A Dream Deferred: How The NEET PG Crisis Has Hurt Women Aspirants

A doctor and a once-NEET aspirant provides an insider perspective on what the ongoing exam crisis means for the healthcare system and especially for women aspirants who have to constantly deal with the pressure to start family life

It had taken Hupekali Ayemi 13 hours to get from her hometown in Nagaland to Naharlagun in Arunachal Pradesh to write her National Eligibility cum Entrance Test postgraduate (NEET PG) for medical students. So, when the night before the exam, on June 22, the ministry of health notified its cancellation, she could not believe her eyes.

“I read the notice over and over again. I thought it was a joke and I was looking for the punchline,” she said to me.

Subiksha Jaiswal*, another NEET-PG aspirant, points to how thoughtless the sudden decision was. “So many people, including me, spent a lot of money to travel to  hole-in-the-wall places only to be told that there is no exam. It was a rude shock,” she said. 

What was even worse was that there was no intimation of when the exam would be held next. This left the aspirants in a state of utter confusion. “Do the candidates stay there and wait? Do they return to their hometowns? What if the exam was just around the corner and they had to spend and travel again?” observes Silvia Alexander, a general surgery consultant.

But the financial losses and inconveniences the aspirants suffered pale in comparison to what the exam postponement did to their morale and hope.

Every year, NEET PG, a centralised standardised exam is conducted annually where around 2 lakh doctors compete for 70,000 seats. The extreme competitiveness and the vastness of the syllabus – it includes 19 subjects – put those preparing for NEET PG under tremendous stress.

“I have been putting off even the smallest things thinking I’ll do them after the PG exam,” says Subiksha. “Cleaning my fridge, having a haircut, replacing my scratched spectacles, going for a doctor’s consultation, finishing my manuscripts – I put off all these because one needs to put in everything you have got to perform well in this exam.” 

Now, all these 2 lakh candidates who have planned their lives around the exam for the past year find themselves enveloped by uncertainty. “There is no time frame given for when it would be conducted. Is it going to happen next week? Next month? Next year? How am I supposed to plan my life when this is the case?” she says.

‘More Family Pressure On Women’

This postponement and the uncertainty it brings will affect women students more than men, says Aditi Dandawate, a consultant paediatrician from Mumbai.

“Even today, women’s dreams are considered disposable, even if that woman is a doctor,” she says. “Women PG aspirants are definitely getting less support from their families than men. While men are given the leeway to finish their studies and then consider family life, that is not the case for women doctors. I know colleagues who were married off during their internship and are taking care of homes and children while preparing for NEET PG. A postponement, with the uncertainties it brings, will bring more family pressure on them.”

This kind of gender skew is all pervasive in the medical profession. Though more women attempt the NEET UG exams and become MBBS doctors, they have been underrepresented historically  in MD and DM courses, a trend which has only begun to change in recent years. 

Ten years ago, women became doctors but rarely practised or pursued higher studies. Data from the  National Medical Council shows that while equal number of postgraduate seats were held by women in the past one or two years, more women join ‘family-friendly’ low workload departments such as pathology and microbiology whereas men outnumber them in challenging fields such as general medicine, general surgery and orthopaedics. Women, however, also find themselves out represented by men in superspeciality studies and occupy only 18% of leadership roles in the healthcare sector.

This slow trend towards gender parity will be threatened by the untimely postponement of the NEET PG exams.

Ophthalmologist Anita Nair* says she had to do all the housework even as she prepared for her NEET PG exam. Both she and her husband, from whom she is now divorced, did the prep work at the same time but only he got to focus all his attention on the preparation. “I was a great student, I got a distinction every year of my MBBS, but because I had to balance housework with studies I didn’t get MD paediatrics that I wanted and ended up with MS Ophthalmology. I am happy now, but it’s sad how my choices were limited,” she says.

Anita says a friend was sent away from her marital home because her in-laws did not want to support her while she studied. “She was told that she will get this one chance to clear NEET PG and if she doesn’t she will not be allowed to attempt the exam again.” 

Had the exam been postponed when they were attempting to write the NEET PG, Anita and her friend would have just remained MBBS graduates.

Not An Easy Career Choice

I remember the immense pressure on me to get married as I was preparing for the NEET exam all too well. I was 25 years old at the time and it was my second attempt. My parents had been looking frantically for a groom for me and I was expected to plan my higher education and career around this possibility. So much so that my parents dissuaded me from taking the NEET and suggested that I instead write the USMLE (the US medical licensing exam) or the PLAB (Professional and Linguistic Assessments Board test for the UK), which would allow me to practise medicine in those countries, in case my future groom lived there. A postponement of the NEET exam would have meant an end to my career goals.

For many  women aspirants, like I once was, postgraduate studies in medicine is not an easy career choice. In a patriarchal society like ours where marriage is a central life event, the very act of writing the NEET PG exam is an act of resistance for women. In the marriage ‘market’, an MBBS bride is often preferred over one with a postgraduate degree in medicine, especially those in work-heavy clinical departments such as general surgery and orthopaedics. It is accepted that in a marriage where both partners are doctors, the woman would settle for a less demanding work role.

