Medical exam paper leaks happening through WhatsApp. The Supreme Court rejected petitions seeking cancellation of the medical entrance exam, despite admitting to a question paper leak. A Gujarat student who failed her class 12 exam scores 705 out of 720 marks in NEET 2024. An infuriated CJI.
Health is wealth is absolutely apt in the murky world of the National Eligibility-cum-Entrance Test (NEET).
Manipulations of the medical system by a network of bent agents, educational officials, tech-savvy crooks and middlemen leaking papers and destroying evidence have only one endgame: rake in the rupees and put public health at risk. IT, AI, MBAs and a host of other professions have opened up in the Indian job market, but the majority still want their children to become doctors. The only way to do that is to take and pass the NEET exam.
Like Jyoti Sharma, for example. For the past two years, she has been her daughter’s dedicated driver, ferrying her to the coaching centre, extra classes, group study sessions and even shopping, ensuring that no time was wasted. She believed her efforts would culminate in her daughter’s success in the NEET-UG exam, and secure her a spot in a government medical college. The results are out, her daughter’s ranking however may not be enough to get her into a government medical college.
The family is in despair. Everyone cannot afford a private medical college education that is horrendously expensive compared to a government medical college: the first-year fee for the former could be as low as Rs 10,000 a year while some private colleges charge above Rs 25 lakh in annual fee. For Dr Neeraj Gupta, Associate Professor, Ganga Ram Institute of Postgraduate Medical Education and Research, industrialisation of the sector has deteriorated the quality of medical education.
Dr Prafull Kumar Manjhi, senior ophthalmologist who graduated from AIIMS Delhi way back in the ’90s, flags his biggest concern is the mushrooming of private colleges across the country with only “30 per cent giving quality education”. Ask Sharma whether the exams be scrapped and the Kolkata-based entrepreneur goes on a rollercoaster rant about the hard work and the sacrifices the family had made for her daughter.
“What about those students who are taking the exam for the third or fourth time? What’s the guarantee that everything will be foolproof the next time?” she questions.
With alleged frauds about paper leaks and dodgy procedures in various examinations being exposed, Sharma has little faith left in the current system. According to an X post on the NEET-UG exam held on May 5, students complained that teachers gave them papers with answers written in advance and took it back. On the same day National Testing Agency (NTA) said 120 of the students got a retest.
NEET had never had it so bad. Skulduggery apart, the scandal has become political. Student unions are pressuring the new Andhra Chief Minister N Chandrababu Naidu to clear his stand on the matter. The Karnataka Cabinet has pulled out of the NEET system and introduced a new entrance exam for undergraduate and postgraduate medical students.
The Tamil Nadu government passed a resolution to scrap it but the governor has held up the bill. Amid the right and wrong of NEET, the future of 24 lakh students (2024) is at stake.
Many students didn’t get enough time to finish their papers. Some question papers were wrong. The Optical Mark Recognition sheets that collect data from fill-in-the-bubble questions were defective. No one can credibly explain why the results were released 10 days early on June 4. The answer keys were wrong. The evaluation of papers were not uniform. Impossibly 67 students, most of them from the same centre, got the perfect score: 720/720: a first in NEET history. The impossible scores of 716 to 719 was attributed by the NTA to the grace marks allowed by the Supreme Court.
The road to hell is paved with good intentions, which is the also the case with NEET. It has a single entrance test to get into a medical or dental course: no time-consuming, multiple-fee sundry state-level and private exams like before. NEET is supposed to minimise corruption, malpractice and paper leakage which was the norm in many state and private medical college exams. NEET also excludes donations or capitation fees since admission is supposed to be merit-based where rank in the NEET exam is the criterion.
Ideally, it was conceived as an equitable meritocracy for aspiring doctors since NEET is not bound by state or Central reservation policies: anyone can enter.
There is a state quota and national quota based on student preference and eligibility. Rural students can compete with urban counterparts on an equal footing since the exam is conducted in 13 languages, including English, Hindi, Assamese, Bengali, Gujarati, Kannada, Malayalam, Marathi, Odia, Punjabi, Tamil, Telugu and Urdu. The downside is the highly competitive nature of the exam with lakhs of students competing for roughly 1.8 lakh MBBS seats of which 55,880 exist in government medical colleges. Failure means waiting for another year.
Moreover, since NEET is based on CBSE syllabus, students who have studied under different state boards are disadvantaged, while grappling with the syllabus and exam levels. A NEET exam is expensive: Rs 1,500 for general category candidates, Rs 800 for reserved category, coaching fees, study materials, travel expenses and more, making it cost-prohibitive for poor or rural students.
Grace marks are a NEET conundrum. It was introduced in NEET by flouting a court judgment that categorically excludes medical and engineering exams from its purview.
So what happened this time? The biggest concern of Palak Arora, an 18-year-old from Gurugram is if she should settle for a drop year. A drop year will allow her lots of time to practice at home, though she will get little time to review the subject or train in many questions. Arora has struck off private medical colleges from her list, inhibited by the exorbitant fee.
