What happened to ‘merit’ in medical education?

The biggest reform in the medical education sector has been the introduction of National Medical Commission. The professed objective was to increase transparency, professionalism, accountability, availability, distribution, merit-based admission, affordability, and quality of medical education.

The National Eligibility-cum-Entrance Test – NEET has been introduced with the aim of ensuring a ‘one country, one examination, one merit’ system. The NMC is also proposing to introduce the National Exit Test – NEXT. Against 381 medical colleges in 2014, today there are 562 colleges, an increase of 48 per cent in six years. In addition, 22 new AllMS have been sanctioned. The number of UG seats has increased by 56 per cent and the number of PG seats has increased by 80 per cent as compared to 2014.

Neet is not so neat!

India is still churning out large volumes of unmeritorious doctors-in-waiting. The NEET has become a farce, as eligibility scores have been decreasing since 2016.

The number of candidates who appeared in 2020: 13.66 lakhs The number of candidates who qualified: 7.71 lakhs.

We need doctors by merit, not privilege. In a majority of cases, the ability to pay, and not merit, is what counts. This year, 15 lakh students competed to join these medical college that offer 80,000-odd MBBS seats. Shouldn’t the cut-off be raised, so that just the topscoring 90,000 students get placed, allowing a margin for the drop-outs? Here lies the master plan to subvert merit in medical admissions.

Since NEET became mandatory in 2016, the cutoffs have been decreasing every year. This year, the cut-off in the unreserved category went down from 131 to 119, out of a total score of 720. The cut-off in the reserved category has also fallen by a similar margin, from 107 to 96, out of the 720. There are no cut-offs prescribed for individual subjects. Last year, there were people who had got scores of zero and even negative marks, in chemistry and physics. Yet, they qualified for a medical college seat.

Medical college admissions are driven by money, caste, and yes, in some cases merit! India is the only country that authorises, as official policy, the sale of medical seats by private medical colleges, in which the ability to pay, and not merit, is what counts. Others gain entry purely on the basis of caste.

Medicine deals with human life and, consequently, there is a widespread conviction that the admission criterion in medical colleges be merit alone. Similarly, the concept of caste-based reservation generates passionate arguments. Many have castigated the entire admission process as based on money and caste.

Medicine is art, science!

Medicine is not about just knowing. It is the training component of medicine that makes a good doctor. This training gives an insight to the myriad conditions that affect humankind while imparting an ability to make sound judgement in relation to various illnesses by putting disease symptoms into a specific pattern.

Medicine needs hard work, diligence, commitment, passion and compassionate humane people. The growth of private medical schools in the 1980s and 1990s coincided with changing social values. Money is no longer seen as an evil. It is a necessity. A few institutes in India have remained free of accusations of malpractice.

CMC–Vellore has consistently been voted amongst India`s best medical institutions despite religious sponsorships accounting for a fair proportion of places. It has even been awarded a five-star rating by the National Assessment and Accreditation Council.

This further underlines the fact that academic merit is not the sole indicator of performance. A great deal of competence can be acquired with rigorous training in professional life irrespective of one`s performance in graduate-level entrance examinations.

No matter how many colleges or seats there may be, 30-40 per cent of the students will always be fake. You cannot expect them to rightly handle a lifesaving situation.