Centralised medical admissions have caused friction with States over in-service quotas. Analyse this with reference to recent developments.

Since the 2017 session, NEET-SS has been the only entrance route to DM/MCh courses, and no State-level or institutional exam is valid [1]. In-service quotas are seats that States reserve for their own government doctors. They fit awkwardly into this central system, as the September 2026 Tamil Nadu seat dispute shows.

Parts of the centralised framework

• Exam: NBEMS conducts NEET-SS for more than 7,000 seats through 15 group papers, each with its own cut-off. It is an autonomous body under the Union Health Ministry [3].
• Counselling: the Medical Counselling Committee (MCC) allots seats nationally [3].
• State role: in Tamil Nadu Medical Officers Association v. Union of India (2020), the Supreme Court upheld the States' power to reserve PG seats for in-service doctors under Entry 25, List III [2]. States still have to work within central exam and counselling timelines.

Why friction arises

• Constitutional: medical education is a concurrent subject. The Centre sets standards, while States fund and staff the hospitals. Both claim the same seat.
• Health delivery: in-service doctors who train as super-specialists usually go back to State hospitals. A seat absorbed into the central pool produces no specialist for the State that built the hospital [3].
• Administrative: under one 50th-percentile cut-off across 15 different papers, seats went unfilled [3]. There was no automatic route to return unused in-service seats to States.

Recent developments (September 2026)

• 1,857 NEET-SS 2025 seats were vacant. On the Supreme Court's suggestion, the Centre cut the qualifying percentile from 50 to 30, and the MCC began a stray round on 25 September [3].
• The Centre agreed to return 40 vacant in-service seats to Tamil Nadu [3]. This was a one-off concession won in court, not a standing rule.
• Contrast: of the 265 DNB PG seats granted to Jammu & Kashmir government hospitals, 50% are reserved for local in-service doctors [4]. Central and State aims can line up when the system is designed for it.

Way forward

• Return unfilled in-service seats to States automatically after a fixed counselling round.
• Announce fallback cut-offs before the exam, set group by group.
• Set up a standing Centre–State consultation mechanism for medical admissions.

Centralisation has brought uniform merit standards and transparency. Its rigidity, however, has strained cooperative federalism where States' own doctors are concerned. Writing seat reversion and flexible cut-offs into the rules would protect both merit and public-hospital staffing, and would advance SDG 3's aim of a stronger health workforce.