By P Sesh Kumar
There is a particular silence in an Indian household on the morning of the NEET result. It is not suspense, exactly. It is closer to the hush before a verdict, because everyone in the room understands that what is about to be read out is not a score but a sentence: a rank that will determine whether a family spends four lakh rupees or one and a half crore on the same degree, whether a nineteen-year-old sleeps in a government hostel in Guntur or a rented room in Bishkek, and whether the next five and a half years are an education or a mortgage.
The arithmetic that produces this silence is brutally simple and almost never stated plainly. For the 2026-27 session the National Medical Commission’s own matrix records 1,36,939 MBBS seats across 823 colleges, of which 63,296 are in 441 government institutions and 73,643 in 382 private ones– an increase of 9,911 seats over the previous year, and the largest single-year expansion in the country’s history. Against that, some 22.7 lakh candidates entered the 2026 cycle. The previous year’s counselling round put the ratio in the only form that matters to a parent: 12.36 lakh qualified candidates competing for about 1.18 lakh MBBS seats, which is to say that roughly one qualified aspirant in ten obtained a seat at all. Qualifying, in other words, is not success. It is permission to enter the real contest, which is a contest about money.
Alongside the MBBS pool sits a second, larger and far less discussed reservoir: roughly 52,720 undergraduate AYUSH seats across some 914 colleges, of which Ayurveda alone accounts for about 31,000. These too are filled on NEET merit, through the AYUSH Admissions Central Counselling Committee and the State AYUSH departments. The consequence is a single national ranking that sorts the
same cohort of eighteen-year-olds into three entirely different professional universes on the strength of a few marks in a three-hour paper– and then hands each of them a certificate that says, in effect, doctor.
Three Doors, One Key
Let us look at the comparison tables that aspirants actually read– the counselling portals, the Edufever-style explainers with their pinwheel infographics and their Talk to Counsellor banners–and the three degrees are presented with an almost aggressive symmetry. All three run five and a half years, four and a half academic plus a twelve-month compulsory rotatory internship. All three require a Class XII pass with fifty per cent aggregate in physics, chemistry and biology, and a minimum age of seventeen. All three are entered through NEET-UG. All three end in a degree whose name contains the words Medicine and Surgery. The tables then diverge politely on fees –Rs 5 to Rs 12 lakh for MBBS, Rs 1 to Rs 3 lakh for BAMS, around Rs 1.5 lakh for BHMS–and on career opportunities, where the MBBS column lists cardiologist and neurologist while the BAMS and BHMS columns list, with a candour that ought to stop the reader cold, medical representative and pharmacist.
That single asymmetry in the last row is the whole story, and the symmetry of the first four rows is what obscures it. Duration parity is not competence parity. Eligibility parity is not scope parity. Naming parity– and the word surgery appears in all three degree titles–is emphatically not practice parity. The three courses are governed by three different statutory regulators (the National Medical Commission, the National Commission for Indian System of Medicine, and the National Commission for Homoeopathy), examine three different epistemologies, and confer three sharply different bundles of legal privilege. A BAMS curriculum opens with Padartha Vigyan, Sanskrit and Ashtanga Hridaya before it reaches pharmacology; a BHMS curriculum devotes a full subject to the Organon of Medicine and to homeopathic philosophy and psychology; an MBBS curriculum spends its clinical years in wards where the pathology is confirmed by histology. These are not variants of one training. They are three different professions wearing a common uniform.
Where the divergence becomes legally hazardous is in prescribing rights. By default, neither a BAMS nor a BHMS graduate may prescribe modern allopathic medicines. A handful of States–Maharashtra prominent among them–have permitted registered Ayurveda practitioners to use specified modern drugs after a pharmacology bridge, but the position is State-specific, professionally contested by the Indian Medical Association under the polemical banner of mixopathy, and has attracted adverse consumer-forum rulings. A very large number of AYUSH graduates nonetheless build practices that depend, in daily fact, on exactly this grey zone. An entire tier of Indian primary care therefore rests on a legal ambiguity that no regulator has resolved and every regulator finds convenient. That is not integration. It is deniability with a prescription pad.
The Second Tournament: Why a Bare MBBS Is a Half-Finished Bridge
There is a proposition circulating among Indian medical students that would have been unintelligible to their grandparents: that an MBBS, on its own, is close to unemployable. Stated that baldly it is an exaggeration–a fresh graduate can register with a State Medical Council, take a junior residency, join a corporate emergency department, sit a public service commission for a medical officer post, or hang out a general practitioner’s shingle. But the exaggeration points at something true and structurally new: the bare MBBS has been demoted from a destination to a qualifying heat.
