A candidate who scored minus twelve marks out of eight hundred has been allotted a seat to pursue MD in Physiology. Another candidate with four marks got MS Orthopaedics seat at a government medical college. One more with minus eight entered Biochemistry postgraduate training. Yet another with twelve marks got allotted MD Forensic Medicine. ^{1 2 3}

These are not imaginary scenarios that I have made up to make a point. These are allotments from the third round of NEET-PG 2025-26 counselling that got over on 13 Feb 2026, as reported in the MCC data and national press.

The qualifying percentile for reserved categories now stands at zero. In an exam with negative marking, zero percentile in this exam worked out to be minus forty marks. For the general category, the qualifying percentile reduced from the 50th percentile to the 7th (from 276 marks to 103).

When I read these numbers, my first reaction was not outrage or frustration. It was clinical.

The Reform That Worked – 2017

I must give credit where it’s due. I want to say this clearly, because what comes after this section will be critical. I don’t want this to be mistaken as cynicism about NEET-PG itself.

Before 2017, postgraduate medical admissions in India were a total mess. Students appeared for a dozen different entrance exams, travelling across the country, spending money that they didn’t have, and without any guarantee that the process was fair. “Seat blocking” syndicates ran their operations quite openly, and institutional frauds, the Vyapam scandal of Madhya Pradesh being the most notorious, were just the tip of the iceberg. ^{4 5}

The “One Nation, One Exam” policy that gave rise to the NEET-PG clearly dismantled the retail corruption of rampant seat-selling. That was a real achievement. I remember the relief among my colleagues and students when it was announced. No more running from city to city writing five exams in three weeks. One exam. One rank. Fair opportunity. This system also came with one specific disadvantage, which I will discuss later on this page.

Building a good system is only half the job. Running it on time and properly is the other half. We traded the corruption of the old system for the delays of the current one. The architecture of NEET is strong. But currently, there are some blocks in the plumbing.

Timeline & Numbers

Timeline matters, so let me elaborate the sequence of events.

NEET-PG 2025 was held on 3 August 2025. First round of counselling happened in October–November. Second round completed in early December. ⁶

After the first two rounds, more than 18,000 postgraduate seats were still remaining vacant. About 9,000 of those were All India Quota seats. Union Minister of State for Health Anupriya Patel confirmed this to the Rajya Sabha on 10 February 2026. She used the word “precious” to describe the seats. Each one, she said, took years to sanction and lakhs to establish. ⁷

On 9 January 2026, the Ministry directed NBEMS to lower the qualifying percentiles. On 13 January, NBEMS notified this lowering. ⁸

Here’s the before and after:

This isn’t the first time.

In 2023 too, cutoffs were reduced to zero percentile, though the lowest qualifying mark that year was five.

In 2024, the qualifying score was reduced to the 5th percentile across all categories.

What was considered as a one-time measure is now happening every year. This is no longer an exception. It has become a policy. ⁹

Eligibility Exam or Ranking Exam?

This is a point worth pondering about.

Regulation 9 of the Postgraduate Medical Education Regulations (PGMER) 2000, framed by the erstwhile Medical Council of India, is quite clear. A candidate must obtain a minimum of the 50th percentile to be eligible for PG admission. For reserved categories, the minimum is the 40th percentile. ¹⁰

This is the language of a qualifying exam. Not a ranking exam. NEET-PG was built on those regulations.

A pure ranking exam needs no cutoff at all. You simply list the candidates by their score and allot seats from top to bottom. Nobody is “ineligible.” Everybody competes. The rank decides everything. But NEET-PG was not designed that way.

Now let’s think about what happened in January 2026. The NBEMS, as per directions, reduced that qualifying percentile to zero for reserved categories. ⁹

If NEET-PG were truly just a ranking exam, there would be no threshold to lower in the first place. The very fact that a statutory minimum exists, and must be specifically dismantled each year to fill vacant seats, confirms what the regulation always intended: NEET-PG is an eligibility exam with a ranking function added on.

Why Are 18,000 Seats Going Empty?

This is the question that should be at the centre of policy meetings.

AIIMS seats fill up in the first round. Top government institutions have no vacancies. Top deemed universities and private institutes have no vacancies. So the problem isn’t a shortage of doctors who want to specialise. It’s about which seats are going empty and why. I see three clear reasons, and none of them get fixed by lowering a cutoff.

