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The replacement of an admission procedure marred by serious problems of access and high cost and allegations of corruption among private medical institutions with the National Eligibility cum Entrance Test (NEET) has resulted in a new set of injustices and a major federal dispute between the Union and some states.
It is still logical to dismantle NEET in its present form and replace it with a multi-tiered federal admissions architecture that preserves stringent national criteria, even while sharing real power with the states. This will also help reject the coaching-driven elitism forced into the admission matrix.
Before NEET, the MBBS admissions were through a combination of state-level entrance tests, a few private college entrance tests and the All India Pre-Medical Test (AIPMT) for about 15 percent of “all-India quota” seats. Private and deemed universities conducted their own entrance examinations, interviews and ‘management quota’ channels. The biggest concerns were capitation fees and opaque, donation-based admissions. Most of the seats in government colleges were filled through official entrance exams. There was little scope for manipulation here, as the admissions to government colleges and quota seats were system driven.
But the growth of private institutions produced large variations in standards in admission processes, forcing earnest candidates to take multiple tests in multiple states, thus increasing costs and stress for candidates and their families.
In 2012-13, the Medical Council of India and the Union Health Ministry suggested NEET as a single national test to bring in uniformity in quality and to curb malpractice in admission to private medical colleges. The Supreme Court put a halt to the roll-out of NEET in 2013 stating that MCI could not intervene in institutional admissions. However, it was revived in 2016. The new system replaced all other admission tests from 2017. NEET was made the mandatory common admission test for all MBBS and BDS seats including AIIMS and JIPMER and was firmly entrenched in law under the National Medical Commission Act, 2019, Section 14, which makes it a legal requirement for the present structure.
In fact, NEET did away with the earlier “multi-exam maze” and introduced a single assessment and nationally coordinated counselling which has a simplified process for many students and reduced the direct likelihood of manipulation at the college level. Official statistics indicate the number of medical schools and MBBS seats has more than doubled since the mid-2010s. Supporters often cite this large expansion of government and private seats as evidence of a better organised system. The story line is that, in principle, NEET lowered capitation, introduced minimal uniform requirements and promoted meritocracy in admissions.
The critique of equality: language, coaching and curriculum
State governments, backed by some scholarly research, say the single, high-stakes, CBSE-pattern exam of NEET has tilted the edge dramatically in favour of a majorly urban, English-medium and coaching-served youth.
In the Supreme Court, Tamil Nadu submitted that NEET discriminates against state-board and rural students who have no education on the lines of NCERT/CBSE curriculum and cannot afford expensive coaching, thereby violating equality under Article 14. There have also been serious issues with translations and question papers in regional languages such as the infamous Tamil NEET paper glitches in 2018, which have directly impacted students and resulted in litigations and interim grace-mark decisions.
A larger issue Tamil Nadu and other political players have repeatedly raised: a common entrance exam for all seats, including in state government colleges, is against the federal structure and state control over the public health and education systems. The broader argument advanced by states is to shift education from the Concurrent List to the State List or at least to create a collaborative mechanism.
Legitimacy and leaks: the new NEET vulnerabilities
A single high-stakes national exam can become a gigantic single point of failure. When NEET’s credibility is questioned, the legitimacy of the entire system goes down. As demonstrated by the present spate of paper leak allegations, cancellations, grace-mark concerns and protests. Those who oppose NEET say that centralised entrance tests widen the scope and impact of leaks. Those opposing the centralised NEET system wanted this rolled back, and the state’s power over admissions, restored.
The countrywide marches, the arrest of opposition leaders outside the Prime Minister’s residence and the current agitation in Tamil Nadu, have turned the NEET into a symbol of administrative ineptitude
Thus, any serious effort to remove NEET and yet preserve rigorous selection must respect three constraints—the need for national minimum standards, the obligation to restore genuine state autonomy, and the moral obligation to level the playing field for disadvantaged students. A sustainable design will have to be multi-tier (national, state, institutional), multi-metric (exam + school performance + weightage for those from disadvantaged sections) and legally sustainable in the spirit of cooperative federal framework, unlike a simple centralised command system.