The numbers make the demotion visible. In 2025 more than 2.42 lakh candidates sat NEET-PG in a single day, of whom 1,28,116 qualified. The postgraduate pool they were competing for is genuinely hard to state, which is itself part of the problem: the NMC matrix records approximately 52,173 MD, MS and PG-diploma seats, while wider counts that fold in DNB and CPS places reach about 73,111. On the more generous count, the applicant-to-seat ratio is roughly one in three; on the narrower, closer to one in five. Either way, a majority of those who qualify do not specialise in that cycle, and a very large number never will. The Government’s answer– and it is a real answer– is expansion: postgraduate capacity has grown from about 31,185 seats before 2014, and undergraduate capacity from about 51,348, in each case more than doubling. But undergraduate intake has been expanded faster than postgraduate intake, which means the bottleneck has not been relieved; it has been relocated one year further down the pipeline and made more crowded.
Meanwhile the market has quietly repriced the general physician. Insurance empanelment, corporate hospital credentialing, tertiary referral pathways and patient expectation now all discriminate in favour of the specialist. A young MBBS graduate in a metropolitan city competes for casualty and junior-resident slots at stipends that, notwithstanding the parity mandated by the Post-Graduate Medical Education Regulations 2023, are routinely under-paid or paid late in private and deemed institutions– a grievance so persistent that stipend compliance has become a standing item in resident doctors’ agitations.
Into this bottleneck the National Exit Test (NExT) was supposed to arrive as a rationalising instrument, simultaneously licensing graduates, replacing NEET-PG and screening foreign graduates. It has now been deferred repeatedly since 2023, and in October 2025 the NMC indicated a further postponement of three to four years pending mock testing. One may reasonably regard the deferral as prudent –a badly designed single exit test would be worse than none– but the effect is that the single most consequential structural reform in our medical education has been in permanent gestation for the better part of a decade while three cohorts a year graduate into the uncertainty it was meant to resolve.
The AYUSH Cul-de-sac
If the MBBS funnel is narrow, the AYUSH funnel is a keyhole. Set roughly 52,720 undergraduate AYUSH seats against the approximately 2,274 postgraduate seats available through the All India AYUSH Post Graduate Entrance Test for 2026-27, and the ratio is of the order of twenty-three to one– an order of magnitude worse than the MBBS position. Yet the counselling literature is unanimous that strong outcomes in Ayurveda and homeopathy require postgraduation, and that a surgical specialisation is available only through the Ayurveda route. The advice and the arithmetic are irreconcilable. Twenty-two graduates in every twenty-three are being counselled towards a door that does not exist for them.
What remains for them is a thin and honourable but small band of options: AYUSH medical officer posts in the government cadres, the National AYUSH Mission’s placements at primary and community health centres, research positions in the central research councils, teaching, the pharmaceutical and wellness industries, and private practice. Entry-level earnings in clinics are commonly reported in the range of two and a half to five lakh a year, with government medical officer scales beginning at an in-hand figure around thirty thousand rupees a month. For a graduate who has spent five and a half years and, at a private college, anywhere between Rs 8 and Rs 25 lakh, that is a return profile which would not survive scrutiny in any other professional education sector.
The steel-man case for these streams deserves to be made properly, because it is not weak. We have a genuine, documented and growing demand for traditional and integrative therapies; the wellness economy is not a fad but a durable consumer market; Panchakarma and classical Ayurvedic practice command real willingness to pay in urban and diaspora markets; the AYUSH cadres provide health workers in rural postings that MBBS graduates decline; and Ayurveda’s pharmacopoeia is a legitimate object of pharmacological research rather than an embarrassment to be apologised for. Homeopathy’s defenders can point, fairly, to patient satisfaction, to low iatrogenic risk, and to a large body of practitioners with settled and loyal clienteles. None of that, however, answers the structural question, which is not whether these systems have value but whether India should be minting 52,000 graduates a year into them on the strength of comparison tables that promise parity with modern medicine and deliver a keyhole.