The first is fees. Many private and deemed university PG seats charge very high fees. I’ve heard of clinical seats costing three to five crore rupees over the duration of 3 years. A young MBBS graduate, probably expected to take care of their ageing parents, or at least not be a burden to them, looks at those numbers and decides that it is better to drop a year and try again. Can you blame them?

The second is quality. Many colleges don’t have proper faculty, adequate patient loads, or the basic infrastructure you’d want for training a specialist. Students know which colleges to avoid. Word goes around. So those seats stay empty. ¹¹

The third is the unpopularity of certain non-clinical specialities. Anatomy, Physiology, Biochemistry, Pharmacology, Microbiology… these departments struggle to fill seats year after year. I understand the problem. I have taught in a medical college and I have seen it from close quarters. The solution is to make these careers worth choosing. Better pay, clearly defined career progression, academic incentives, and research funding. We can’t fix a low-demand problem by removing all filters on the supply side.

The Supreme Court Wants Answers

The legal challenge came from the United Doctors Front who filed a PIL in the Supreme Court challenging the NBEMS notification. ¹²

The argument by the petitioners deserves close attention. They told the Court that the existing regulations (PGMER 2000 regulations mentioned above) allow cutoff reduction only when there aren’t enough eligible candidates for the available number of seats. This was meant to be an exception. But for the 80,000 PG seats that are available, more than 1,28,000 candidates were already eligible within the original qualifying percentiles. There are more than enough qualified candidates even before lowering the qualifying percentile. ¹³

So the bar was not lowered because nobody could clear it. It was lowered because many qualified candidates chose not to join certain seats at certain colleges. That’s a very different problem. And it needs a very different solution.

The Missing Batch: What Happens in Our Hospitals

Something very real is happening in hospital wards.

Teaching hospitals run on what we call the “three-batch” system. You have first-year, second-year, and third-year residents, each carrying defined responsibilities. When admissions are delayed by months, and they’ve been delayed by months now, over 5-6 years, one of those batches simply doesn’t show up for most of the year. We are calling this the “missing batch” problem for a while now.

What happens next is predictable. The residents who are present must absorb the work of the absent batch too. Emergency departments stay short-staffed. Outpatient clinics stretch. Waiting times for patients increases. On-call duties pile up. People who should be getting 12-24 hours off after a night shift are back on the wards without rest because there’s nobody to replace them, but the work needs to be done.

A 2025 cross-sectional study showed significant burnout, high perceived stress, and falling empathy among postgraduate medical trainees in India. ¹⁴

An earlier article called it “Burnout: The Resident Evil,” and the title wasn’t exaggerating. ¹⁵

I don’t need a study to tell me what a sleep-deprived resident looks like, or how their clinical judgement changes after thirty consecutive hours of busy duty. I’ve seen it. A tired doctor makes mistakes. Not because they’re bad doctors, but because they’re human beings, and human beings don’t function well without sleep.

Reservation Isn’t the Problem.

I need to address this directly, because I know how these conversations can go online. They miss the point entirely.

The zero percentile cutoff applies to reserved categories. The internet has, predictably, turned this into a “reservation versus merit” debate. That’s not correct.

Reservation is a constitutional commitment. Its purpose, ensuring that historically marginalised communities have access to higher education, is valid. I believe that.

The conversation shouldn’t be about reservation. It should be about what happens after a candidate gets that seat. Does the college have enough faculty to teach them? Are there enough patients for them to learn from? Will they come out, three years later, as a specialist who can confidently walk into a hospital and handle sick patients?

The goal of reservation was never to hand out degrees. It was to create doctors, teachers, surgeons, and scientists from communities that were historically denied the chance. That goal is honoured only when the seat leads to genuine training, a meaningful career, and a real contribution to the healthcare of our country. It is dishonoured when a candidate ends up at a substandard institution, given a certificate after three years, and sent out without the skills to match the title.

Every seat, reserved or otherwise, should be a road to competence. Not just a line on a degree certificate.

One Shot, One Year: Why a Single Exam Is Also a Problem

There’s another issue that’s not getting enough attention.

NEET-PG is held once a year. One exam. If you’ve prepared for twelve months and you fall sick on exam day, bad luck, you have to wait for another year. If you have a family emergency the night before, if your anxiety peaks and you freeze during the paper, you lose an entire year. Not a semester. Not a term. A full year of your professional life.

