The NEET route to medical excellence

Guest article by Dr. Indranil Basu Ray. The author is an interventional cardiac electrophysiologist based in the US.

I was recently invited to give a talk to physicians belonging to the Texas Medical Association in Dallas, Texas. I happened to meet a few Indian-American doctors. Among the different things that we talked about was our experiences with getting into medical school in India, vis-à-vis American kids of Indian origin. With the National Eligibility and Entrance Test dominating the headlines, these physicians of Indian origin were expressing their frustration over the existing situation and efforts to deprive the establishment of a common medical entrance examination. In the United States of America, there is one single examination called the Medical College Admission Test. Every applicant who intends to be a physician has to take this. Entrance to a medical course of study in the US depends on the scores obtained in this exam, along with cumulative performance in school and undergraduate courses. In the US, medical school admission does not occur after 12th grade, as in India, but is only for post undergraduate degree students.

I got into a medical school in India in the late 1980s. Thanks to the beguilingly convoluted entrance protocol for getting into a medical school in India, it was not a smooth ride, but a painful experience to say the least. I had to go through the usual grind and unfortunately, decades later, thousands of innocent kids still have to suffer the same byzantine processes. Almost every state in India has its own entrance exam for applying to medical colleges. Obviously, the standard of this examination varies widely depending on the state. There is an all-India examination for getting into state-run medical colleges under the all-India category. There are also many individual exams conducted by national institutions like the All India Institute of Medical Sciences, New Delhi, the Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, and the list goes on and on. As a candidate wishing to be a doctor, I had to appear for multiple entrance examinations. The process to get into a medical school in India is both expensive and time-consuming. Unfortunately, a candidate has to spend more time taking care of miscellaneous practical hassles than studying for the exams. It is extremely expensive as students have to travel to multiple institutions to be able to sit for their entrance exams. Thus, many brilliant candidates without financial resources are rooted out through no fault of their own. Most of these nationally famed institutions, while charging a hefty fee for their examinations, provide only a few seats. You also have to pay for the travel and stay in different cities overnight to take these tests. The third set of institutions are the private medical colleges. Initially, they were a few located mostly in the states of Tamil Nadu and Karnataka, which charged a substantial amount of money as capitation fees, making it an option only for the wealthy elite. This business practice under the guise of "providing education" was soon discovered by corrupt operators to be an extremely profitable venture with little risk and absolutely no responsibility. Multiple private medical colleges thus cropped up all over the country with the purpose of making quick profits, throwing basic standards of medical education to the wind. In spite of the fact that many of them do not maintain the appropriate standards prescribed by the Medical Council of India, they continue to give medical degrees. What is sadder is that these now ubiquitous private medical colleges, while charging astronomical amounts of money for a single MBBS seat, provide mostly suboptimal education. Many of these corrupt institutions have developed political clout by aligning themselves with political parties. Thus, they remain protected, and this menace ruins the entire medical education system in the country.

The total number of MBBS seats in India is believed to be around 50,000. Almost half of these are in the so-called private medical colleges. The seats in the state-run medical colleges are at present filled through individual medical examinations provided by the state governments and by centralized exams like the All India Pre Medical Test or the Common Entrance Test. Most states have no problem with this, as these individual examinations with varying syllabuses are intended to be replaced by a centralized exam like NEET. This revision will ensure that applicants to medical school have to appear in a single examination, but this will also bring more transparency to the whole process. Although states individually hold these tests, until now, many of them did not have the required transparency. Some state governments have been charged with being complicit regarding the provision of seats for less capable competitors with dishonest employees getting paid lakhs of rupees in return. Many deserving candidates were left in the lurch, and the nation suffered owing to a cohort of sub-par physicians graduating. A centralized computerized examination will do away with such irregularities. Moreover, it will create a uniform standard throughout the country for getting into a medical college.

The question then, obviously, is, why is NEET so controversial? And why has the Central government passed an ordinance to postpone it by a year? The simple answer might be greed, but a more detailed analysis is needed to comprehend the complicated situation.

