Why Tamil Nadu opposes NEET-UG? AIIMS peer reviewed medical journal explains

Public health, a state’s responsibility 

The article argues that, according to Article 21 of the Indian Constitution, the right to life implies a basic right to reasonable healthcare. Public health is primarily a state subject, giving state governments like Tamil Nadu the authority to legislate and manage health services.

“ the State Government of Tamil Nadu runs government medical colleges, which train health professionals who can provide primary, secondary and tertiary medical care. Therefore, viewing the medical colleges through a lens of ‘higher education institutions’ which produce medical graduates is, at best myopic, and lacks the systems thinking perspective, that allows one to visualise the strong link between the constitutionally mandated ‘right to life,’ public health and medical education,” said the paper.

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History of medical admissions in Tamil Nadu

The authors pointed out that before 1984, Tamil Nadu used higher secondary exam marks and interviews for medical college admissions, but due to corruption and favoritism, this system was replaced by the Tamil Nadu Professional Courses Entrance Examination (TNPCEE). It weighed TNPCEE scores and higher secondary marks equally. In 1989, the improvement examination system was introduced, allowing students to retake exams for better scores. Over time, this favoured wealthier students with resources for preparation, sidelining economically disadvantaged students.

In 2006, an expert committee found that entrance exams disadvantaged rural and poor students, causing stress and promoting an urban-centric coaching culture. Based on these findings, Tamil Nadu abolished entrance exams in 2007, relying solely on higher secondary marks for admissions to ensure fairer access. This move aimed to reduce the impact of expensive coaching and address gender disparities seen in other high-cost entrance exams like the JEE for IITs. Tamil Nadu continues to comply with the national requirement of reserving 15 percent of medical seats for the All India Quota.

Problems with NEET exam

The authors also said that in a letter from 2013, then Chief Minister J Jayalalithaa expressed concerns that NEET would undermine Tamil Nadu’s policies aimed at ensuring equitable access to medical education. She argued that NEET, a national test with high participation costs, was misaligned with the state’s socio-economic context and would hinder students from disadvantaged backgrounds. NEET’s implementation bypassed consultation with states, ignoring its impacts on state’s medical infrastructure and socio-economic factors.

The mandatory adoption of NEET led to the rise of costly coaching centres and a push for enrollment in CBSE schools, as NEET’s syllabus is aligned with the CBSE curriculum. This created financial burdens for families, favouring those who could afford expensive coaching and CBSE fees. The Justice AK Rajan Committee reported that the NEET coaching industry in Tamil Nadu is worth ₹5250 crore rupees.

Additionally, the prevalence of repeaters – students who retake the exam multiple times – has increased, resulting in further disadvantages for first-time candidates. In 2023, 69 percent of NEET candidates in Tamil Nadu were repeaters, highlighting the financial and competitive pressures on aspirants.

NEET was introduced to ensure the quality of students entering medical colleges, address capitation fees, and reduce the burden of multiple entrance tests. Since 2020, NEET has been the sole qualifying exam for MBBS/BDS courses across India, including prestigious institutions like AIIMS and JIPMER. However, the promises of improving student quality, accessibility, and affordability have not been fulfilled.

The National Medical Commission lowered the qualifying percentile for postgraduate and super-specialty courses to zero in 2023 to fill vacant seats, potentially leading to corruption and disadvantaging high-merit students.

The author said that in NEET-UG, students can qualify with low scores in Botany and Zoology if they score well in other subjects, and high tuition fees have replaced capitation fees, with some students paying as much as 7.2 million rupees annually through the NRI quota.

The National Testing Agency claims NEET improves equity in education, but the reality is starkly different. Poor rural students from backward classes, studying in local languages, are forced to compete with well-prepared students from elite backgrounds who can afford expensive coaching and multiple attempts.

“It is unfortunate that a poor rural girl student from scheduled caste/other backward classes, studying in local language is forced to compete with an NRI student from United States of America, who is studying in a creamy private school, taking expensive coaching classes, having the leisure of multiple attempts and who is prepared to take up the expensive NRI quota. The greater irony is both are judged by the same exam,” reads the article.

This scenario highlights the disparity and challenges within the NEET system, where both groups are judged by the same exam, undermining the principles of equity and fairness in medical education.

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The dummy school system

The authors points out that the negative consequences of NEET-UG on mainstream high school education is significant, particularly in places like Kota (Rajasthan), Telangana, and Andhra Pradesh.

The “dummy school” system in Kota allows students to enrol in a school but prioritise coaching institute preparation over actual school attendance.

This system, prevalent in Kota, is spreading to other states, disrupting the quality of high school education. “This system allows students to enrol in a school, often paying full tuition, with the implicit understanding that attendance will not be a priority. This frees them to focus on rigorous preparation at coaching institutes. The cosy relationship between these coaching centres and dummy schools is no secret,” said the authors.

For instance, NEET-UG 2018 topper Kalpana Kumari, while registered at a school in Bihar, prepared for the exam at a coaching institute in Delhi. Despite abundant data on the socio-economic, caste, and gender backgrounds of medical college entrants and their subsequent performance, the Union Government has disregarded these insights, enforcing a centralised entrance exam that was initially not meant to be compulsory for all states.

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This centralisation prevents states from tailoring medical education policies to their unique public health needs and socio-economic conditions. Tamil Nadu, in particular, opposes NEET-UG for its government medical colleges, preferring to use higher secondary exam marks as a more inclusive and lower-cost selection method.

High participation cost selection mechanisms like NEET-UG are disadvantageous to students from marginalised backgrounds, perpetuating inequality. The low representation of women in IITs, despite supernumerary seats, highlights the deeper issue of access to coaching classes and gender bias.

Furthermore, the quality of medical professionals is better assessed at graduation rather than entry, with weak correlations between entrance exam performance and medical school success, as seen in the United States.

Tamil Nadu initially adopted entrance exams to counteract interview biases but later scrapped them due to their role in perpetuating said inequality and is now seeking the abolition of NEET-UG and better regulation of private medical colleges, reads the article.

“The state of Tamil Nadu introduced the entrance examination as an alternative to the interview system, a system which was vulnerable to personal biases and failings of the interview committee, and later scrapped the barriers (CET, Improvement Examination), acknowledging how the alternative became a justification for inequality. It is precisely the reason why the state wishes for the NEET – UG to go, while strongly feeling that the private medical colleges and deemed universities need regulation,” concludes the authors.

(Edited by Neena)

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