— ✍️K. Ashok Vardhan Shetty

Recent paper leak controversies, structural flaws, excessive reliance on coaching, bias against rural students has been continuosly discussed every were.

The Key reasons are as follows.

1. A Single-Day Test is a Poor Measure of Real Merit

Global educational research shows that a single three-hour multiple-choice question (MCQ) test is a weak predictor of long-term academic success. Sustained performance in high school examinations (GPA) over several years far better reflects a student's perseverance, work ethic, and ability to complete rigorous professional degrees than a single high-stakes test. So, probably an average of 7th, 10th and 12th to show consistent academic performance is a better indicator than one day NEET test which is conducted in 3 hours.

2. Deep Socio-Economic and Geographic Bias

NEET heavily aligns with the CBSE and NCERT curricula. While CBSE students make up only about one-eighth of school-leaving candidates in India, around 85% study under various State Boards. Because CBSE schools are disproportionately urban and better funded, NEET acts as an implicit filter that disadvantages rural, poor, and vernacular-medium students. Many students inspite of getting good scores in State Boards are not getting through NEET.

3. Destruction of Secondary Schooling and Rise of Coaching Rackets

When university admissions depend entirely on a single entrance test, standard secondary schooling loses its meaning. High school attendance becomes nominal, schoolteachers are sidelined, and students are driven into expensive, big-city coaching institutes. This turns education into a privilege that favours those who can afford commercial coaching. When protests were going on all over country, NEET celebration success meet happened in Kota. This shows coaching has taken over NEET.

4. Severe Erosion of State Autonomy and Federalism

Education and public health are fundamental responsibilities of State governments. By snatching away the authority of States to set admission criteria for medical colleges established and funded by State taxpayers, NEET undermines federalism and university autonomy. A good state medical system requires quality doctors who can serve in the remotest regions. Now usually the elite CBSE/ICSE students never serve in rural areas. Now state governments can relax the admission norms and allow more state students from rural areas to get a medical degree so that can they can go and serve the community.

In Tamilnadu, a similar system was created and a large number of doctors came out. But today the number of doctors getting through from Tamilnadu has reduced. But the question is whether a doctor from Bihar and Uttar Pradesh serve the rural masses in Tamilnadu. Absolutely know. Localised Medical education and state intervention is very much needed for large number of Medical doctor pool to be created. Too much of centralisation also leads to too many bottlenecks.

States should be allowed to put up many medical colleges, give seats to local state board students. However, for PG and surgery courses, strict monitoring can be done. Specialised courses can be with the central government control. But to say that medical education entirely should be controlled is not at all correct. Some decentralisation and private funding through states is a good solution for Medical education.

5. Single-Point-of-Failure Risk and Systemic Vulnerability

Concentrating the future of over 20 lakh candidates into a single national test managed by a central agency creates massive operational vulnerability. As seen in recent paper leaks and exam cancellations, a breach at any single node compromises the entire national medical admission system, inflicting immense psychological distress on millions of students.

Again, states should be allowed to conduct their own exams or take based on 12th marks. Now traditionally there were State CETs all over India. Now is there any statistics to show that these doctors were not good enough. Frankly speaking some of the best doctors are from the state boards and they have served large number of rural patients.

NEET poses a single point system failure issue and hence we need multiple points of admissions with in the states. For example, Rural Medical colleges at Taluk levels should be encouraged so that more kids join their. Innovative modeling will increase the reach of medical education to even rural areas.

6. Commercialisation and the "Zeroth Percentile" Farce

Although marketed as a guardian of medical standards, NEET qualifying benchmarks are routinely slashed—sometimes down to the 7th or even "zeroth percentile" (allowing negative marks)—to ensure that high-fee seats in private colleges and deemed universities do not remain vacant. A test that lowers its pass mark to zero to fill private seats cannot credibly claim to protect academic quality.

7. A Two-Tier System That Penalises the Poor

NEET creates a stark double standard. For poor and lower-middle-class aspirants competing for affordable government medical college seats, the cutoff routinely exceeds 600 out of 720 marks. However, wealthy students scoring as low as 100–140 marks can easily secure admission into expensive private institutions. In practice, the poor must excel, while the rich need only nominally qualify. Now NEET cutoffs have been extremely low and this is done deliberately to benefit the private medical colleges. Research has shown that even with 110 marks, by paying a hefty management fee, many students are able to get in. NEET has not reduced capitation fee but instead it has formalised the process. Today it is a norm to spend Rs 1 crore for many to complete the MBBS course. With this kind of a spending, how can we expect ethical doctors to come in is the question.

8. Language and Cultural Barriers in Healthcare

Effective healthcare delivery relies heavily on clear communication, empathy, and an understanding of local cultural contexts and regional disease burdens. Diverting large proportions of medical seats away from local students leads to language barriers between doctors and patients, especially in rural and regional public hospitals.

Now NEET is biased against local languages. In all NEET papers, local language should be tested. For example for state seats, there should be a Tamil exam conducted so that only local students get in. This is important because local language and cultural contexts in medical delivery is very important. The elite english educated doctors manage to escape to US or Europe and work for other countries.

9. Proven Alternatives Exist (Statistical Harmonisation)

Proponents of NEET argue that marks from different State Boards cannot be compared fairly. However, statistical scaling and percentile adjustment—methods already successfully used by the UPSC across 48 different optional subjects—can easily standardise Class 12 Board marks across different regional boards without putting students through a central exam ordeal. UPSC is an example where moderation can be done. Instead of looking at rapid computerisation and making it more difficult to state board kids, a formula for state board kids should be developed so that they dont be tested in areas where they cannot excel. A state board has no access to laptop, computers, how can be manage computer based test.

10. Centralised Regulatory Overreach Without Accountability

Centralised agencies like the National Testing Agency (NTA) and National Medical Commission (NMC) lack adequate permanent staff, depend heavily on outsourced private vendors, and offer zero direct representation to many States. Replacing regional systems with a centralised bureaucracy has not eliminated corruption; it has merely created a single window for systemic failure. So clearly structural governance issues with adequate staff also should be fixed. Conclusion Reforming medical education does not require forcing every adolescent through a high-pressure, centralised filter. Restoring authority to State Boards, implementing statistical mark-scaling, and investing directly in school infrastructure would create a fairer, more resilient, and truly equitable admission architecture for India.

-K Ashok Vardhan Shetty IAS (Retd) is a prominent advocate for decentralisation of NEET and has written many articles on the subject.