India has the highest number of medical colleges of any place in the world. As of 2015, India has 381 medical colleges which admit about 64,000 students every year for undergraduate (MBBS) and postgraduate courses (MD/MS). Of these, 188 medical colleges are private colleges with 38,715 seats. There are about 100 different entrance exams conducted by these various institutions, all having a different syllabus and exam pattern. Most private colleges have their own entrance exams for obvious reasons. There is little transparency to these admission procedures, and the system is exploited to garner maximum income by illegally selling medical college seats to the highest bidder. Any effort to induce transparency would obviously hurt this downright fraudulent activity. The merit of the candidate is not the dominant criterion, but rather an ability to dole out lakhs of rupees. This should not be interpreted as an indictment of all private players as depraved cut-throats. Many private colleges do exist that have maintained the highest standards and integrity as premier centres for providing medical education. Prestigious institutions like Christian Medical College, Vellore and a handful of others exist, which have their own unique style of conducting entrance tests with perfect integrity. They have been providing yeoman's service to the nation for decades now. However, they do lack a uniform syllabus, a problem that will be adequately addressed by NEET. The scenario with other private medical colleges which are the poster boys of corruption is different. Their very existence is based on questionable business principles. It might be remembered that NEET would have already been in place in 2013 if the Supreme Court had not turned it back based on a petition by mostly private medical colleges the interests of which would be harmed by such a transparent exam. However, credit goes to the judiciary and the far-sighted judges. In spite of opposition by strong financial vested interests, they have ordered a nationally viable transparent medical entrance exam for the country.

However, starting NEET immediately has some practical problems, more for the examinees than the examiners. It may be recounted that following the announcement from the MCI that it would introduce the NEET exam in 2012, several states including Andhra Pradesh, Karnataka, Gujarat, West Bengal and Tamil Nadu strongly opposed the change. The reason they gave was that there was a huge variation in the syllabus proposed by the MCI and their existing state curricula. This contention of multiple state governments has merit and needs more thorough investigation. It is impossible to expect thousands of examinees to prepare themselves for this examination with a different syllabus by July 2016 when the second part of the exam is scheduled. This lack of a common playing ground would adversely effect many competitors required to compete with candidates used to the current syllabus. Thus, it would be unfair to those thousands of kids who need to orient themselves to this new syllabus in order to have a fair chance in the upcoming exam. Thus, delaying NEET for a year is a positive step to this end. The argument in some sectors that it will also help private operators to continue their raking in of loot is equally bona fide and not an exaggeration. However, it must be understood that when accosted by two evils, it is a lesser evil than having to deprive thousands of young people of a level playing ground to sit for the medical entrance. Administration of the NEET examination within a month or two as scheduled would be potentially disastrous to thousands of competing young minds looking for a bright future. Thus, ample time needs to be provided to create a uniform competing platform before any such test is implemented.

The other point of contention is that NEET, as conducted in the English language, would be difficult for students of the vernacular medium. In spite of this being entirely true this problem is unlikely to be solved by delaying the implementation of NEET. Those harping on this point are either naive about the ground situation or have a hidden agenda for delaying NEET. In India, MBBS is taught in English and thus a good working knowledge of the language with years of study in schools and colleges is mandatory to understand and learn the foundations of becoming a physician. Thus, a vernacular language-trained individual completely devoid of any training in English is seriously disadvantaged even if he/she manages to get into a medical school. English is the only working language in an MBBS curriculum. Thus, delaying implementation of NEET for vernacular students may not be of much help. Holding NEET in vernacular languages may benefit some, but that does not negate the importance of knowing English for the reasons given earlier. I have had native language-trained compatriots who have gone on to do exceedingly well as physicians. There is very little opportunity to circumvent the use of English in MBBS or any medical training for that matter. Creating the MBBS curriculum and providing it in a vernacular language, unfortunately, is a utopian proposition that is hard to comprehend and nearly impossible to realize, since most medical research and training the world over is in English. Even non-English speaking countries like France and Germany have their doctors learn English.

My sincere hope is that in the interest of the nation, vested and narrow political ambitions would be put aside to enable a nationally conducted transparent medical entrance exam to create a band of brilliant and well-trained future doctors in India.