And the harder empirical dispute must be named rather than tiptoed around: the efficacy of homeopathy beyond placebo remains rejected by the mainstream of evidence-based medicine and by several national health authorities, and Ayurveda’s clinical claims are unevenly evidenced, strong in some domains and unsubstantiated in others. A State that regulates, funds, staffs and expands these degrees while declining to adjudicate that dispute is not being pluralist. It is deferring a decision whose cost is borne entirely by nineteen-year-olds who were never told there was a dispute at all.
The Price of the Door
Let us return to the single most politically explosive number in this note: 73,643 of 1,36,939 MBBS seats — 53.8 per cent– are in private hands. A majority of India’s future doctors are now trained in institutions whose revenue model requires them to charge what the market will bear, and the market will bear a very great deal, because the alternative for the family is no doctor at all.
What it bears, concretely: total MBBS cost in private colleges commonly ranging from about Rs 40 lakh to over Rs 1.5 crore, with management-quota tuition alone at Rs 15 to 45 lakh a year. In Karnataka, a government seat costs roughly Rs 64,000 a year and the whole degree about Rs 3.5 lakh, while a
management or NRI seat in the same State runs to Rs 27 to 45 lakh a year and a total of up to Rs 2.2 crore. Some deemed universities exceed Rs 1.38 crore for the course. Two students of the same nationality, holding the same qualifying certificate from the same examination, sitting in adjacent seats in the same lecture theatre, can therefore be separated by a cost differential exceeding Rs 1.40 crore. No principle of merit, need or public interest explains that spread. It is a scarcity rent, collected privately, on a shortage the State created and has chosen to fill through private capital.
The mechanics of collection are worth noting for their elegance. Capitation fees are illegal; everyone says so, loudly, including the colleges. What is legal is the management quota and the 15 per cent NRI quota, priced at multiples of the notified rate and settled by bank transfer during official counselling. The illegality has thus been substantially domesticated into a lawful tariff. Layered on top are the heads that fee-fixation committees do not effectively police: one-time deposits, hostel and mess charges of Rs 1 to 3 lakh a year, instrument kits, examination fees, development contributions. Education loans typically finance tuition and hostel but not deposits or kits, so the family bridges the gap with the instruments Indian families always use– gold, agricultural land, a second mortgage, a chit fund, a relative in the Gulf. The Indian medical seat is, in a precise financial sense, a leveraged asset purchased on household collateral against a projected professional income that, as the previous two sections showed, may never materialise without a postgraduate seat the family cannot also buy.
Ghost Faculty, Phantom Patients
A high fee would be defensible if it bought a high-quality clinical education. The evidence that it frequently does not is now not merely anecdotal but the subject of a criminal investigation.
On 30 June 2025 the Central Bureau of Investigation (CBI) registered a First Information Report (FIR) naming thirty-four persons–among them officials of the Ministry of Health and Family Welfare, a former NMC Joint Director, a former chairman of the University Grants Commission, and doctors serving on NMC inspection teams–in what the agency described as an organised syndicate for the manipulation of medical college inspections across at least six States. The alleged modus operandi is worth reproducing in its own terms because no paraphrase improves on it: confidential inspection schedules and assessor identities were leaked in advance, which enabled colleges to arrange the bribing of assessors, the deployment of non-existent or proxy faculty —ghost faculty– the admission of fictitious patients to project an operating hospital, and the tampering of biometric attendance systems. Six to eight persons including three doctors were arrested in a sting at Nava Raipur over a bribe of Rs 55 lakh for a favourable report on one institute; cash of Rs 38.38 lakh and Rs 16.2 lakh was recovered. Investigators suspected a going rate of Rs 3 to 5 crore for guaranteed recognition, irrespective of infrastructure or merit. On 19 July 2025 The Lancet published an editorial describing the National Medical Commission as systemically corrupt and
inefficient. It is difficult to overstate the significance of that sentence appearing in that journal about that regulator.
Strip away the criminality and a structural defect remains. The deficiencies the syndicate existed to conceal– absent faculty, empty wards, missing equipment, inadequate patient load– are precisely the deficiencies a paying student cannot detect at admission and cannot escape afterwards. A medical college without patients is not a medical college; it is a lecture hall with a hospital-shaped building attached. New colleges in low-density districts, and colleges whose fee structures presuppose a wealthy intake rather than a sick population, systematically under-supply the one input that cannot be purchased: sick people who need treating, seen by a student under a teacher’s eye, often enough for competence to form. The Indian regulatory apparatus counts beds, not bed occupancy; sanctioned posts, not taught hours. It was therefore always going to be gameable, and it was gamed.
