Repeatedly lowering the NEET-PG qualifying threshold may fill some seats, but it does not address why postgraduate medical seats remain vacant - and risks confusing the expansion of medical education with the quality of specialist training.

Education | Policy Analysis

In 2019, when the government lowered the qualifying threshold for NEET-PG by six percentile points to enable more candidates to compete for postgraduate medical seats, it could reasonably be seen as an administrative response to an immediate problem. The general category threshold was reduced from the 50th to the 44th percentile and the threshold for SC, ST and OBC candidates from the 40th to the 34th percentile. The stated objective was to prevent thousands of postgraduate seats from remaining vacant at a time when India needed more specialists. That decision, reported at the time by ThisisNews, appeared to be an exception designed to deal with an unusual mismatch between available seats and eligible candidates.

Seven years later, the exception has become a pattern, and the pattern has acquired proportions that should concern anyone interested in the quality of India's medical education. For NEET-PG 2025, the qualifying threshold was reduced to the 7th percentile for General and EWS candidates, the 5th percentile for General candidates with benchmark disabilities and zero percentile for SC, ST and OBC candidates. Because NEET-PG has negative marking, the zero-percentile threshold effectively permitted candidates with scores as low as minus 40 to enter the counselling pool.

The striking feature of this development is not simply the number itself. It is the reasoning behind it. The policy has increasingly treated vacant postgraduate seats as evidence that the qualifying threshold is too high, and therefore as a problem that can be solved by bringing more candidates below the original threshold into the pool of those eligible for counselling. Yet the experience of the last several years suggests that this diagnosis may be fundamentally wrong.

A vacant medical seat does not necessarily mean that there are insufficient eligible candidates. It may mean that the speciality is unattractive to candidates, that the institution lacks sufficient appeal, that the fee is beyond the means of most medical graduates, that the location is undesirable, that clinical exposure is inadequate or that candidates would rather wait another year than accept a seat that does not meet their academic or professional aspirations. These are very different problems, and none of them is solved merely by lowering the qualifying percentile.

The government's own experience should have prompted a reassessment. The qualifying threshold was reduced to zero percentile in 2023 precisely to prevent postgraduate seats from going vacant. Contemporary reporting described the move as an attempt to ensure that no PG seat remained unfilled. Yet the extraordinary measure did not eliminate the underlying problem. The fact that the same basic remedy had to be deployed again for NEET-PG 2025 is itself evidence that the policy is treating a structural problem as though it were an examination problem.

The distinction matters because NEET-PG is not merely a mechanism for distributing seats among colleges. It is the principal national screening mechanism through which doctors enter postgraduate specialist training. The government is correct when it points out that the qualifying percentile is only an eligibility threshold and that actual admission continues to be determined by rank, preference and availability. A candidate who becomes eligible after the cut-off is lowered does not automatically leapfrog a candidate with a better rank. That is an important qualification, and any serious criticism of the policy must acknowledge it.

But it does not answer the more fundamental question of why the national eligibility threshold should repeatedly be altered after the examination in order to accommodate vacant seats. An examination establishes a standard before the consequences of that standard become known. If the standard can subsequently be moved whenever the seat matrix produces an inconvenient number of vacancies, the examination gradually ceases to function principally as an academic filter and begins to function as an instrument of seat management.

That is where the policy becomes difficult to defend.

The problem becomes still more apparent when one examines the economics and preferences underlying postgraduate admissions. A postgraduate medical seat in a private institution is not simply a seat waiting for an academically eligible candidate. It can represent an enormous financial commitment. In some institutions and categories, postgraduate medical education costs tens of lakhs of rupees and, in certain cases, considerably more. At the same time, candidates have strong preferences for particular clinical disciplines and institutions. The result is a market in which some seats attract intense competition while others remain unfilled despite the availability of candidates.

