NEET mess: Miscalculations behind the zero percentile

The government’s direction on 20 September to reduce the cut-off to qualify in the NEET PG 2023 to zero percentile across all categories was greeted with disbelief. Last year, the government had refused to reduce the qualifying percentile and argued that it would affect the minimum standards of postgraduate medical education. So why the sudden U-turn when counselling had already begun?

Could it be to accommodate the Union health minister’s daughter? For several days, social media and doctors’ WhatsApp groups were abuzz with speculation, as sheets full of marks against roll numbers were widely shared. It was claimed that the health minister’s daughter had not qualified for admission and hence the cut-off was being reduced to accommodate her. This was contested by others who claimed that the minister’s daughter had not even registered for counselling.

The explanation did little to allay the suspicion that the dramatic and unprecedented reduction was designed to benefit some of the favoured few, possibly the sons and daughters of BJP politicians.

Percentile is not to be confused with percentage, of course. A student might secure 90 per cent in an exam but belong in the 20th percentile, if 80 per cent of the students secured more than 90 per cent. The zero percentile implies that literally everyone can join the fray. The NEET PG cut-off percentile used to be 50 for students from general/ unreserved categories, 45 for candidates with disabilities and 40 for students of other reserved categories until last year.

Overtly, the reduction is meant to benefit private medical colleges. While both government and private medical colleges offer postgraduate courses, seats in government medical colleges rarely remain vacant. The fees are more reasonable, at Rs 30,000 per annum for the three-year course.

Before 2019-20, when the government hiked the fees to be charged by private medical colleges and minority institutions, the fee for private colleges was in the range of Rs 72,737 to Rs 5.81 lakh for government quota seats, with institutional quota seats at Rs 1.09-8.72 lakh. Now, the fees are 15 per cent higher. Most private medical colleges charge a lot more, thanks to capitation fees.

Earlier this year, Madras High Court directed a private medical college to deposit the Rs 2.5 crore paid by parents of three undergraduate students. For postgraduate courses, the asking rate increases by orders of magnitude. For some super-specialty courses like neurology or radiology, it goes to a few crores.

In 2023, there are 68,142 postgraduate medical seats and 91,925 MBBS seats in 612 medical colleges across the country. The seats have doubled since 2011-12. The number of government medical colleges has increased from 154 to 321, private medical colleges from 181 to 291.

The government has justified the reduction in cut-off to zero percentile by citing a request from the Indian Medical Association. "We request you to reduce the NEET PG 2023 cut off percentile up to 30 per cent so that most of the seats are filled in both clinical and non-clinical branches," the IMA wrote. That is no explanation, though, for dropping all the way to zero.

The Federation of All India Medical Associations described the move as shocking. “It’s ridiculous... This makes a mockery of the standard of medical education,” it said in a statement. “It would be good for any such policy decision to be substantiated in terms of rationale, otherwise it will be seen as a way of protecting the interests of some stakeholders in medical education,” said Dr Anant Bhan, a researcher in health policy.

Tamil Nadu chief minister MK Stalin fumed, “NEET has nothing to do with merit, which we have been saying all along. It has become a mere formality, devoid of any real eligibility criterion.”

In a post on X, Congress general secretary Jairam Ramesh said, “While access to medical education and supply of doctors needs to be dramatically increased to meet the demand, who does it benefit by completely doing away with minimum basic standards?” The scandalous dilution would benefit only private medical colleges who want to sell the seats to the highest bidder, he added.

"When the number of private medical colleges began shooting up at Pune's Armed Forces Medical College, we were faced with a dilemma," said a retired doctor. "We were being strict and failing several of our students, who then took longer to complete the MBBS course. But in private colleges, the unwritten rule was that everyone had to pass because they had paid." As a result, in government medical colleges too, most students began to be allowed to pass on their first attempt. “The dilution in standards is now pervasive,” he said.

Doctors with a minimum of eight years of teaching experience (the base criterion) are hard to come by, leaving a demand-supply mismatch following the jump in the number of colleges. Not surprisingly, the National Medical Commission has found 'ghost doctors' in both government and private colleges. It is common to show doctors on the rolls who appear in person only during inspections and examinations. Government colleges enable 'temporary transfer' of doctors in bulk, from one hospital to another.

Even so, 44 per cent of faculty posts lie vacant in the 18 new branches of the All India Institute of Medical Sciences (AIIMS), with AIIMS Rajkot being the worst off with just 40 of the 183 sanctioned posts filled.

Of the 4,026 sanctioned posts overall, only 2,259 had been filled in the 18 new AIIMS branches.

The overall shortage of doctors in the country is pegged at around 15 lakh. There is an even more acute shortage of specialists. The Rural Health Statistics Report released in January 2023 revealed a shortfall of nearly 80 per cent in community health centres. While the government therefore needs to rapidly increase the supply of doctors, a section of the medical fraternity remains sceptical, arguing that the haste to dilute the standards is unwarranted.