NEET UG is only the first hurdle in a long race for aspiring doctors

Bitter pills: High cost of studying medicine, timing of NEET PG, skewed student-teacher ratio, uncertainty over NExT

The result of the National Eligibility cum Entrance Test (NEET) was declared on Tuesday evening. This time, 2.08 million students had taken the test – 25o,000 more than last year. Cracking NEET, an entrance exam for undergraduate students who wish to pursue medical, dental and AYUSH courses in government and private medical colleges, isn’t easy. Add to that the glitches and other preventable issues that mar the process.

Last year, for instance, the exam was delayed from its May schedule. Aspirants alleged that a centre in Rajasthan allowed students to write the exam without taking their biometrics. Elsewhere in Rajasthan, students alleged they were made to write the paper twice on account of a mix-up in the question paper for Hindi and English medium aspirants.

NEET is no cakewalk. But those who have cracked it will tell you that neither are the years after that.

Nitya Singh (name changed on request), a 28-year old doctor who is practising with an institute in Gurugram in the Delhi National Capital Region, says she spent over Rs 1 crore on coaching in Kota and her college fees. Her salary after an MBBS degree is not even a fraction of that.

“We spend a lot of money on coaching and college fees. It takes years to recover the amount we have invested,” she says.

A large part of the expenditure in medical schools is on account of the books, says Prashanth S, immediate past president, Indian Medical Association (IMA). “Different states have different fees for medical colleges. While a few offer scholarships, in some private institutions, the fees can go up to Rs 1.5 crore,” he adds.

The high fee is a setback for people from humble backgrounds. A daily-wager from Ferozepur, Punjab, says he borrowed Rs 82,000 for his son’s admission to a medical college in Amritsar. “The fee for the semester is higher than my family’s annual income. God knows how I’ll be able to pay the fees for the rest of the course,” he says.

For several students, the problem does not end with getting through the exam. The course, too, brings with it a plethora of challenges. One of the most difficult parts is preparing for NEET PG while studying MBBS, students say.

“Preparations for NEET PG start when you are in your third year. The internships should be used for revisions. It becomes hectic after a point because we have our clinical postings as well but we cannot do much about it,” says Priyanka Chadha, third-year MBBS student, Bharati Vidyapeeth Medical College, Pune.

“NEET PG for fresh graduates is held at the end of the internship, and the interns have to study within their duty hours. This work schedule can stretch from 12 to 48 hours,” says Prashanth, adding, “There are several cases wherein they choose to drop a year after UG since the internship is very demanding.”

Mental health of the students remains an issue. Last year, the National Medical Commission (NMC) wrote to principals of over 600 medical colleges in the country asking them to furnish details of post-graduate medical students who have died by suicide during the past five years. This is likely the first serious attempt by the regulator to address the issue of stressful working conditions and mental health issues faced by resident doctors. There is little clarity, though, on how NMC proposes to use the data it collects.

According to a recent Right to Information (RTI) reply from the NMC, 119 students have died by suicide in the past five years. The RTI reply also revealed that 1,166 students dropped out of medical colleges, among whom 116 were from MBBS and 956 from post-graduation.  

“Mental health issues and a rising number of suicides among medical students haven’t been adequately addressed,” says Prashanth. “A number of uncertainties also add to the pressure. Current MBBS students face the prospect of appearing for NExT (National Exit Test, proposed by NMC) sometime soon. But the rules around it haven’t been framed to date.”

Another problem for students is the process of documentation, which was introduced in 2019 but got delayed because of the pandemic. It requires the students to analyse and note down what they have learnt across sessions on a particular day.

“The process needs to be worked out quickly because it adds to the students’ burden. In addition to it, the teacher-student ratio is skewed (1:200). So, the burden on teachers too is high,” says a faculty member of Madras Medical College who does not wish to be named.

Nobody wants an anxious doctor

In 2020, the government introduced NExT. This will be a common final-year exit test, compulsory for a licence to practice. In July 2021, NMC said the test would be conducted in the first half of 2023. According to an update in the official gazette, the government has extended the exam to September 2024.

“Current MBBS students will have to appear for NExT. It’s been nearly four years and the fate of the exam, including its rules and framework, remains unknown,” says Prashanth.

“The exam was scheduled for this year. The response to it has been mixed, with some lauding the streamlining of the final exam and others ruing the lack of clarity,” says the Madras Medical College faculty member quoted above.

This exam will replace NEET PG and will be held in two stages, says Chadha, the medical student from Pune. “But we still don’t know when it’s going to start,” she adds. “A new exam also means changes and adjusting to a new format. This might lead to a lot of confusion in the initial years.”

Growth of medical colleges

Year	Private colleges	Govt colleges
2017-18	243	237
2018-19	248	253
2019-20	260	279
2020-21	269	289
2022-23	290	322

MBBS seats in government colleges: Top 5 states

State	Colleges	Seats
Tamil Nadu	38	5,225
Maharashtra	29	4,825
Uttar Pradesh	35	4,303
Gujarat	18	3,700
West Bengal	20	3,225
Source: Lok Sabha