The same pattern is visible in the speciality-wise distribution of demand. Certain clinical branches attract intense competition, while non-clinical and less-preferred disciplines can struggle to attract candidates even when seats are available. If a seat in an unpopular speciality remains vacant, lowering the examination threshold does not necessarily make that speciality more attractive. It merely enlarges the number of candidates who are permitted to consider it.

This is why the government's policy risks confusing two entirely different objectives: increasing access to postgraduate education and filling every sanctioned seat. They are not synonymous. India unquestionably needs more specialists, particularly in areas where shortages are acute. But the number of specialists the country needs cannot be determined simply by counting sanctioned postgraduate seats and then attempting to fill every one of them. The seat matrix itself must reflect the country's healthcare requirements, speciality-wise demand, geographical distribution and the capacity of institutions to provide adequate training.

There is a particularly important legal dimension to this debate. The Supreme Court has previously considered the argument that vacant postgraduate and super-speciality seats justify a relaxation of qualifying standards. In its May 2022 judgment concerning NEET-PG, the Court noted the government's concern that further reduction of the qualifying percentile could have implications for the quality of medical education. In the context of super-speciality admissions, the Court similarly recognised that medical education cannot be treated as an ordinary exercise in filling seats because the ultimate consequences of inadequate training are borne by patients. The judicial record therefore provides an important counterweight to the administrative instinct to regard vacancies as sufficient justification for lowering standards.

The issue has now returned to the Supreme Court in a much more dramatic form. A petition challenging the reduction of the NEET-PG 2025-26 qualifying thresholds was taken up by the Court in February 2026, with the challenge specifically raising concerns about the effect of allowing candidates with zero or negative scores to enter postgraduate counselling. The Court has not struck down the government's decision, and it would be premature to suggest that it has found the reduction unconstitutional or inconsistent with medical standards. The matter remains under consideration.

That distinction is important because the Delhi High Court has already taken a different view. In January 2026, while considering a challenge to the reduction, the High Court accepted the distinction between eligibility and admission and declined to interfere with the government's decision. The court's reasoning gives considerable weight to the fact that the actual allotment of seats continues to be based on merit and candidate preference. That judgment, however, does not foreclose the issue before the Supreme Court.

The Supreme Court proceedings have now acquired a significance beyond the immediate question of whether the 2025-26 cut-off reduction should stand. The Centre has constituted a 12-member expert committee headed by the Director General of Health Services to examine the NEET admission system, identify deficiencies and recommend practical solutions. The committee has been asked to undertake a broader review rather than merely defend one particular reduction in the qualifying threshold.

That may ultimately prove to be the most constructive development in this controversy, because the country needs to stop asking only how many candidates can be made eligible and start asking why postgraduate seats remain vacant in the first place.

The answer should be sought through speciality-wise and institution-wise data. How many seats remain vacant in clinical disciplines and how many in non-clinical disciplines? How many are in government institutions and how many in private colleges? How many vacancies are attributable to fees, and how many to location, institutional reputation, infrastructure or clinical exposure? How many result from the timing and structure of counselling? How many are in specialities for which the country actually has a shortage, and how many exist simply because capacity has expanded without corresponding demand?

These questions matter far more to the future of Indian medicine than the headline figure of the qualifying percentile.

There is also a larger principle at stake. Medical education is different from many other forms of higher education because its consequences extend beyond the student and the institution. A person who obtains a postgraduate medical qualification will eventually diagnose, treat and sometimes make life-and-death decisions affecting patients. That does not mean that a candidate who qualifies at a very low percentile is necessarily incompetent; such a conclusion cannot be drawn from an entrance score alone. Nor does it mean that the original qualifying percentile is a perfect measure of future clinical competence. It does mean, however, that the standards governing entry into specialist training should be determined by educational and public-health considerations rather than by the imperative to prevent a seat from becoming vacant.

There is an uncomfortable irony in the government's approach. India needs more doctors, but the answer cannot be to create the appearance of a larger specialist workforce by progressively lowering the threshold for entry into specialist education. The country needs specialists who have received adequate clinical exposure, worked under competent supervision and trained in institutions with sufficient patients, faculty, equipment and infrastructure. A filled seat is not synonymous with a trained specialist, just as an occupied classroom is not synonymous with education.

