Medical education reservation for the rich: From merit to money

By Dr. P.K. Gupta* 

Medical education in India has undergone a profound transformation over the last four decades. What was once a system primarily driven by merit and public service has increasingly become a marketplace where financial capacity often determines opportunity. The rapid expansion of private medical colleges since the early 1990s has undoubtedly increased the number of seats, but it has also introduced commercial incentives that critics argue have weakened the traditional values of professionalism, academic excellence, and social responsibility in medical education.

The commercialization of medical education has fundamentally altered its ethos. Medical degrees have become among the most lucrative educational products in the country. Profit maximization has increasingly overshadowed the pursuit of excellence, while regulatory institutions such as the erstwhile Medical Council of India (MCI) and its successor, the National Medical Commission (NMC), have frequently been accused of failing to uphold rigorous academic standards. Critics argue that regulatory dilution has often favoured private education providers over merit-based admissions.

A major turning point came when the qualifying percentile for NEET admissions was reduced to effectively permit admissions even with extremely low scores. In 2023, the qualifying threshold for certain categories was reduced to the zero percentile, allowing candidates with minimal performance to become eligible for admission. Similar concerns have emerged in postgraduate admissions, where qualifying cut-offs have been lowered substantially over successive years. The Delhi High Court, in January 2026, dismissed a petition challenging such admissions, leaving the existing policy unchanged.

These developments have intensified concerns that financial strength has replaced academic merit as the principal determinant of entry into medical education. Private medical colleges, charging fees approaching one crore rupees or more for an MBBS course, remain beyond the reach of most middle-class and economically disadvantaged families. Critics allege that fee fixation committees, together with institutional managements, have permitted fee structures that effectively circumvent the spirit of Supreme Court directions intended to ensure affordability and fairness.

The consequences are visible in the composition of medical admissions. Until around 2000, government medical colleges outnumbered private institutions. Since then, private colleges have expanded rapidly, and today a substantial proportion of medical students graduate from institutions where admission is closely linked to financial capacity. Many academically deserving students are unable to pursue medicine because of prohibitive fees, while seats remain available for candidates with significantly lower entrance scores who can afford the cost.

This phenomenon raises difficult questions about equality of opportunity. Every year, lakhs of students securing respectable NEET scores fail to obtain admission because they cannot afford private college fees. Simultaneously, candidates with much lower scores obtain seats through high-fee institutions. In effect, wealth functions as a parallel reservation system—one reserved not for disadvantaged communities but for those with substantial financial resources.

The economics of this system are enormous. Estimates suggest that annual tuition fee collections by private medical colleges exceed ₹55,000 crore, with thousands of crores more collected as refundable security deposits. Medical education has thus evolved into a major commercial enterprise with significant financial interests influencing policy decisions.

The disparity becomes even more striking when compared with the treatment of Indian students graduating from foreign medical universities. Foreign Medical Graduates (FMGs) must clear the Foreign Medical Graduate Examination (FMGE), where they are required to secure at least 50 percent marks to qualify for registration. Historically, FMGE pass percentages have ranged between approximately 15 and 30 percent, indicating a demanding qualifying standard. By contrast, domestic medical graduates become eligible for postgraduate admissions even after qualifying through substantially reduced NEET-PG cut-offs. Critics argue that two different standards are effectively applied to Indian citizens depending upon where they studied medicine.

Many students choose foreign medical universities primarily because their total educational cost is often significantly lower than that of private medical colleges in India. Yet, upon returning, they face a licensing examination with a substantially higher qualifying benchmark than the entrance standards applied domestically. This disparity has led to allegations that the regulatory framework indirectly favours expensive domestic private medical education while placing additional hurdles before graduates from more affordable foreign institutions.

Another concern relates to the restructuring of postgraduate medical education. Over time, several shorter-duration, lower-cost training pathways and skill-development programmes have either been discontinued or significantly reduced in importance. Critics argue that this has narrowed educational opportunities while increasing dependence on lengthy and expensive postgraduate programmes, making higher medical education progressively less accessible to meritorious students from economically weaker backgrounds. The burden falls particularly heavily on students belonging to socially and economically disadvantaged communities who may qualify academically but lack the financial resources to continue their education.

The central issue, therefore, is not merely one of educational policy but of social justice. If deserving candidates are excluded because of unaffordable fees while lower-scoring candidates secure admission through financial means, the principle of meritocracy is weakened. When governments justify lower qualifying thresholds primarily to prevent private seats from remaining vacant, institutional financial viability appears to take precedence over academic standards and equitable access.

A possible reform deserving serious consideration would be the establishment of a uniform national qualifying framework for all Indian medical graduates, irrespective of whether they study in India or abroad. A common preliminary licensing examination with identical passing standards could determine eligibility for medical registration and further postgraduate education. Thereafter, the existing competitive postgraduate entrance process could continue for specialty admissions. Such a system would apply the same benchmark to every Indian medical graduate, promote fairness, strengthen public confidence, and ensure that professional competence—not financial background—remains the defining criterion for entry into medical practice.

Medical education is not merely another educational commodity. It prepares professionals entrusted with human lives. Any system that allows wealth to outweigh merit risks undermining public confidence in the healthcare profession itself. Preserving excellence, ensuring equal opportunity, and maintaining uniform standards should remain the guiding principles of India's medical education policy.

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*Contact: guptapradeepkumar698@gmail.com