Meanwhile, acting on the Supreme Court’s directive, the NTA, which is responsible for conducting the exam, announced centre-wise and city-wise results on July 20. It found that 10 centres in Haryana and eight in Kottayam, Kerala, have scored well above average.
“The Court must take strict measures against this fraud and injustice to deserving candidates so that it is not repeated in the future,” says Gayatri Gandas, parent of a Delhi-based MBBS aspirant. Her daughter’s ranking hangs in limbo till the time counselling opens up and clarity comes across around the results.
The situation had to come to a boil sometime or the other. Now it has. The dark history of NEET is full of paper leaks for money, student suicides over wrong exam results, and grace marks awarded in a non-transparent manner. It shows how rotten to the core the medical exam system has become. For example, in this year’s exam, over 67 students in one centre in one row got perfect scores while the average score a year is two or three max.
The cancellation of the NET examination conducted by NTA by the government has put the credibility of the system in doubt. Arora’s frustration is echoed by Rashika Garg from Chandigarh. She is studying for Bachelor of Dental Surgery (BDS) and her internship will get over by September. But she is unclear about the NExT (National Exit Test), the licensing exam conducted by the National Medical Commission (NMC), the apex governing body of medical education, which she was supposed to appear for. NExT is a forthcoming regulation (first announced in 2019, then deferred for the 2020 batch) intended to serve as a standard entrance exam that grants MBBS graduates a licence to practise medicine in India.
This exam aims to replace the final MBBS exams, NEET-PG exam and the Foreign Medical Graduate Examination for foreign medical graduates to practise medicine in India. NMC, despite opening up registrations last year, cancelled it and asked stakeholders to send in suggestions by the first week of July. The decision is pending.
The Indian Medical Association (IMA) too was drawn into this controversy. It has opposed the NExT. In its letter to the National Medical Commission chairman, IMA states it has serious reservations: “NExT defeats the vision of the government, of affordable and accessible medical education, by seriously hampering the survival of medical institutions in underprivileged communities and situations. We can’t afford to train doctors and deny degrees to practise.”
The cost of medical education is likely to double in the coming years, according to a February 2024 report by analysts at Mumbai-based financial services firm, Anand Rathi. Little wonder that for middle-class students who cannot afford private tuition, programmes in nearby countries offer a cheaper option.
According to foreign ministry data, in 2022, more than 7,50,000 Indians went abroad to study to study in places like Russia, China, the Philippines, Kyrgyzstan and Kazakhstan - almost double the number in 2018. But many of these students fail to clear the Foreign Medical Graduate Examination in India. It is a screening test for Indian citizens who have completed their medical education abroad and wish to practise in India. On July 6, a total of 35,819 students took the test. Of these, only 7,233 students passed, while 27,297 failed.
The horror story doesn’t end here for students. The NEET post-graduation exam, which was scheduled for June 23, was cancelled by the central government, without any official explanation, just hours before it was to take place. It is now widely reported that there were intel inputs about impersonation. It is now scheduled to take place in August in two batches thereby pushing the counselling dates forward and cause a delay in the start of new batches.
The problem is not just about the medical examinations, the system itself is designed to favour incompetency and corruption for profit. At every step, from when a student decides to become a doctor to when he or she starts practising, is fraught with challenges.
Government college seats are limited. The student-to-faculty ratio is poor. In private medical colleges, which have been mushrooming across the country, exorbitant fees, poorly trained faculty, no R&D and low patient turnouts are key concerns. Not to mention how suicides by medical students are on the rise as are medical negligence cases in reputed hospitals.
An RTI response in 2023, from the NMC said that 119 medicos died by suicide in the last five years and 1,166 students dropped out of medical colleges due to the stress. Another scandalous state of affairs is the introduction of non-specialised staff into areas that require a high degree of specialisation, for the sake of meeting an ideological agenda.
The ongoing tussle between Centre and practitioners of modern medicine is escalating as the former pushes AYUSH - a traditional system of medicine that stands for Ayurveda, Yoga, Unani, Naturopathy, Siddha and Homeopathy.
Earlier this year, the health ministry launched the AYUSH-ICMR Advanced Centre for Integrated Health Research in AIIMS, Delhi. In the book Sick Business written by Dr Sumanth C Raman, and published earlier this year, the physician calls the Indian healthcare system a “horror”. And there may only be a few who would disagree with him. Ayush doctors being cheaper to hire are on night duty in ICUs in top city hospitals especially in Pune and Mumbai.
“Maybe,” says Dr Anand Krishnan, Professor, Centre for Community Medicine, AIIMS, Delhi. “A demand-supply mismatch, faculty crunch, unregulated fee structure, distrust in examinations, pressure to excel in super-speciality, no stipend parity, all of this point to a system where urgent intervention is required.”
The gateway to saving lives of patients in not crossed by destroying the lives of aspiring doctors. Unless a progressive, realistic and equitable medical education structure is put in place that suits the Indian social climate, scandals like NEET will continue to weaken the will of medical students, doctors and the community as a whole.