The danger becomes greater when private institutional economics enters the equation. If a medical college has invested in postgraduate seats but cannot attract enough candidates because its fees are too high or its programmes are less preferred, the solution should not automatically be to enlarge the national pool of eligible candidates. That effectively transfers an institutional or market problem to the national examination system. It may help a college fill a seat, but it does not necessarily advance the public interest.

The same logic applies to the distribution of specialities. If India requires more anaesthesiologists, psychiatrists, geriatricians, emergency physicians or specialists in other areas of public-health need, the government should create incentives that make these careers attractive. Scholarships, subsidised postgraduate education, predictable employment opportunities, service-linked incentives and better working conditions would address the underlying problem far more directly than reducing the examination threshold.

The policy should also distinguish between the expansion of medical education and its quality. India's rapid increase in medical colleges and postgraduate seats is undoubtedly a major achievement. But capacity without adequate faculty, clinical material and infrastructure can create a misleading impression of progress. The objective should not be to maximise the number of sanctioned seats. It should be to maximise the number of competent specialists produced through high-quality training.

This is where the evolution from 2019 to 2026 becomes instructive. What began as a six-percentile reduction intended to address a particular vacancy problem has moved through increasingly drastic interventions, including the zero-percentile experiment of 2023 and the 2026 decision that permitted negative raw scores to satisfy the qualifying threshold for some categories. The progression itself should prompt policymakers to ask whether they are repeatedly adjusting the instrument because they have not adequately diagnosed the problem.

The answer cannot be to lower the threshold indefinitely. There has to be a point at which the government recognises that a vacancy is information, not failure. An unfilled seat is telling policymakers something about the functioning of the system. It may be telling them that the speciality is poorly designed, the fee is excessive, the institution is unattractive, the location is unsuitable, the counselling process is defective or the country does not need that particular seat in that particular place. Suppressing that information by repeatedly lowering the qualifying threshold may make the statistics look better while making the underlying problem harder to see.

The Supreme Court's intervention therefore comes at an appropriate moment. The Court need not determine whether every candidate admitted after a reduced cut-off is capable of becoming a competent specialist. That is too broad and ultimately unanswerable a proposition. The more consequential question is whether the regulatory system has a coherent, evidence-based rationale for repeatedly changing the eligibility threshold and whether the objective of filling vacancies has been allowed to overwhelm the independent requirement of maintaining appropriate standards for postgraduate medical education.

The expert committee now has an opportunity to move the debate beyond the sterile opposition between "more doctors" and "higher standards." India needs both. The challenge is to build a system in which access expands without treating educational standards as an adjustable variable and in which postgraduate capacity follows healthcare needs rather than the financial or administrative convenience of institutions.

The original decision in 2019 was understandable if viewed as a limited response to a specific problem. What is much harder to justify is allowing an exceptional remedy to become a recurring instrument of policy. If the threshold has to be lowered again and again, and if even extreme reductions do not eliminate vacancies, the rational conclusion is not that the threshold has still not been lowered enough. It is that the government has been looking in the wrong place.

The country should not ask how low the NEET-PG bar can be lowered before every sanctioned seat is occupied. It should ask why the seats are empty, whether they are needed, whether they are affordable, whether the institutions can train the specialists they promise to produce and whether those specialists are the ones India's healthcare system actually requires.

That is a harder question, but it is the question that matters. A medical postgraduate seat is not a commodity whose value is established when someone finally occupies it. It represents a public investment, an educational obligation and, ultimately, a patient's trust. Public policy should be designed to protect all three.

The real measure of success, therefore, cannot be the number of vacant seats eliminated at the end of a counselling round. It must be the number of competent specialists India can confidently place in the service of its people. Anything less risks turning the management of medical education into an exercise in filling seats rather than building a healthcare system.