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The structure and administration of India’s medical education system have come under growing pressure in recent years, with 2026 proving a watershed. Two developments stand out. First, malpractices in the conduct of the 2026 undergraduate National Eligibility cum Entrance Test (NEET AND) sparked nationwide protests in June and Julyrenewing public calls for increasing medical seats to accommodate more students. The central government has since indicated that it intends to keep increasing medical seats, and the state governments of Tamil Nadu and Assam have announced seat expansion plans of their own. Second, the percentile cut-off in the NEET-PG 2026 counselling process was reduced to zero to fill vacant seats, as it had been for the super-speciality test (NEET-SS) in 2023 and 2024. The Federation of All India Medical Association (FAIMA) warned that the move risks “the quality of future specialists”.
Together, these events illustrate the fine balancing act India faces: widening access to medical education without diluting standards in professional licensing and entry into specialty training. This analysis examines the health economics theories that support and oppose expanding medical seats, and advocates a shift from simply increasing seats towards targeted measures that enlarge the pool of competent doctors.
The Economic Case for Easing Licensing
There is an economic rationale for expanding medical seats and easing licensing and regulatory requirements. Occupational licensing has traditionally been viewed as an entry barrier that unduly restricts the supply of providers. By limiting competition, it allows the existing pool of providers to operate as a ‘collective monopoly’ and raise prices artificially, to the detriment of consumers.
Indian economic analyses of the issue are rare, but the global literature discusses it extensively. The American Medical Association’s advocacy, for instance, has been linked to fewer medical schools and substantially higher physician incomes. Research on relicensing barriers for immigrant physicians in Israel found that such barriers may reduce the average quality of service provided by incumbent physicians.
It is also argued that there is little empirical evidence that licensing requirements work: licensing authorities do not act against errant doctors often enough, and most cases never reach the public recordwhich prevents the public from making informed choices. India, for example, has no comprehensive, searchable national database of disciplinary actions against doctors, and the National Medical Commission’s (NMC) searchable blacklist has only 11 names. State Medical Councils, moreover, tend to favour warnings or mandatory attendance at continuing medical education (CME) over other measures.
Risks of Easing Licensing Barriers
The theoretical effects of reducing licensing barriers and expanding the supply of doctors, however, are not wholly positive. Lowering the entry barriers to practising medicine carries significant risks.
First, information asymmetry is large because medicine is a highly technical field that demands years of training and experience. Doctors are far better placed than patients to judge whether a treatment plan is appropriate, which lets them over-provide care (for example, more tests, medications, and follow-ups than needed) or under-provide it (for example, giving a patient’s case inadequate attention or avoiding expensive tests in public hospitals). The problem is compounded by the gap between what is “objectively” best for a patient and what the patient believes is best for them. A patient may, for instance, prefer a doctor who prescribes antibiotics because it matches their expectations of “good” treatment, even if the drugs are medically unnecessary.
Second, patient heterogeneity and clinicians’ differing views of optimal care complicate disciplinary action against doctors. Since it is difficult to assess a doctor’s quality of service and treatment plan “objectively,” errant doctors are rarely disciplined.
Both challenges imply that high entry barriers, particularly around clinical competence and ethics, are essential in medicine, because standards are harder to enforce post-facto, even though such enforcement is equally important.
The consequences of a poorly selected doctor pool are stark. A landmark 2016 BMJ study estimated that medical error is the third-leading cause of death in the US. In India, research suggests that certain classes of antibiotics have been overused, and the Indian Council of Medical Research (ICMR) has recommended “reducing unnecessary exposure to broad-spectrum [antibiotics]”. Such overuse contributes to the emergence and rising prevalence of deadlier, antibiotic-resistant bacteria.
From More Seats to More Competent Doctors
Whether India faces an aggregate shortage of doctors has been hotly disputed since as far back as 2000. Some analyses rely on the gap between India’s doctor-population ratio and the purported World Health Organization (WHO) “guideline” of 1:1000, but no such formal guideline exists. It is, however, well recognised that India faces shortages of trained medical personnel and faculty in rural areaswith even regional campuses of the All India Institute of Medical Sciences (AIIMS) struggling to meet their target faculty strength.
