“I love you, Papa.”
Those were among the last words reportedly left behind by a young woman in Dehradun who had spent years preparing for India’s National Eligibility cum Entrance Test (NEET), the gateway to a medical education and a career in medicine. She was preparing for a retest amid allegations of paper leaks and growing doubts about the integrity of the examination process when she died by suicide.
She was just 24 and had been a topper in her 12th standard – in other words a good, sincere student broken by the killing machine called the Indian education system.
Her death is not an isolated tragedy.
Every year, India subjects hundreds of thousands of young people to an ordeal that has become a defining feature of middle-class aspiration. Families exhaust savings on coaching classes. Teenagers spend years memorising facts and solving mock papers. Entire towns such as Kota have built economies around the hopes and anxieties of medical aspirants. Some succeed. Most do not. Some are broken by the experience. Many do not survive it.
The justification is familiar. Medicine is a serious profession. Standards must be maintained. Quality must be ensured. The country cannot allow unqualified people to become doctors.
Yet behind this argument lies a question India rarely asks.
Why does a country suffering from a chronic shortage of doctors devote so much energy to preventing people from becoming doctors? This is the central contradiction of Indian health policy.
India is home to nearly one-fifth of humanity. It carries one of the world’s largest burdens of disease. Large sections of the population, especially in rural areas, struggle to access qualified medical care. Community health centres remain understaffed. Specialist shortages persist. Millions of people rely on informal practitioners because no qualified doctor is available nearby.
And yet India’s medical education system functions less as a mechanism for producing doctors than as a mechanism for excluding aspiring doctors. The result is a system that fails both students and patients.
The shortage of health personnel is often obscured by official statistics claiming that India has achieved the World Health Organization’s recommended doctor-population ratio. These figures typically include practitioners from AYUSH systems alongside MBBS doctors. Whatever one thinks of traditional systems of medicine, counting them alongside allopathic physicians does not solve the problem of inadequate access to evidence-based medical care.
More importantly, national averages conceal enormous inequalities. A resident of South Delhi and a resident of a remote village in Bihar do not experience the same healthcare system. One may have access to multiple specialists within a few kilometres. The other may travel hours to find even basic medical attention. Medical colleges too are concentrated in the south and west of India with central and east India having too few for their regional needs.
If the purpose of medical education is to improve population health, India’s current system is clearly not succeeding.
Part of the problem lies in a mindset that treats medical education as a scarce commodity. For decades, regulations, licensing requirements, infrastructure norms and seat restrictions have limited the supply of medical graduates. While concerns about quality are legitimate, they have often been used to justify bottlenecks that bear little relationship to the country’s actual health needs.
The result is a system in which scarcity has become an objective in itself. This scarcity is then defended through the language of merit.
But the claim that examinations such as NEET guarantee fairness and quality has become increasingly difficult to sustain. Allegations of paper leaks, organised cheating networks and irregularities have repeatedly shaken public confidence. If admission to medical school can be manipulated by money, influence or corruption, then the argument that extreme competition is necessary to preserve merit loses much of its force.
The NEET paper leak debacle has given rise to the Cockroach Janata Party which, along with the opposition Congress party, is asking for the resignation of the current education minister Dharmendra Pradhan. The demand is valid but inadequate to deal with the larger crisis of medical education in the country.
India has created one of the most competitive medical entrance systems in the world without creating one of the world’s most effective healthcare workforces.
The contradiction becomes even sharper when one considers how traditional medicine is treated. A student seeking admission to an MBBS programme must survive one of the most competitive examinations on the planet. Yet thousands of practitioners from traditional systems are routinely counted as part of the national health workforce without any equivalent public debate about outcomes, effectiveness or quality assessment.
If quality is truly the concern, quality standards should apply consistently. If population health is the concern, then the priority should be expanding healthcare capacity rather than policing educational scarcity.
Other countries have recognised this reality. China faced a challenge remarkably similar to India’s: a huge population, vast regional inequalities and an urgent need for health personnel. Its response was not to intensify competition for a limited number of seats. It was to expand medical education on a massive scale. New medical schools were established, existing institutions increased enrolment and public investment flowed into teaching hospitals and health-worker training.
