a retest and two states – Tamil Nadu and West Bengal – have asked that the exam be scrapped and the old system of states conducting their own tests be brought back.

The legislative assembly of Tamil Nadu – which has seen the biggest protests – has also passed a resolution saying that the exam has negatively impacted the state’s health system as it favours students from urban and affluent backgrounds, leading to fewer doctors who want to work in poorer, rural areas.

As the opposition – including leader in parliament Rahul Gandhi – continues to protest, demanding a discussion on NEET, the issue shows no sign of dying down.

Before NEET was introduced, there was a national exam which decided who got into premier government colleges such as the All India Institute Of Medical Sciences (Aiims). Many states also conducted their own exams, while some relied on the results of a key school-leaving test.

K Sujatha Rao, who was federal health secretary in 2010 when NEET was formally notified by a Congress-led government, says there were three objectives behind a common medical exam: to standardise the educational competence of students, many of whom turned out to be weak in basic subjects; to reduce the number of entrance exams students had to write; and eliminate the so-called capitation fee – extra payment – charged by private colleges.

Many states opposed NEET, saying it took away their autonomy in college admissions.

In 2013, India’s Supreme Court agreed with this argument when it struck down the exam (by then, one round of NEET had already been held). It also said that a single test affected the “level playing field” because of the educational disparity between urban and rural areas. The court said that just “academic brilliance” was not enough in medicine but that the country needed “barefoot doctors” who would be ready to serve in remote areas.

But three years later, a constitution bench of the court recalled the order. The court’s opinion, just four pages long, did not provide any substantive reasons, only saying that the 2013 bench did not follow “some binding precedents” and that “there was no discussion” among the judges before the order was pronounced.

So from 2016, NEET replaced all other medical entrance tests and has been conducted every year.

In 2017, the suicide of a student in Tamil Nadu sparked outrage and let to huge protests against the exam. The daughter of a daily wage labourer, the 17-year-old had scored 98% in her school-leaving exam – which should have got her admitted to a good medical college – but her NEET score wasn’t good enough. She was part of a petition in the Supreme Court which argued that the exam hurt students from poorer, rural backgrounds, but the court ruled that admissions should go ahead based on NEET scores.

Tamil Nadu has the highest number of medical colleges in any state in India and has protested against the exam from the start. The state’s governing party Dravida Munnetra Kazhagam has been vocal against NEET and claims that 26 students in the state have died from suicide since it was introduced.

In 2021, a high-level committee, tasked with studying the impact of NEET in Tamil Nadu, recommended abolishing the exam. It said it found that NEET disproportionately favoured students who studied in private English-medium schools, belonged to affluent and urban backgrounds, and could afford extra coaching classes.

This would “very badly affect” the medical system in the state, leading to a shortage of doctors in government hospitals and rural areas, it said.

Sathriyan, 23, says he is among those who suffered because he couldn’t afford private coaching. He wrote NEET five times, starting in 2019, but never passed despite scoring well in school exams.

“I studied on my own and I could not crack the exam,” he says, adding that he has now given up on his dream of becoming a doctor and works as a postman in his village.

In principle, says Ms Rao, the former health secretary, one exam across the country is “not a bad idea”.

But the current disparity in education “puts rural students at a disadvantage, worsening our rural and primary health centres”, she says.

“An elite-school student who clears the exam would ideally want to go abroad or work in private hospitals. They will not be interested in working in remote districts.”

So, she thinks that in the short run, Tamil Nadu’s demand that results of a school-leaving exam be used as the criteria for admission to medical colleges “is not a bad option at all”.

“[Tamil Nadu] had one of the best health systems in the country before NEET as well,” she adds.

But others say that the exam has its advantages.

“NEET has absolved students from preparing for various state exams, and I think it should continue,” says Dr Aviral Mathur, president of Federation of Resident Doctors’ Association.

Dr Lakshya Mittal, national president of the United Doctors’ Front Association, says “one exam is a better alternative” also because it means aspirants don’t have to apply to more than one exam and travel to various states to write them.

But both agree that NEET’s implementation has to improve.

“The exam needs to be organised better and the government has to stop paper leaks,” Dr Mittal says.