It should be said in fairness that the NMC responded: assessors were blacklisted, implicated colleges had seat renewals and expansion proposals frozen for 2025-26, and inspection protocols were placed under review. A regulator that punishes captured assessors is better than one that does not. But an inspectorate whose integrity depends on the CBI catching it is not an inspectorate; it is a hostage.
The Leak, and What It Taught
The gate failed this year. NEET-UG 2026 was conducted on 3 May for over 2.27 million candidates. Investigators recovered from Rajasthan a guess paper carrying more than three hundred questions, of which roughly 140 matched the actual paper. On 8 May the National Testing Agency (NTA) escalated to central agencies; on 12 May it cancelled the examination and announced a retest; the matter went to the CBI, and thirteen or more persons were arrested or detained. The re-examination was held on 21 June and the result declared on 16 July. In the seventeen days before the retest, fresh claims circulated that the replacement paper was being sold on Telegram; the NTA escalated to the cyber-crime authorities and the Press Information Bureau’s fact-check unit declared several viral documents fabricated. No leak of the June paper was established.
Three lessons follow, and only the first is the obvious one. The obvious lesson is that a single high-stakes paper-based examination distributed physically across two thousand cities is an integrity architecture from the 1970s operating at 2026 scale, and that the announced migration to computer-based delivery is not a concession to critics but the minimum condition of credibility.
The second lesson is less comfortable. The cancellation was, on the facts as reported, the correct decision– and it was also catastrophic for the candidates. Seven weeks of additional preparation under conditions of maximum uncertainty were imposed on 2.27 million young people, most of whom had done nothing wrong, in order to correct a wrong done to and by a few. There is no version of this trade-off that is fair. Any examination system that concentrates a life’s prospects into one sitting will produce, whenever it is breached, exactly this choice between ratifying fraud and punishing the innocent. The design fault is the concentration, not the response to the breach.
The third lesson is about the aftermath. Once a retest has been held and counselling has begun, the leak ceases to be a live political issue and becomes a closed file– which is precisely when the criminal cases quietly weaken, the arrests fail to become convictions, and the institutional learning fails to happen. We have a long record of paper-leak prosecutions that dissolve for want of admissible evidence, and no volume of statutory penalty enhancement substitutes for investigative and forensic capacity at the State level, where most examinations are actually conducted. A law that is never successfully applied deters nobody; it merely permits the State to announce that it has acted.
The Body Count Nobody Audits
It is at this point that the analysis stops being about seats and starts being about children, and I want to handle it with the care it demands rather than the rhetoric it invites.
The National Crime Records Bureau (NCRB) recorded 13,999 student suicides in 2022, against 7,696 in 2011–a rise of nearly eighty-two per cent in eleven years. More than two lakh students a year converge on Kota alone. An India Today analysis of media reports identified approximately 93 NEET-linked deaths over five years, rising from 4 in 2021 to 32 in 2025, with at least 14 already in 2026 including 5 following the announcement of the cancellation on 12 May. That dataset is media-derived and therefore certainly an undercount; its authors say so themselves. Within institutions, the Supreme Court’s National Task Force was told by the NMC that thirty-one medical students died by suicide across 2022, 2023 and 2024, eighteen of them undergraduates, while the Task Force’s own compilation from media reports found 198 student suicides in higher education between January and August 2025, of which 47 were in medical institutions. An earlier disclosure under the Right to Information Act had put the figure at 122 medical students between 2018 and 2022. The reconciliation of those numbers is itself a scandal: a regulator that can count 1,36,939 seats to the digit cannot count its own dead to the nearest fifty.
The institutional response has, at last, begun to have shape. The Supreme Court constituted the National Task Force on 24 March 2025 under Justice (Retd.) S. Ravindra Bhat; its interim report, released on 8 June 2026, insists that student suicide be treated as a structural and institutional problem rather than a purely psychiatric one, and notes the complete absence of any statutory framework for prevention in educational institutions. Following the Court’s order of 15 January 2026 in Amit Kumar v. Union of India, the NMC issued a mandatory advisory in March 2026 requiring every medical college to report suicides and unnatural deaths, to file monthly action-taken reports, to maintain a student-to-counsellor ratio of five hundred to one with full-time qualified psychologists and confidentiality protocols, and to guarantee emergency medical access. These are the right instruments. Whether they will be complied
with by the same institutional class that was allegedly staffing inspections with ghosts is a question the note cannot answer and the reader should not assume.
