Discuss the tension between centralised All India Quota admissions and State-specific in-service reservation policies in medical education, with reference to recent Supreme Court interventions.

Super-speciality (DM/MCh) admission today rests on a single national exam and centralised counselling, while States such as Tamil Nadu earmark seats for in-service government doctors. The ongoing litigation over unfilled seats shows how uneasily these two logics coexist.

The centralising pull of the All India Quota

• Uniform gateway: NEET-SS is the single national qualifying test for DM/MCh admission, with the qualifying percentile fixed by NBEMS [1].
• Statutory centralisation: the NMC Act, 2019 vests standard-setting and regulation of medical education in a national commission [2].
• Centralised counselling: DGHS, through the Medical Counselling Committee, conducts counselling for 100% super-speciality seats [3]; State seats left unfilled are diverted to the All India Quota [4].

The State's case for in-service reservation

• Health and State-run medical colleges remain largely a State responsibility; the Supreme Court upheld Tamil Nadu's 50% in-service reservation in super-speciality courses in 2021 [5].
• In-service doctors prepare while discharging public duty, unlike full-time aspirants, making a uniform cut-off effectively unequal.
• Such doctors return to government service, addressing an acute deficit — Rural Health Statistics recorded roughly 80% shortfall of specialists at Community Health Centres [6].

Where the tension bites

• Of 152 seats Tamil Nadu transferred to AIQ, about 40 remain vacant, while 111 in-service candidates wait just below the cut-off [4] — seats stay empty and the State quota is hollowed out.
• Percentile relaxation has been ad hoc and case-by-case rather than a standing policy for in-service candidates [1].

Recent judicial interventions

• The Court has observed that cut-offs for in-service candidates "should be lesser", and has asked the Union government to consider reducing the NEET-SS percentile, listing the matter for 31 August [4] — nudging the regulator rather than substituting for it.

The dispute is less merit-versus-reservation than designing a national framework flexible enough for State health-workforce needs. A codified differential percentile for in-service candidates, negotiated between NMC/NBEMS and States, with unfilled seats reverting to the State before diversion, would fill seats without diluting standards — the cooperative federalism a Concurrent List subject demands.