Many people wonder why is there such a craze for MBBS in Tamil Nadu? So much to the extent of committing suicide? It’s a cultural phenomenon whose existence is easy to recognise and genesis is hard to track. When I was young, I remember seeing a Tamil movie called Gentleman. The story – a student who fails to get MBBS commits suicide by self immolation. His friend, the hero, gets dejected with the system. In Robin Hood style, he does high profile heists, makes a ton of money and builds a free medical college. The movie resonated with the audience. No one wondered, “How strange it is to commit suicide for not getting a seat”. Because it’s not just any seat. It’s MBBS seat. Had the director tried Engineering or Law seat, people would have said “May be the guy was suffering from some other problem”. This was long before NEET. Popular culture, movies, media, have tacitly accepted “NEET suicide” is a term. Politicians don’t help either. The topic is so hard to talk about that even as I type this, it feels like walking on egg shells.
There are at least 3 layers to the NEET debate in Tamil Nadu.
1. Emotion – that determines how one sees the debate
2. Logic – that predicts data from first principles
3. Data – that validates or refutes the logic
Unfortunately much of the debate is stuck in the base layer of emotions.
Why Is There A Resistance To NEET Only In Tamil Nadu?
The answer lies in
1. Gross Enrollment Ratio (GER)
2. Survivorship bias
3. Goodhart’s law
Tamil Nadu has the highest Gross Enrollment Ratio (proportion of eligible students enrolled in educational institutions at each age group) in Higher Education in the country – a whopping 13 % above Kerala, a state that’s well known for literacy. Tamil Nadu’s system is aimed at one thing – to enroll as many eligible students in schools and colleges as it can.
To do this, Tamil Nadu relies on a huge array of welfare initiatives. Tamil Nadu also has the maximum number of government medical seats of any state in the country. Reservation is 69%. What does this GER translate to? Poorer sections of the society genuinely feel they can get into medical colleges. So they dare to dream. The glass ceiling doesn’t exist here. This is why Tamil nadu protests.
Why do other states keep quiet? This is where survivorship bias comes in.
A team was tasked with finding out where to reinforce the allied planes during World War II, to prevent them from being fatally shot by German forces.
Others looked at the planes which returned and suggested that they should fortify the tail, since it was hit most often. Abraham Wald realized the problem – the ones which were hit in the engine, died and got buried in Nazi territory. He realized that the failures held more information than the relative successes. What is unseen is more important than what is seen.
Tamil Nadu students started with a lower pass percentage in NEET partly because, unlike in other states, the poor student is encouraged to write the exam. Who knows – Had he been born poor in another state, he might have considered NEET,an exam for the rich. Or worse, he may not have even reached 12th std. So if we look at only the successes, we will fail to gain the useful information hidden in failures. The ones who never wrote the exams are the failures we can’t see.
You might wonder, “Who is to say, that GER is the main metric we should aim for? What about the quality of those who are already enrolled?”. That brings us to Goodhart’s law.
Goodhart’s law states, “If a metric becomes a target, it ceases to be a good metric”. The reason is the system gets optimized to get that metric right, at the expense of everything else. Tamil Nadu’s socialist educational policy has resulted in the highest GER, while spending three times less than Uttar Pradesh.
At the same time, to level the playing field, the syllabus was initially diluted, relative to CBSE. Whether this trade off really exists and if so is it reasonable, is something you have to answer for yourself. However, unlike engineering, where the market provides valuable feedback for the system in the form of employment, in medicine such feedback is hard. Success of Tamil Nadu students in PG entrance exams is the easiest proxy we have.
Tamil Nadu’s robust public health statistics speaks for its success – but it is an imperfect metric of merit. The bottom line is Tamil Nadu has built a formidable healthcare system from the ground up, taking into account the local sensibilities and needs. The system is designed to keeps students in the schools and colleges, through removal of barriers. The side effect is CBSE/ICSE students were getting a raw deal – since their board exam marks are typically lower. Such a system can be frustrating for the top 5% of students – who desire the flexibility of studying throughout the country as well as the option to study in Tamil Nadu. Nevertheless, for good or bad, Tamil Nadu’s policy is based on providing the maximum benefit to maximum number of people. Is “merit” sacrificed at the altar of populism? It is impossible to say, because “merit” is too hard to define. One thing is sure though- the resistance is not just politically motivated. And Tamil Nadu’s exceptionalism is largely rooted in reality.
Is A Win-Win Situation Possible?
What would have made people welcome NEET in Tamil Nadu?
NEET for private colleges and entry into All India seats of 15%.