What can be said analytically is this. The pressure these young people are under is not a by-product of the system; it is the system’s operating mechanism. A funnel that admits one qualified aspirant in ten, prices failure at a crore, offers a second funnel one in three, and stakes family honour on the outcome does not accidentally generate despair. It manufactures it at scale, and then treats the manufactured despair as a mental health issue to be counselled. Counselling a nineteen-year-old about resilience while declining to fix the ratio is not care. It is asking the victim to absorb a design defect.
The Foreign Detour
Confronted with a crore-rupee private seat, a very large number of Indian families take what looks like the rational option and send the child abroad: Russia, Kazakhstan, Kyrgyzstan, Uzbekistan, Georgia, Bangladesh, Nepal, China, Iran, the Philippines. Kyrgyzstan can be done, all in, for Rs 17 to 28 lakh for the full six years. Against forty lakh to one and a half crore at home, the arithmetic appears to settle itself.
It does not, and the reason is the Foreign Medical Graduate Examination (FMGE). In the June 2025 session 36,034 candidates appeared and 6,707 passed–a pass rate of 18.61 per cent, meaning 29,327 graduates of foreign medical schools failed to qualify for Indian registration in a single sitting. In December 2025, 42,872 appeared and 10,262 passed, a rate of about 23.4 per cent, with over seventy-six per cent failing. Across the decade the pass rate has exceeded thirty per cent in no session, running from 10.20 per cent in mid-2023 to 29.62 per cent at its best. Add the two 2025 sittings together– nearly seventy-nine thousand appearances, fewer than seventeen thousand passes– and the shape of the thing is unmistakable: We have constructed, offshore, a shadow medical education sector that produces graduates at scale and licensed practitioners at a trickle.
The regulatory tripwires are numerous and unforgiving. Under the Foreign Medical Graduate Licentiate Regulations 2021 the course must run a minimum of fifty-four months of combined academic and clinical training at the same institution, followed by a twelve-month internship, with the medium of instruction in English, the qualification registrable in the country of training, and the school listed in the World Directory of Medical Schools. NEET qualification is mandatory even for admission abroad if the graduate ever intends to practise in India–and many foreign universities admit students without it, cheerfully, because their revenue does not depend on the graduate’s Indian licensure. In March 2026 the NMC further clarified that any portion of the course delivered online must be compensated by physical onsite training that cannot be used to compress course duration, a ruling that reached back into the COVID cohorts across
Russia, Kazakhstan, Georgia, Bangladesh, Nepal, Kyrgyzstan, Iran and Uzbekistan. Any single breach is fatal: no screening test, no registration, no practice, ever.
The NMC has also, tellingly, abandoned the maintenance of an approved list of foreign universities in favour of an approved set of rules, transferring the entire verification burden onto an eighteen-year-old and a family who have never read a gazette notification. Standing between them and the rules is an unregulated agent industry paid on commission at enrolment, with no stake whatever in whether the student is ever registrable in India. That is the single most under-regulated intermediary in Indian education.
And then there is the risk that no fee comparison captures. On 24 February 2022 Russia invaded Ukraine, where some twenty thousand Indians, overwhelmingly medical students, were living. Operation Ganga eventually brought back more than twenty-two thousand nationals. Similar plight awaited scores of students pursuing MBBS in Iran after the US-Irael led attacks recently. On 1 March a Karnataka student, Naveen Shekharappa Gyanagoudar, was killed in Kharkiv, and the evacuation escalated. Those who survived faced a second ordeal: degrees suspended in mid-course, and transfers negotiated individually to Russia, Uzbekistan, Serbia and elsewhere in order to salvage the years already paid for. A cost-benefit calculation that prices tuition in Bishkek against tuition in Bengaluru but assigns zero to sovereign risk, consular exposure, war, language, isolation and the twenty-per-cent probability of returning home unlicensable is not a calculation. It is a wager dressed as one, and it is being placed by tens of thousands of families a year who have not been shown the odds.
Why the Queue Still Forms
Given all of the above, the honest question is not why students suffer but why they keep coming. Twenty-two lakh a year, after a cancelled paper, after the ghost-faculty FIRs, after the crore-rupee fees, after the FMGE statistics. Something is holding, and it is worth naming precisely, because reform that misdiagnoses the attraction will fail.