Here is a 10-point policy-oriented framework that meets these tri-objectives:
Amending Section 14 of the NMC Act through Parliament
The necessity for a “single common entrance exam” in Section 14 of the National Medical Commission Act should be replaced with a framework of “national minimum standards” and a list of authorised assessment tools from which states can pick and choose or combine. The amendment should clarify that states can continue to design admissions for seats in state-financed institutions so long as they meet the NMC’s standards for transparency and baseline competency.
A lighter National Medical Aptitude Test (NMAT) instead of NEET
Conduct a National Medical Aptitude Test based on concepts testing basic biology, chemistry, physics and reasoning – less lengthy and less trick focused than NEET to reduce exam anxiety and coaching advantage. This Aptitude test can be rolled out more than 3 – 4 times a year. Students can carry over their best score for say 12 – 24 months to further reduce the one-shot pressure.
A three to five year transition plan
Years 1-2: Write NMAT together with NEET. In states such as Tamil Nadu, that have publicly opposed NEET, pilot state evaluations and merit indexes, initially applied to some seats and data on outcomes being gathered. Once the new architecture is stable, phase out NEET completely in 2 or 3 years. States can then shift to the new architecture.
Give due weightage for Plus-Two marks and contextual assessments
Allow each state to choose between (a) state-level medical entrance examination that is compatible with its syllabus; (b) calibrated application of Plus-Two board marks with moderation and external audits; or (c) short situational judgement/ aptitude test developed by the state that tests language, ethics and local health context. Ask states to give 40 – 50 % weightage to these components for entry into state-funded colleges. This acknowledges the local curriculum realities and consistent school performance, and discards them.
An open multi-factor merit index
Fix a legally defined merit formula comprising NMAT score, state assessment/Plus-Two marks and an equity index which takes into account socioeconomic disadvantage, rural origin, first generation status and attendance at government or state-board schools. Publish this formula and weights in advance to prevent manipulation and require all universities public or private to adopt the same index for their individual quotas using similar software and real time public dashboards.
Federal architecture for counselling
The one “national counselling” needs to be replaced with “multiple counselling platforms, shared counselling standards.” State medical councils should be allowed to do their own counselling for state quota seats through the common merit index. DGHS/NMC should conduct all-India counselling, restricted to central institutions and a limited all-India quota. Private colleges can be included in the respective pool but cannot run separate entrance tests or have off-counselling admissions.
Equity-based limits on private universities
The first corruption issues that led to NEET should be tackled by banning separate entrance tests for institutions and capitation-based admissions. Their record of recognition and affiliation should be mandatory to participate in the common merit index and counselling. Regulate the fee structure and provide subsidies based on need, partly funded by the public exchequer and partly by the national equity pool.
Make public coaching and school education the major “pipeline”
States and the Central government can create “medical foundation” programs run by the state and integrated into higher secondary schools and provide free or low-cost preparation for state and NMAT exams particularly in districts with low doctor density and to benefit economically weaker students.
Exam administration is decentralised but audited
Let the state test boards and colleges execute their parts with stringent rules. The NMC and an independent test Integrity Authority can audit random centers, question-paper security and post-exam statistics. This will prevent a single central testing agency from being the sole executor. Use technologies for anomaly detection, creating multi-city item banks and encrypted question delivery but retain a scattered operational footprint so that the failure of one jurisdiction does not disrupt the whole national cycle. Take international examples to make this more perfect but suited to our context.
Political and constitutional re-configuration
Build an interstate coalition, together with legislative amendments (Tamil Nadu has already spoken of bringing “other state governments into confidence”) to push for re-insertion of education in the State List or the explicit codification of shared competence over medical admissions. Oppose the notion of standards, not the centralisation of power in a single exam and agency. Use the present protests and leakage scenario to achieve this. Offer the alternative as a state-sensitive, yet standards-driven, cooperative paradigm.
K Ramachandran, a former journalist, is an entrepreneur, offering consulting services for institutions and ed-tech companies. Views expressed are the author's own.