The struggles in 2021 of medical aspirants to undergraduate and postgraduate courses through NEET testifies the anecdotal truth of the quote ‘Better is the enemy of good’.
In trying to solve the myriad issues that beleaguered medical admissions, the Central government, the bureaucracy and the MCI proposed in 2012 what was considered to be the panacea to rid medical education of all its ills.
A decade from then and six years from the time NEET became a law, medical entrance and education remains a fiasco where the solution has become bigger than the problem. There is hardly a day in the admission season when some aspect of its conduct or consequence does not find a place in the news.
A range of disturbing issues, from student suicides and unclear marks distribution to social inequity have come to the fore.
Tamil Nadu has taken the step of rejecting what it feels is a self-defeating formula as far as career opportunities of state aspirants are concerned. There is much truth in this assumption, confirmed also by the trends of manpower deficits in other parts of the nation.
New regulations are known to have teething problems in the first two years of implementation. But to have them for a decade calls for serious introspection. The NEET story is going wrong from the perspective of future human capital in healthcare, which opening of new medical colleges alone will not address.
NEET was undoubtedly formulated with good intentions. It was intended not only to standardise medical admissions in terms of merit, but also to curb the capitation fee menace.
The first Supreme Court judgement in 2013 did not favour the examination, but the verdict was brought back for a review and a pro-NEET verdict pronounced in 2016. NEET thereafter has become law, despite the cries of several state and minority institutions that it would be detrimental to the plight of students from socially disadvantaged backgrounds.
That fear has come true. What is more worrying and unfathomable for the health ministry is that NEET has tilted the results of medical education away from the public health needs of the country. In that regard, NEET has been self-defeating.
The problem of high-payment seats, marks-matrix conundrums and unacceptable commencement delays continues. The year 2021 went by without a single admission, adding significantly to the frustrations of students and colleges. The NEET formula may be silently diminishing the pool of motivated doctors for the new health needs of the country.
Fundamental issues that nuance medical education have failed to catch the attention of lawmakers. Legal logic has veered too much into objectivity and less on contextual differentiation.
That the concept of one nation one exam is unsuitable for a country with such socio-economic diversity has been trivialised by the powers that be. There are many soft aspects unique to the discipline of medicine that cannot be measured or quantified. Medicine, unlike engineering or IT, is not dependent solely on merit determined by marks.
Worldwide, it has been established that it requires high levels of emotional and social intelligence with reasonable scholastic merit. That a student with 99% marks in an entrance examination without a reason-to-be is not necessarily suitable for medicine, but a rural student with 55% with a mission and motivation may be, is a fact that needs greater recognition.
The sense of entitlement that merit endows makes the meritorious less sensitive to social needs and more pursuant of career ambitions. The Week, in their 17 August 2019 issue, had reported a 40% increase in the migration of doctors between 2015 and 2017. Candidates empowered by socio-economic weightages are more likely to return to their roots and serve long term in their native environments, driven by a deeper sense of obligation. This equation has been somewhat fractured by the merit monolith enshrined in the NEET philosophy.
The NEET system is not just about one MBBS entrance exam, but a series of them for PG and higher specialty in increasing order of difficulty. Most qualify only after a gruelling one or two years of expensive coaching. From the third year of MBBS, instead of acquiring bed-side skills, they are peer-driven to chase the next target—the PG NEET. Night coaching classes and the pressure to crack NEET makes them disinterested in acquiring bedside clinical skills. The cycle repeats for higher-specialty NEET. They have realised, and rightly so, that acquiring skills has been second-placed in the pursuit of career objectives in the highly meritocratic system of NEET. It has become one long tunnel of exams that leaves the medico no time or inclination to learn the science and art of medicine. The proposed exit exams, NEXT, will add yet another layer to this saga.
The hypothesis that merit determined by marks alone will produce the best doctors is erroneous. While a few may be, most eminent doctors in India today are not necessarily toppers. They are products of good training unhindered by the pressure of examinations, and mentored with a missional approach to serve their motherland. India is still grossly deficient in health infrastructure, supplies, mobility and manpower. At an average of 30,000 graduates every year for the last five decades, India should have no numerical deficits even after factoring the natural attrition of retirements and resignations. Why are they not on the healthcare radar?
There are unsolved paradoxes. It is not pragmatic to expect a lad from a rural background to compete with compatriots from metros. It is not realistic to expect city-bred doctors to work long-term in rural areas, even if the incentives are doubled. To say that differences in language, culture and social beliefs can be bridged by NEET is plain rhetoric. Even with 83,000 new graduates every year, achieving the required 1:1,000 doctor-patient ratio is a distant dream.
It is time to review NEET and its outcomes from the viewpoint of India’s primary health needs. The question of whether it is empowering our nation or largely providing medical manpower to wealthy nations overseas is worth looking into. Meanwhile, those who waited patiently in 2021 are tired and burnt-out even before their long journey of examinations has begun.
Dr Sunil Chandy
Chief Medical Officer, ITC Healthcare
(Views expressed are personal)
(sunilchandycmc@gmail.com)
