Inclusivity or institutional failure? Politics behind NEET-PG’s ‘0 percentile’

Ghost faculty, dummy patients, and now ‘0 percentile’ — all point to India's failing medical education system

Strangely, this year, the government has lowered the cut-off for medical postgraduate admissions for certain categories of students to the ‘0 percentile’. Effectively, all those who appeared for the postgraduate medical admissions National Eligibility cum Entrance Test (NEET-PG) have been declared eligible to join.

Since ‘0 percentile’ translates to the lowest scorer, the government has decided to have no cut-off at all in 2025-2026. In earlier years, the cut-off used to be a score out of 800, which corresponded to, say, the 50th percentile for the general category and lower for persons with disabilities and SC/ST and OBC candidates.

The Ministry of Health and the National Board of Examinations for Medical Sciences (NBEMS) have justified this year’s decision by the need to fill about 9,000 vacant postgraduate seats under the all-India quota in medical colleges. With State quotas, the number of vacant seats reportedly goes up to 18,000. About 1.5-2.2 lakh students appear for NEET-PG every year.

A senior government official defended the measure saying, “Final competence is not tested at entry but at the exit stage.” One might say that NEET-PG is only a screening test for entry; however, since it tests medical knowledge through multiple-choice questions, it is misleading to say that lower or negative scores do not indicate inadequate medical knowledge.

NEET-PG was introduced to have a common benchmark ranking system across India, and to replace multiple state and institutional entrance examinations in existence. The Supreme Court also mandated NEET in order to curb the practice of capitation fee that favoured rich students. Holding a national ranking examination created the appearance of fairness and transparency.

If NEET was an attempt to stem the corruption in medical college admissions, clearly, malfeasance has continued to exist structurally. What else explains the rise in the number of postgraduate medical seats in private medical colleges to the extent that thousands go vacant every year?

A number of these postgraduate seats are in para-clinical subjects such as pharmacology, community medicine, biochemistry, pathology, and microbiology, which are less lucrative than clinical disciplines that are more amenable to private practice.

It is, therefore, governance failure in medical education that is being retroactively rationalised in the name of the shortage of doctors in India, healthcare gaps in the country, and the need to increase the pool of medical specialists. The reality is that vacant seats mean loss of revenue for private medical colleges, and fee-paying students, regardless of merit, ensure that the revenue streams of these colleges keep flowing.

The expansion of postgraduate medical seats has taken place in collusion with corrupt regulators, especially in smaller cities and towns, and in institutions lacking proper infrastructure or sufficient patient load to offer specialised training.

The expansion of medical colleges happens with the oversight of the National Medical Commission (NMC) that conducts inspections of the colleges. Before 2020, this process was overseen by the Medical Council of India (MCI). Based on these recommendations, the expansion of medical college seats is finally approved by the Ministry of Health and Family Welfare. Both processes were, and are, open to lobbying by private medical colleges and, in effect, have corruption in-built structurally.

India’s explosive expansion of medical colleges taps into the ambition of middle-class parents for their children. However, it is not matched by investment in faculty strength and infrastructure.

A report in British medical journal The Lancet pointed out that India’s private medical colleges get prior information of inspections from corrupt officials, and on the inspection day bring in borrowed faculty from hospitals and other institutions for the day, presenting them as full-time employees. They are known to create fake faculty, attendance records, and to bring in patients from other facilities or even hire ‘dummy patients’ to occupy beds for proving an adequate patient load. ‘Ghost infrastructure’ like labs, libraries and equipment are also borrowed to pass inspections. There are instances known of faculty being rotated across various private medical colleges during inspection season.

In fact, the CBI recently exposed such medical scams across six States — in one instance, a medical college in Bhopal was found to have used cloned fingerprints to manipulate biometric attendance records of ghost faculty. Bribes to accomplish successful inspections were routed through hawala and temple funds. An apocryphal story describes how a Minister in the Congress-led UPA government kept his office open till midnight on the last day of approvals for expansion of medical seats, sitting on files. One can only speculate on why this was done.

Widespread corruption was the reason why the MCI was replaced by the NMC. It is unclear whether the NMC has broken from the MCI’s culture of regulatory corruption.

Additionally, there is a social dimension to the NEET-PG cut-off. The ‘0 percentile’ admission criterion applies only to SC/ST and OBC candidates. For the general category and EWS the cut-off is 7th percentile, and for persons with disabilities the 5th percentile, for the 2025-2026 admissions. Any criticism of the ‘0 percentile’ cut-off, could be seen as opposing affirmative action and social justice commitments.

However, the government’s justification in terms of ensuring ‘seat utilisation’ appears to be directed towards protecting the profitability of private medical colleges. The debate should be more about better preparatory support for the SC/ST and OBC medical graduates than about lowering the qualifying criteria to the ‘0 percentile’. Equal opportunities to achieve specialised competence in medical science must not mean relentlessly lowering competence thresholds, and increasing faculty burden with under-prepared students.

Nor should the argument for ensuring social justice be used to disguise regulatory capture by private colleges.

Reducing seats, which would be an honest thing to do, however, will go against the government’s narrative of medical education as yet another success story, and a rollback will mean admitting failure. Government propaganda is that the doctor-patient ratio in India (including AYUSH doctors) is 1:811, better than the 1:1,000 benchmark recommended by WHO. It is unclear how the practitioners are counted, the extent of their expertise, and their distribution by rural-urban locations and specialisation.

Lowering admission cut-offs to the bare minimum is, therefore, preferred because it creates a positive narrative of progress, inclusivity, and keeps private investment in medical education profitable.

Bharat Bhushan is a New Delhi-based journalist.

(Disclaimer: The views expressed above are the author's own. They do not necessarily reflect the views of DH)