From Dream Careers to Dead Ends: Why Doctors Are Walking Away from PG

Walk into any crowded government hospital in India and the story feels painfully familiar. Patients line corridors, junior doctors run on caffeine and hope, and senior consultants juggle impossible caseloads. India, it seems, can never have enough specialists. Yet thousands of postgraduate medical seats lie vacant across the country. The contradiction is confusing. In the 2025–26 academic session, more than 18,000 NEET-PG seats remained unfilled even after the second round of counselling. To plug the gap, the qualifying percentile was pushed down to zero for reserved categories, a move that raised eyebrows and deeper questions. How did a country desperate for doctors reach a point where training seats go vacant?

Data from the Medical Counselling Committee and the Health Ministry shows that Maharashtra, Karnataka, and Tamil Nadu together account for a significant share of these vacancies. Each of these states has more than 2,000 empty seats, largely concentrated in private, management, and NRI quotas. This is happening despite a dramatic expansion in postgraduate medical education over the last five years. In 2020, India had just over 40,000 PG medical seats. Today, that number has nearly doubled to around 80,000, including MD, MS, DNB, and diploma programmes. Expansion was meant to ease shortages and democratise access to specialist training. Instead, it has exposed deep cracks in how medical education is structured, priced, and perceived.

At first glance, the usual explanation is supply and demand. Clinical branches such as general medicine, radiodiagnosis, general surgery, dermatology, obstetrics and gynaecology, and paediatrics continue to be fiercely competitive. They are seen as gateways to stable careers, professional prestige, and financial security. Non-clinical and para-clinical subjects tell a different story. Microbiology, pathology, biochemistry, pharmacology, and forensic medicine account for the bulk of vacant seats year after year. These are disciplines that underpin modern medicine, shaping diagnostics, infection control, drug safety, and public health. Yet they remain unattractive to young doctors who see limited career growth, lower pay, and fewer private practice opportunities.

But reducing the problem to “students don’t want these subjects” is too simplistic and dangerously misleading. The real issue lies in a complex mix of economics, aspiration, policy choices, and systemic neglect. Private medical education, especially at the postgraduate level, has become prohibitively expensive. Fees starting at ₹20 lakh and soaring up to ₹4 crore are not uncommon under management and NRI quotas. For many families, this is not education; it is financial self-harm. Even doctors who have already invested heavily in undergraduate medical training are unwilling or unable to take on such crushing debt, particularly when the return on investment in certain specialties is uncertain.

This is where the credibility of the system begins to wobble. When the National Board of Examinations and Medical Sciences lowered the qualifying percentile to zero, it sent out a signal that something fundamental was broken. Entrance exams are meant to balance access with standards. Diluting cut-offs may temporarily fill seats, but it risks eroding trust in the examination process and raises uncomfortable questions about quality. As doctors associations have pointed out, lowering benchmarks does nothing to address why candidates are walking away in the first place.

Another layer to this crisis is the uneven quality of training across institutions. Not all medical colleges offer the same exposure, mentorship, or infrastructure. Many private colleges struggle with inadequate patient load, outdated laboratories, and shortages of experienced faculty. For a young doctor, committing three years of postgraduate training in such an environment feels like a gamble. Add to this the issue of stipends, which in some private institutions are delayed, reduced, or not paid at all, and the decision to opt out becomes rational rather than reckless.

Today’s medical graduates are more aware of work-life balance, mental health, and long-term sustainability than previous generations. Non-clinical subjects often lead to academic or laboratory-based careers, which could, in theory, offer better balance. In reality, these fields are undervalued, underpaid, and poorly integrated into healthcare decision-making. Teaching posts are limited, research funding is scarce, and industry opportunities remain concentrated in urban pockets. Without clear career pathways, students see these branches as professional dead ends.

Ironically, this reluctance comes at a time when India desperately needs expertise in precisely these areas. The COVID-19 pandemic underscored the importance of microbiologists, pathologists, and pharmacologists. Antimicrobial resistance is rising, diagnostic delays remain a major bottleneck, and forensic medicine plays a critical role in public health surveillance and justice. Yet policy attention and financial incentives continue to favour clinical practice almost exclusively.

The NEET-PG examination itself adds another dimension to the problem. In August 2025, over 2.42 lakh candidates appeared for the exam across more than 1,000 centres nationwide. Competition is intense, preparation is expensive, and the emotional toll is high. For many aspirants, a marginally lower rank can mean the difference between a coveted clinical seat and an option they never seriously considered. Faced with this reality, some choose to drop a year, prepare again, or explore opportunities abroad rather than settle for a seat that demands heavy fees and offers limited prospects.

State-wise disparities further complicate the picture. Maharashtra, Karnataka, and Tamil Nadu have invested heavily in private medical education, resulting in a high concentration of seats. While this has expanded capacity, it has also created regional imbalances. Students from less affluent backgrounds or other states are reluctant to take up seats far from home, especially when costs are high and language or cultural barriers exist. Meanwhile, government colleges with lower fees and better stipends remain oversubscribed, highlighting the persistent divide between public and private medical education.

Each empty seat is a missed opportunity to train a specialist who could serve in hospitals, laboratories, or teaching institutions. At a time when India is struggling with an ageing population, rising burden of non-communicable diseases, and recurring infectious threats, the shortage of trained specialists is already visible. Long waiting times, delayed diagnoses, and overworked clinicians are not abstract problems; they affect real patients every day.

The conversation, therefore, needs to move beyond short-term fixes. Reducing cut-offs may help colleges balance their books, but it does not address affordability, quality, or relevance. Fee regulation in private medical colleges has been discussed for years, yet meaningful reform remains elusive. Transparent fee structures, realistic caps, and strict enforcement could go a long way in restoring confidence. Equally important is improving training quality across all institutions. Adequate patient exposure, modern laboratories, committed faculty, and fair stipends should be non-negotiable.

Non-clinical and para-clinical specialties also need a serious rebranding, backed by policy support. Better pay scales, defined career progression, research grants, and integration into national health programmes could make these fields attractive again. Encouraging interdisciplinary roles, linking these specialists to industry, public health agencies, and global research networks can open new avenues that go beyond traditional teaching posts.

There is also a need to rethink how India plans its medical workforce. Simply increasing seat numbers without aligning them to healthcare needs, economic realities, and career outcomes is a recipe for waste. Workforce planning must be data-driven, region-specific, and responsive to changing disease patterns. Incentives for serving in underserved areas, combined with targeted postgraduate training, could help bridge gaps between supply and demand.

For young doctors, the decision to pursue postgraduate training is deeply personal and often fraught with anxiety. Years of preparation, family expectations, financial pressure, and professional dreams collide at the counselling table. When thousands choose to walk away from available seats, it is a signal that the system is out of sync with their realities. Listening to these signals, rather than silencing them with diluted cut-offs, is crucial.

Ultimately, the crisis of vacant NEET-PG seats is not about a lack of ambition among medical graduates. It is about a system that has expanded rapidly without ensuring fairness, quality, and sustainability. It is about private education that has priced itself beyond reach, public policy that has been slow to adapt, and essential medical disciplines that remain chronically undervalued.

If India is serious about strengthening its healthcare system, it must treat empty postgraduate seats as a warning sign, not a statistical inconvenience. Reforming medical education is not just about producing more specialists; it is about producing the right specialists, trained well, supported fairly, and motivated to serve. Until then, the paradox will persist where hospitals overflow with patients, and medical colleges echoes with the silence of empty classrooms

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