Here’s a straightforward proposal. Conduct NEET-PG twice a year, with a gap of eight to ten weeks between the two sittings, enough time to maintain exam security and prepare independent question papers. Allow candidates to appear for both. Take the better of the two scores for ranking purposes.

This isn’t a radical idea.

We already have the precedent sitting right under our noses. INI-CET, the entrance exam for AIIMS, JIPMER, PGIMER, and NIMHANS, is conducted twice a year, in January and July, for the very same pool of medical graduates. ¹⁶

JEE Main, conducted by the same National Testing Agency that runs NEET-PG, is held in two sessions every year. Candidates can appear for both. The better of the two scores is used for ranking. ¹⁷ Lakhs of engineering aspirants benefit from it every year. Nobody argues that two sessions dilute the exam’s credibility.

Naturally, two different papers will have different difficulty levels. JEE Main handles this through percentile normalisation, and NEET-PG would need to do the same. This is standard practice, not a new invention. The NTA already has the methodology in place.

The USMLE in the United States allows candidates to schedule their attempts within defined windows. The PLAB in the UK offers two sittings a year. ^{18 19}

Now compare this with NEET-PG. Everything you’ve worked for comes down to three and a half hours on one morning. One bad day. One bout of diarrhea or dengue. One panic attack. A full year of your professional life.

Some will argue about logistics. More exams means more expense, more invigilation, more coordination. But a country that runs hundreds of exams every year including UPSC, JEE, NEET-UG, banking exams, and state-level competitive exams can certainly manage two NEET-PG sittings. It’s a practical suggestion. It deserves a serious hearing.

So, What Needs to Change?

I’m not writing this to complain. Complaints are easy.

I’m writing this because I think the fixes are within reach. The foundation, a single national exam, is solid. We just need to build on it.

The good news is that the same administration that unified medical entrance exams across this vast country is certainly capable of running them on a predictable schedule. The system has the ability. What it needs now is a commitment to make these changes.

A Fixed Calendar

“Exam in January, Joining in May.” Written in stone. No exceptions. If banking and civil service exams can stick to a timetable, NEET-PG can too.

Honest Vacancy Analysis

If 18,000 seats go empty, we need to ask why. Is it fees? Then there’s a case for capping them, or at least tying government recognition to fee transparency. Is it substandard colleges? Then it may be worth cancelling new PG seat approvals at institutions that can’t fill the ones they already have. Is it unattractive non-clinical branches? Then make them attractive. Provide higher stipends, defined career paths, research funding. Lowering the cutoff to minus forty is like treating malaria with paracetamol instead of chloroquine.

Judicial Urgency

The involvement of Supreme Court in this matter is welcome. But there’s a broader principle that needs to be recognized. When medical admission timelines get stuck in litigation, the downstream effect on hospital capacity and patient care should be fair grounds for expedited hearing. Every month a teaching hospital runs without its full set of residents is a month where patients receive less attention. That’s the ward reality.

Stricter Exit Standards

Some argue that entrance scores don’t matter much, that what really matters is the training. I’ve seen average entrance scorers become outstanding clinicians, so there’s some truth in that. But that can’t be a policy foundation. If entry scores are going to stay low, we need much stronger guardrails at the other end. Rigorous competency assessments during training and meaningful final examinations before someone is certified as a specialist.

Restore the Dignity

In 2027, I want to be writing about advances in medical education, clinical training, and reflections. Not about whether someone with close to zero marks should be holding a scalpel.

Our residents deserve better.

Our patients deserve better.

The medical profession deserves better.

Author’s Note:
This article represents my personal views as a doctor and a concerned citizen, and not that of my institution. This is a contribution to a public conversation that I believe matters deeply, for our students, our residents, our patients, and the future of medicine in India.
I have no political affiliation and no financial interest in any medical college, coaching institution, or edtech platform.
The facts cited here are drawn from official notifications, court proceedings, parliamentary statements, and published news reports. Readers should verify claims independently and form their own views.

…

Shashikiran Umakanth

Dr. Shashikiran Umakanth (MBBS, MD, FRCP Edin.) is the Professor & Head of Internal Medicine at Dr. TMA Pai Hospital, Udupi, under the Manipal Academy of Higher Education (MAHE). While he has contributed to nearly 100 scientific publications in the academic world, he writes on MEDiscuss out of a passion to simplify complex medical science for public awareness.

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