The first thing holding is that a medical licence remains one of the very few credentials in our country that converts reliably into both income and status, and that cannot be devalued by credential inflation, outsourced offshore, or automated away in the near term. In a labour market where an engineering degree has become a lottery ticket and a general graduate degree close to worthless, five and a half hard years for a protected, portable, socially untouchable licence is not irrational. It is the most rational bet on the board.
The second is that the profession carries a social meaning that no spreadsheet captures. In much of India, a doctor in the family is not a career outcome; it is the family’s transition into a different class of respectability, a marriage-market asset, an insurance policy for ageing parents, and the redemption of a previous generation’s sacrifice. The child is not choosing a job. The child is discharging a debt. That is why
cancellation of an examination lands as a bereavement, and why failure is experienced as dishonour rather than as a bad outcome in a stochastic process.
The third is the absence of designed alternatives. India has never built the credible mid-tier health professional pathways–physician associates, advanced nurse practitioners, licensed paramedics, diagnostic and imaging technologists, public health cadres– that in other systems absorb the ambition of exactly the students who now sit NEET four times. Nursing and allied health remain socially discounted rather than professionally structured. When there is one honourable door and twenty lakh applicants, the queue is not a pathology of the applicants. It is a failure of architecture.
The fourth, and least discussed, is migration option value. An MBBS in our country is a globally tradable asset, a route to the USMLE, the PLAB, Australia and the Gulf. For a meaningful fraction of the queue, the Indian seat is being bought not for Indian practice but as an export licence–which is one reason the crore-rupee private fee clears the market at all, and one reason India’s expansion of undergraduate seats does not translate proportionately into Indian doctors serving Indian patients.
The Case for the Defence
The Government’s answer to all of this deserves to be put at its strongest rather than at its most convenient, because parts of it are true and the note would be dishonest without them.
Capacity has genuinely and dramatically expanded. Undergraduate seats have grown from about 51,348 before 2014 to 1,36,939 now, postgraduate from about 31,185 to somewhere between fifty-two and seventy-three thousand depending on the counting convention, and 9,911 MBBS seats and twenty-five new colleges were added in this cycle alone. On any historical comparison this is one of the fastest expansions of professional education capacity anywhere. Second, the private sector was not an ideological indulgence but the only available instrument: a medical college is capital-intensive and faculty-intensive, and no State exchequer could have delivered eighty-five thousand additional seats in a decade from the fisc alone. Third, the regulator has in fact acted– assessors blacklisted, seats frozen, protocols reviewed, biometric attendance mandated, a mandatory suicide-reporting and counselling framework imposed within weeks of the Supreme Court’s direction. Fourth, the NEET cancellation of May 2026, whatever its cost, is evidence of a system willing to void its own flagship examination rather than certify a compromised result, which is more than several comparable jurisdictions have managed. Fifth, on the AYUSH question, the State can fairly say that it is responding to authentic patient demand and to an established constitutional and cultural pluralism in health care, not manufacturing it. Sixth, the doctor-population ratio has genuinely improved and rural access has genuinely widened, however unevenly.
Each of these is a real defence. None of them, however, meets the central charge, which is not that the State has done nothing but that it has expanded the mouth of the funnel while leaving its throat unchanged, has financed the expansion through a private tariff that transfers a scarcity rent from households to promoters, has regulated that private sector through an inspectorate the CBI says was for sale, and has declined to publish the reconciled data that would allow any of these propositions to be independently audited. Expansion without throughput is not access. It is a longer queue at the same window.
Ten Things That Would Actually Move the Needle
First, publish honest numbers. There is no excuse in 2026 for a country that cannot state, from one authoritative reconciled register, how many postgraduate seats it has, how many AYUSH seats it has, how many of its medical students have died, and how many of its foreign-trained graduates are practising. Every serious claim in this note had to be assembled from commercial counselling portals because the regulator’s own data is fragmented, undated or unpublished. That is itself an accountability failure of the first order, and it is the one failure that costs nothing to fix.
Second, subject the National Medical Commission and its Medical Assessment and Rating Board to a full CAG led performance audit– not a compliance audit of vouchers, but an examination of whether the assessment system produces reliable findings, whether its ratings correlate with student outcomes, and whether the inspection process is capable of detecting the deficiencies it exists to detect. After the June 2025 FIR and The Lancet’s verdict, the burden of proof has shifted; the regulator should now have to demonstrate its own reliability rather than presume it.
