To NEET Or Not To NEET Is Not The Question

In Tamil Nadu, NEET (National Eligibility cum Entrance Test, a medical entrance exam) is no longer new. It is entrenched, annual, and predictable in the way only deeply contested systems can be - arriving each year in May with equal parts inevitability and dread. The protests are no longer unprecedented either. Nor, disturbingly, are the stories that precede them: students collapsing under pressure, families recalibrating dreams, a familiar cycle of outrage and resignation.

What has changed is not the structure of the exam, but the way it has seeped into everyday decision-making. NEET is no longer just a test at the end of Class 12; it shapes how students study from much earlier, what boards they choose, whether families migrate cities, and how much they are willing, or able to spend on coaching.

For parents like Jayanthi Thiagarajan, the question is no longer whether NEET is fair in principle, but whether it is survivable in practice. “Actually this year I stopped her NEET class as I felt she is struggling so much with both the portions,” she says. The “both” is doing a lot of work here: the CBSE board syllabus that her daughter is formally enrolled in, and the NEET syllabus that runs parallel, heavier, and is far less forgiving.

This dual burden is one of the quieter fault lines in the NEET ecosystem. While the exam is positioned as a uniform national standard, the pathways leading up to it are anything but uniform. Students from CBSE schools, often already aligned with the exam’s framework, move through a more continuous system. State board students, especially those in government schools, must effectively learn a second academic language—often through private coaching that may be geographically inaccessible or financially prohibitive. The result is a system where preparation itself becomes a marker of privilege.

Dr Vivek Karthikeyan, who specialises in Family Medicine and is a rural medical practitioner in KC Patti in Dindigul district, sees the downstream effects of this filtering. “We must understand that the practice of medicine is both art and science,” he says. “The science part is what the medical student learns first: facts, statistics, concepts to memorise and reproduce in exams. But the practice of medicine is quite the opposite. It’s more of an art, soft skills, practice, human connect - which is sadly not given attention in medical school.”

That imbalance, he suggests, begins right at the entry point. “Given this mismatch from what is taught and what is practiced, I am certain entrance exams like NEET have little to offer for the medical field,” he says. “The nature of the exam caters more towards by-hearting and memorising, which makes students fact-gobblers rather than building grit and resilience.”

His critique is particularly sharp when it comes to rural healthcare. In places like KC Patti, medicine cannot be practised at a distance. It requires improvisation, cultural fluency, and trust—qualities that are neither tested nor necessarily cultivated in a high-stakes, multiple-choice examination.

“The preparation for entrance exams is focused on a high-tech, spoon-feeding methodology that only the privileged few can afford,” he adds. “It doesn’t prepare you for the realities of rural medicine.”

This gap between what NEET rewards and what the profession demands has long been part of the argument against it in Tamil Nadu. Before 2017, the state admitted students to medical colleges based on Class 12 board exam marks. That system, while criticised for its own limitations, had the effect of widening access. Government school students and those from tribal and marginalised communities were able to enter medical education in significant numbers, contributing to a more socially representative healthcare system.

NEET altered that balance. Its reliance on a CBSE-heavy syllabus and its ecosystem of intensive coaching shifted the centre of gravity towards those already better resourced. Over time, this has raised uncomfortable questions about who gets to become a doctor.

The human cost of this shift is often reduced to numbers, but even those numbers are stark. Since NEET’s introduction, Tamil Nadu has seen a steady stream of student suicides linked, directly or indirectly, to the pressures surrounding the exam. Each case is singular, but together they form a pattern that is difficult to dismiss as incidental.

And yet, for all the criticism, NEET has held its ground - legally, politically, and institutionally. The argument in its favour is familiar: standardisation ensures merit, a single exam prevents the proliferation of opaque admission processes, and a national benchmark creates mobility.

But the idea of “merit” itself is what remains under scrutiny.

On paper, Tamil Nadu’s political establishment remains firmly opposed to NEET. As political commentator D.I Aravindan points out, “The official stance of Tamil Nadu’s mainstream political parties remains resolutely anti-NEET… framed as a defense of state autonomy against perceived federal overreach.” Yet, even as this opposition continues to anchor electoral rhetoric, it has run up against the limits of India’s federal structure.

The result is a widening gap between what is said and what is done. “A distinct divergence has emerged between political discourse and civic pragmatism,” Aravindan says, noting that while public sentiment once mirrored political resistance, “students and parents have increasingly seen NEET as an unavoidable reality.”

That shift is visible not just in rising exam registrations, but in the rapid expansion of coaching centres across the state. What was once resisted is now, if not accepted, at least accommodated. Families are not necessarily convinced by the logic of NEET; they are adapting to it. As Aravindan puts it, this is a “fatigue of expectation,” where support for political opposition coexists with a pragmatic turn towards a “path of least resistance” when it comes to children’s futures.

This adaptation, however, is uneven. Those with access to coaching, to CBSE-aligned schooling, to the financial buffer required to absorb failure and try again - are better positioned to navigate the system.

For others, the shift is far more consequential. As Aravindan points out, “However, this transition (i.e., the stakeholders accepting the reality) has not been uniform. While the shift has been navigated by those with the means to access the burgeoning coaching industry, it has simultaneously widened the equity gap for students from rural and underprivileged backgrounds. For these aspirants, the 'reality' is not just a change in exam format, but a structural barrier that places national-level competition beyond their financial and geographical reach.”

The system, in other words, continues to claim uniformity while producing increasingly stratified outcomes - an imbalance that, as he suggests, political parties will eventually have to confront.

Back in his clinic, Dr Karthikeyan returns to what he believes is best suited to identify and train medical students for rural service and it could be something in the style of exams for the civil service. “If we incorporate  a three-stage entrance exam - with prelims, mains and interviews to choose and train medical students interested in rural practice, it gives a higher chance at bringing in equity in medical care among urban and rural , among affluent and poor, among privileged and marginalised,” he proposes. 

For families navigating this landscape, the choices are rarely ideological. They are immediate, practical, and often painful. Invest in coaching and risk financial strain? Push through both syllabi and risk burnout? Or step away, as Jayanthi did, and reimagine what success might look like outside the narrow corridor that NEET seems to define?

These are not decisions made in policy rooms. They are made at dining tables, in late-night conversations, in the quiet recognition of a child’s limits.

In Tamil Nadu, NEET is no longer a question mark. It is a given. What is changing, more quietly, is everything around it. Who prepares, who persists, who opts out, who never enters the race at all. When an unequal system begins to feel inevitable, resistance does not disappear. It adapts. And over time, that adaptation can look a lot like acceptance. And that is how merit is constructed - expensive to access, uneven to prepare for, emotionally exacting to endure.

The debate is no longer just about an exam. It is about the kind of doctors we are training, the kind of system we are building, and the many who are learning, early on, where they stand within it.