China understood a simple truth: a shortage of doctors cannot be solved by conducting more difficult entrance examinations. It can only be solved by producing more doctors.
Cuba offers an even more striking example. Despite limited economic resources, it has one of the highest doctor-to-population ratios in the world. The country trains far more doctors than it requires for its own population and has repeatedly sent medical teams abroad during crises and disasters. Cuba’s achievement rests on a simple principle: healthcare is treated as a public good rather than a business opportunity.
Thailand provides perhaps the most relevant lesson for India. It is neither a superpower nor a socialist state. Yet it has built one of the most successful universal healthcare systems in the developing world. The key was not privatisation. It was public investment. Thailand’s Universal Coverage Scheme is funded primarily through government revenues and taxation, while deliberate policies were adopted to train and deploy health workers in underserved areas.
Brazil followed a similar path. Through its Unified Health System, healthcare became a constitutional right rather than a market commodity. Public investment in primary care and community health workers dramatically expanded access to care.
These countries differ politically, economically and culturally. But they share a common insight: health is too important to be left primarily to market forces. Unfortunately, India appears to be moving in the opposite direction.
Medical education is increasingly commercialised. Private colleges dominate expansion.. Indian households spend significantly more out-of-pocket on private education than the Central Government’s entire annual education budget. While the Indian Central Government allocated ₹1.39 lakh crore for education in the Union Budget, total private household expenditure on education across the country is estimated to exceed ₹7.28 lakh crore annually.
Indian patients also bear some of the highest out-of-pocket health expenditures in the world. Healthcare is treated less as a public service than as a market. In this respect, India increasingly resembles the United States rather than China, Cuba, Thailand or Brazil. That is a bad model to emulate.
The United States spends more on healthcare than any country in history, yet performs poorly compared with many countries that have universal public systems. India has imported some of the least desirable features of the American model without possessing America’s wealth. The result is predictable: expensive medical education, expensive healthcare and a workforce concentrated where profits are highest rather than where needs are greatest.
Nothing illustrates India’s misplaced priorities more clearly than the contrast between engineering education and medical education.
For decades, India has invested heavily in creating world-class engineering institutions. The IIT system has expanded dramatically and continues to receive substantial public subsidies. No one argues that India has too many engineers. No one insists that engineering education must remain artificially scarce to preserve quality. On the contrary, the expansion of technical education is celebrated as a national achievement.
Why is medicine treated differently?
The social return on producing doctors is arguably much greater than the return on producing software engineers. A new engineer may create economic value. A new doctor saves lives. A new doctor reduces maternal mortality, treats tuberculosis, prevents childhood deaths and manages chronic diseases.
If India can subsidise elite engineering education, it can certainly invest similarly in doctors, nurses, midwives and community health workers. The real issue is not money. It is lack of political priority for delivering what a majority of Indians want instead of focusing only on needs of a tiny elite.
The debate should no longer revolve around fine-tuning entrance examinations or tightening eligibility criteria. The real question is why a country of 1.4 billion people continues to ration medical education in the first place.
India needs more government medical colleges, more district-level training institutions, more nursing schools, more residency positions and more scholarships for students from disadvantaged backgrounds.
It must also confront a reality policymakers often prefer to ignore: millions of Indians already depend on informal providers and traditional practitioners. Pretending these practitioners do not exist has not made them disappear. Instead of criminalising or ignoring them, India should train them.
A national programme should provide bridge education, scientific training, clinical supervision and competency-based certification for informal rural practitioners and traditional medicine providers willing to acquire additional biomedical skills. A supervised and trained practitioner is preferable to an unsupervised one. A village health worker with enhanced clinical skills is preferable to no health worker at all.
The goal should not be to create a small elite medical profession. The goal should be to create the largest, best-trained and most widely distributed health workforce in the world. India became an information technology powerhouse because it expanded access to technical education. It can become a healthcare powerhouse only by doing the same for medicine.
The future of Indian healthcare will be secured only by abandoning the politics of scarcity and embracing the politics of abundance. India does not need fewer medical students.
It needs millions more. Let a million medical colleges bloom.
First published in countercurrents.org on 18/6/2026