Third, replace episodic inspection with continuous, machine-readable disclosure. Bed occupancy, outpatient footfall, operative logs, faculty attendance and teaching hours should stream to a public dashboard by institution and by month. Ghost faculty and phantom patients are frauds that survive only in the gap between two annual visits; close the gap and the fraud has nowhere to live. An announced inspection is a rehearsal, and it will always be rehearsed.
Fourth, regulate the fee at the level of the cost, not the market. Fee-fixation committees currently ratify what colleges assert. They should instead publish an audited cost-per-student for each institution, disclose the entire fee–tuition, deposits, hostel, kits, everything– in a single binding notified figure, and treat any unnotified head as a capitation fee by definition. The management and NRI quotas should either be abolished or converted into a transparent, capped cross-subsidy with the subsidy actually traced to named scholarship recipients.
Fifth, break the licensure-scarcity link. So long as a bare MBBS is professionally insufficient, the postgraduate seat becomes a second crore-rupee gate and the despair compounds. Either postgraduate capacity is raised decisively towards parity with undergraduate output, or India builds a genuine, respected, well-remunerated family physician cadre with a defined scope, insurance empanelment as of right, and a structured continuing education pathway–so that the graduate who does not specialise has a profession rather than a purgatory. The second is cheaper and better, and has been recommended for thirty years.
Sixth, resolve the AYUSH question honestly and in public. Either the cross-prescribing right exists, in which case legislate it nationally with a mandatory and examined bridge curriculum and accept the clinical consequences; or it does not, in which case say so plainly, cap undergraduate AYUSH intake to something proximate to the postgraduate and employment absorption capacity, and require every counselling document to carry the scope-of-practice limitation on its face. The present arrangement, in which the State expands intake while leaving the scope ambiguous, distributes the entire risk to the graduate.
Seventh, finish NExT or abandon it. A reform that has been imminent since 2019 and is now deferred to the end of the decade is not a reform; it is an alibi. If a common licensing and postgraduate entrance instrument is right in principle–and it is– then publish the design, run the mocks on a stated timetable, and commit to a date. If it is not going to happen, say so, and reform NEET-PG and the FMGE on their own terms instead of holding three cohorts a year in suspense.
Eighth, migrate the entrance examination to secure computer-based delivery with large randomised item banks, and invest in the forensic and prosecutorial capacity to convert leak cases into convictions. The State’s failure here has never been the absence of penal provisions; it has been the absence of admissible evidence. A single successful prosecution would deter more effectively than a decade of enhanced sentences on paper.
Ninth, regulate the foreign medical education agent. Mandatory registration, a statutory duty of disclosure covering the fifty-four-month rule, the same-institution rule, the World Directory listing, the NEET requirement and the institution’s actual historic FMGE pass rate, commission clawback where a student is admitted to a course that cannot yield Indian registration, and a public register of agents with sanction history. India licenses recruitment agents for overseas employment; it does not license the people who sell its children unusable medical degrees.
Tenth, and most importantly, make the duty of care statutory rather than advisory. The NMC’s March 2026 circular is the right content in the wrong instrument. Reporting of student deaths, the counsellor ratio, the confidentiality protocol, the prohibition on punitive academic practices and the obligation to lodge an FIR should sit in subordinate legislation with named accountable officers and consequences for non-compliance, so that a dean’s failure to report is an offence rather than an omission in a monthly return that nobody reads.
A Final Word
There is an old and slightly cruel joke in Indian middle-class households that the parents decide the child will be a doctor before the child can read. What has changed in the last decade is not the ambition but its price and its odds. The ambition is now transacted at up to Rs 2 crore, adjudicated by a paper that had to be cancelled, mediated by an inspectorate under criminal investigation, funnelled through a postgraduate bottleneck that half the survivors will not pass, and shadowed by an offshore alternative from which three in four return unlicensable.
None of that has dimmed the ambition, and it will not. The queue will form again next summer, longer than this one. The only real question before the State is whether the young people in it are being asked to compete for something scarce, which is honourable, or to pay a rent on an artificial scarcity that the State created, tolerates and declines to measure. On the evidence assembled here, it is largely the second. And the first duty of any accountability institution, faced with a rent it cannot immediately abolish, is to insist that it at least be counted.