Taken together, the path forward is clear: India must lower the entry barriers that give weight to extraneous factors (income, geographical location, and the nomenclature of training programmes) and instead strengthen the entry barriers and licensing requirements that relate to clinical competence and medical ethics. Three major barriers require focused effort to be eliminated.
Affordability
Private institutions account for 54 percent of India’s 140,664 undergraduate medical seats (excluding Institutes of National Importance or INIs) and can charge total course fees well over INR 1 croreso many candidates must rely on government seats or overseas education to pursue a medical career. Capitation fees are now illegal, but the Supreme Court has not backed the requirement under Section 10(1)(i) of the NMC Act to align fees for 50 percent of private seats with government-college rates, since private institutions operate without comparable state subsidies.
Medical education cannot be allowed to become pay-to-play. Instead of arbitrary government-fee benchmarks for selected seats, the NMC should institute evidence-based fee regulation for all seats, tied to the availability of equipment, learning facilities, and faculty.
High fees have had adverse consequences: the lowering of the NEET-PG 2026 cut-offs was driven partly by the large number of unfilled private seats. Medical education cannot be allowed to become pay-to-play. Instead of arbitrary government-fee benchmarks for selected seats, the NMC should institute evidence-based fee regulation for all seats, tied to the availability of equipment, learning facilities, and faculty.
Faculty Shortages
Faculty shortages remain a problem, particularly in ‘non-clinical’ specialities and in rural regions. To ensure quality, governments should direct the expansion of medical colleges to underserved areas, particularly district hospitalsand tie seat expansion strictly to the availability of faculty, facilities, and adequate systems of supervision. This will ensure that seats on paper translate into real increases in doctor supply, and that those doctors are trained to an adequate standard of competence.
Regulatory Capacity
Six years after its foundingthe NMC has yet to fix its regulatory capacity or introduce standardised processes. A Supreme Court-appointed amicus curiae has reported lapses in admissions timelines and violations of statutory requirements to publish inspection reports and regulatory decisions, yet three of the four NMC boards still have no full-time members or no president. The Ethics and Medical Registration Board, for instance, has a single part-time member and no president, which undermines its ability to regulate medical supply and ethics. The NMC needs enforceable quorum and governance requirements, so that each board has a president and an adequate number of members before it takes decisions.
The NMC should adopt overseas best practice, taking a leaf out of the Medical Board of Australia’s book: proactively map medical education in key countries onto India’s and define standardised pathways for assessment. Prospective IMGs could then see at once which countries and courses are automatically considered Indian-equivalent (and with what riders) and where further evidence is required. This would reduce arbitrary entry barriers and move India towards competence-based equivalence.
The processes for recognising the qualifications of international medical graduates (IMGs) remain similarly ad hoc. The NMC says it is developing a portal for foreign medical regulators to apply for equivalence of the Bachelor of Medicine and Bachelor of Surgery (MBBS) degreebut the portal does not cover higher specialty qualifications. It is unclear whether it will draw in regulators beyond the few countries in which Indians make up most of the IMG cohort. Instead, the NMC should adopt overseas best practice, taking a leaf out of the Medical Board of Australia’s book: proactively map medical education in key countries onto India’s and define standardised pathways for assessment. Prospective IMGs could then see at once which countries and courses are automatically considered Indian-equivalent (and with what riders) and where further evidence is required. This would reduce arbitrary entry barriers and move India towards competence-based equivalence.
Conclusion
India needs targeted measures to widen access to domestic medical education for financially vulnerable students, raise the quality of undergraduate training, and create an equitable, standardised process for assessing IMGs. Together, these would help build a robust pipeline of competent doctors who deliver quality care to patients, rather than focusing on seats or credentials alone.
Pulkit Athavle is an Economics undergraduate at the University of Sydney, New South Wales, Australia.
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