“My in-laws were very unhappy when I chose ophthalmology when they clearly told me to pick something non-clinical,” says Anita. According to her, women who enter matrimony with an MBBS degree have to forgo job satisfaction. “One is not secure in their career without a PG seat, you are not earning as much as you could and not respected much at home. And once you are married your in-laws will want to have a say in what PG specialisation you can do and where.” For example, Anita had MD paediatrics options in a few colleges in North and northeast India but was not allowed to choose those because of her husband and in-laws.

A supportive marital home is an absolute must for married women working on an intensive PG workload. For women doctors, who negotiate the timing of marriage with their families, this is trouble. “The postponement means that they will be older when they enter the course and the pressure to marry and have children while working will worsen,” says Aditi.

Hitting Medical Labour Force

Candidates aspiring for a PG degree are not the only ones adversely affected by the postponement of NEET PG. It is common knowledge that postgraduate residents form the primary labour force in medical colleges. They take on the biggest load of patient care. This delay in admission means one less batch of students at work, increasing the workload on the residents, who are second year students.

The delay will also hit medical education adversely. At the time of my postgraduation, there were severe delays in admission for the next batch. As a second year student of general medicine, I was enlisted to work in my parent department due to a shortage of doctors, when I should have been spending my time working in other departments for a well-rounded exposure to super speciality areas such as nephrology, cardiology, and neurology. 

These peripheral postings are important for two reasons. First, many interesting and important cases went to these departments and I didn’t get to acquire the valuable knowledge that a superspecialist applies to diagnosis and treatment.  Secondly, these departmental rotations are crucial for doctors to choose their future area of interest. I felt deprived of such exposure and it is almost as if I ended up doing a PG course I had not actually signed up for.

Subiksha also points out that the PG aspirants essentially remain out of the workforce. “They might or might not have quit their jobs to prepare but I am sure that in the current scenario no one will go back to work. Most will decide to just stay at home and continue to prepare which is very sad considering that India needs more working doctors, not less,” she says. 

For those doctors who cannot afford to quit their jobs and prepare for NEET, dedicating more time to prepare for NEET all over again would mean adding to their already heavy workdays.

Distrust And Disillusionment

Candidates say they can understand the need to postpone NEET PG to ensure fair conduct of the exam in the light of the current scandal but the manner in which this was done has generated immense distrust of the system.

“Why did they do it 12 hours before the exam?” asks Subiksha. “That too without explaining to us exactly what is happening and not letting us know a tentative date?” 

If the notice was sent a few days prior with an explanation, PG aspirants say they may have even welcomed it. After all, who wants to attempt a compromised exam?

“The distrust generated by this fiasco, along with that of NEET UG will ensure that people will prefer writing USMLE or PLAB instead of Indian exams. At least one can be sure that there will be no malpractice there,” says Shivani Bajoria, a PG aspirant from Chennai. The resulting exodus of doctors to other countries would then lead to the weakening of an already fragile healthcare system. “How are these other tests conducted across multiple countries with no issues but we struggle with just a nationwide exam?” she asks.

Such knee jerk responses to exam crises are not new to India. “When I was writing my UG entrance, the AIPMT (All India Pre Medical Test) was suddenly cancelled just three days before it was scheduled to be held and NEET was introduced. That year, NEET UG had to be conducted twice to clarify the process,” says Subiksha. “I felt a lot of pressure to clear NEET PG this year because of all the talk about NEXT (an exit exam being considered for MBBS graduates). I did not want to be trapped in the middle of whatever confusion and chaos that brings.”

Trauma And Accountability

As I look back, I can say that the year I spent preparing for NEET PG was the worst year of my life. I saw my friends who are not doctors succeeding at work, holding well paid jobs, travelling and leading what seemed a happier life while I was stuck with studying for another exam. And then, there was the relentless pressure to meet prospective grooms. Suddenly, my ambition and passion for my work and career were not acceptable and I was expected to minimise myself to fit the ideal ‘ doctor bride’ image. It was traumatising.

I remember the time I walked out of the examination hall, I felt like I had let out a deep breath that I didn’t even know I was holding. What would such a postponement have meant for me? What toll would it have taken on me? I shudder to even imagine it.  

In the midst of this chaos, I still have a faint hope that those responsible for it will be held accountable. In the Parliament as new members took oath for the newly elected Lok Sabha, Opposition members yelled ‘NEET’ repeatedly as the education minister Dharmendra Pradhan walked up. This allows us to hope that the issue will be debated in the Parliament and the government will not get a free pass. I hope it leads to an explanation and an apology because these can go a long way in allaying the fears of lakhs of students. Following that, decisive action and planning to ensure an unbiased exam is important. Without safeguarding the aspirations of medical students India’s healthcare system will flounder.

*Names changed to protect identity.

  • Christianez Ratna Kiruba is an Internal Medicine resident physician currently working in Satribari Christian Hospital, Guwahati

Malini Nair (Editor)

Malini Nair is a consulting editor with Behanbox. She is a culture writer with a keen interest in gender.

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