In short, poor student who can’t anyway afford private colleges, coaching or study in another state can use the 85% state quota. The ones who want access to private seat, other state seat and students from CBSE/ICSE could use the optional NEET. A NEET for private colleges only would have also solved the merit problem (if cut off is 50% not 50th centile). It could have been win – win. But it’s futile to engage in “what if” scenarios. Whether or not one likes NEET, it’s a reality and the student should prepare accordingly. Media and politicians can help by avoiding false hopes, distractions and lionising suicides.
It’s very hard to score above 620/720 in NEET without coaching. Of course, even with coaching it’s hard – it’s not like you pay a few lakhs fee, put an average student through coaching class, and the coaching institute magically pops out a genius. It’s also true that EVEN a top student without coaching won’t score high REGARDLESS of whether he studies in CBSE/state board. So one option is to make coaching more accessible. How?
1. Coaching in schools itself – can be done by existing teachers or contracted to coaching institutes through a district level bidding process. A public private partnership
2. Incentives to coaching institutes to keep fee low – like tax breaks, house hold rates for electricity etc
3. Disincentives and fee regulation So public OR public private partnership model with carefully calibrated carrots/sticks can be done. None of these require judicial intervention. Where there is a will, there’s a way.
What Should Students Do?
Regardless of the exam, you have to be in the top 5% if you have to get into MBBS if you don’t have money. You have to be the best of the best – if not getting into MBBS is hard. What can you do?
Every medical aspirant should have a clear idea of the NEET marks needed to get into medicine in a govt medical college. Just passing NEET meaningless if a student can’t spend ₹ 25 lakhs per year. Here’s what you should know.
Pass mark – 140/720
Govt college cut off – ~600/720
Most people fall in the 140 to 600 – or the pay zone. These students can get in only with money. This payment track existed before NEET too , in the form of management quota. NEET simply made the previous management quota seats payable in white money over 5 years, instead of upfront and avoided the middle men who made money.
So, students, there are only 3 ways to get into medical college
1. Average marks + more money
2. Good Marks + reservation
3. Better marks than option 2
Don’t listen to any random person who doesn’t know what it takes to get into medicine. Ask seniors who have actually cracked the exam. Do your research. What was last years’ cut off ? – write mock exams. The more you write the better. Check if you CONSISTENTLY score above the cut off needed to get into govt medical college – add a safety margin and aim for it. For example, if last year’s cut off is 620, aim to consistently score above 630 – If you really score below 600 always, then you are not getting into govt medical college. I encourage you to reconsider MBBS.
If a student wrote many mock exams and always scored less than 600 and his parents aren’t rich, and he doesn’t have reservation, then there’s little chance he will get into Medicine. And this will be clear months before the exam – especially for a repeater. So there is absolutely no element of surprise. Such a student should be counselled regarding his bleak chances if he himself doesn’t understand. There’s very little chance that NEET will go away. A student shouldn’t be naive enough to believe local politicians who claim otherwise. Otherwise only disappointment results. So, if you are a student know where you stand. Take stock of how much money your parents can spend. If you don’t have one or more of – money (₹22-25 lakhs per year), – reservation (less useful than money) – more than 600 marks (more the merrier) then you ARE NOT getting into a medical college. It is what it is. Facts don’t care for your feelings and there is no point in getting surprised. Remember there’s no glory in self harm.
In case you insist on pursuing MBBS despite your score being mediocre, you can try Philippines. It’s cheaper (₹5 lakhs per year), quality is good, food and climate are fine and it has the highest pass percentage in FMGE exam This tweet may look like a black pill , but it’s better to face reality than be shielded from it. I have cracked every exam I have written in first attempt – but trust me, there’s an element of LUCK in all exams. It’s not just merit. So inspite of being the best and doing your best, you may lose – don’t worry. You can try again.
Any young student dying is a tragedy – but we must be mindful of what message we inadvertently communicate in the aftermath of such tragedy. Lionising the act of suicide, the portrayal of exam as a monster, or the student as a brave martyr should be avoided. A careless word here, a nonchalant nod there can have devastating effect when amplified in the social media era. Some influential celebrity or politician should give a message of hope. There’s always another chance. Another opportunity to set things right. Despite popular belief, MBBS is just another course. There are innumerable ways to serve the society other than joining MBBS. It’s not worth dying for. No matter what it feels like, darkness is never permanent. It dawns eventually. Neither winter, nor spring is eternal. Such is the law of the universe. Everything will be okay in the end. If it’s not okay, it’s not the end.
This article is based on a series of X threads by Karthik Endocrinologist.
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Karthik is an endocrinologist at Sri Ramachandra Medical College, Chennai.