The NEET Conundrum: How a Falling Floor Is Burying Ayurveda Alive

Dr. Aakash Kembhavi

This article was developed with the assistance of an AI language model and has been reviewed, verified, and finalised by the author.

I. The Number Nobody Wants to Say Out Loud

There is a number that sits at the centre of Ayurvedic education in India, visible to everyone inside the system and almost never discussed honestly by anyone in authority. It is the NEET score at which a student can gain admission to a Bachelor of Ayurvedic Medicine and Surgery programme at a recognised college in this country.

It is not a number that reflects the complexity of what is being studied. It is not a number that reflects the depth of the classical tradition that the degree purports to transmit. It is not a number that inspires confidence in the quality of the clinical practitioner who will emerge at the other end of five and a half years of training. It is, in many cases across many institutions, a number that would not secure admission to the overwhelming majority of undergraduate science programmes at reputable universities — programmes far less demanding, far less consequential for public health, and far less reliant on the capacity for complex reasoning than the study of a classical medical system.

This author has spent nearly three decades in Ayurvedic education. The observation that follows is stated plainly and without apology: in a significant majority of BAMS batches across the country, somewhere between eighty and ninety percent of the intake has arrived via NEET scores in the lower ranges of eligibility. Students who scored higher — and they exist, and their existence matters — represent roughly ten to twenty percent of the total. They are the exceptions. They are not the rule. And a system cannot be evaluated by its exceptions.

This article is about what that number means, what it predicts, what it conceals, and what would happen if we were honest enough to design a policy that forced the truth into the open.

II. What a NEET Score Actually Measures — And Why It Matters Here

Let us be precise, because this argument is routinely — and deliberately — mischaracterised as elitism.

A NEET score does not measure a student’s worth as a human being. It does not measure their capacity for empathy, their potential for growth, their cultural knowledge, or their personal integrity. These clarifications are worth making because the moment this argument is introduced in any Ayurvedic forum, it is immediately attacked as contempt for students from disadvantaged backgrounds, or as the privileged gatekeeping of a profession that should be accessible to all.

That is a straw man. It is also, as the previous article in this series discussed, a logical fallacy.

What a NEET score does measure — imperfectly but meaningfully — is the level of foundational analytical competence that a student has developed by the time they seek admission to a medical programme. Physics, chemistry, and biology at the level required for NEET are not arbitrary subjects. They are the intellectual infrastructure on which the study of any biological science — including Ayurveda — must be built. A student who has not understood stoichiometry well enough to score adequately in chemistry will struggle with the pharmacological reasoning that Ayurvedic Dravyaguna demands. A student who has not understood cell biology adequately will struggle with the physiological frameworks that Sharira Kriya requires. A student who has not developed the capacity for logical inference at the level that adequate physics and mathematics require will struggle with every aspect of clinical reasoning — Ayurvedic or otherwise.

This is not about marks as merit badges. It is about cognitive infrastructure. The study of Ayurveda is not less demanding than the study of modern medicine. It is differently demanding — and in some respects, particularly in its requirement for the integration of philosophical, clinical, and empirical reasoning, it is more demanding. The idea that it can be successfully studied by students who have not demonstrated foundational analytical competence is not compassion. It is a fantasy that serves institutional economics at the expense of educational quality.

III. The Thought Experiment That Will Make Authorities Uncomfortable

This author wishes to propose two hypothetical policy modifications. They are not offered as formal recommendations — though neither is without merit. They are offered as diagnostic tools. Each one, if implemented, would generate data. And it is the data — not the policy — that should concern Ayurveda’s leadership most.

The Revealed Preference Experiment

Imagine that the NEET application process were modified to include a mandatory pre-registration of degree preferences. Under this modification, a student who wished to be considered for BAMS admission would register that preference at the time of the NEET application. Their score would be evaluated against the BAMS pool only — it would not be counted toward MBBS eligibility. A student could choose to register for both, but the scores would be assessed separately, and the choice would be explicit and binding.

What this would reveal is something that nobody in authority currently wants to see revealed: the actual, unmanipulated demand for BAMS as a chosen vocation.

At present, the majority of students who end up in BAMS did not choose it first. They chose medicine. They could not secure MBBS. BAMS was the available option within their score range and their family’s financial capacity. This is not a moral failing on their part. It is the honest description of a structural reality. But it means that the BAMS intake, in the majority of cases, does not represent students who chose Ayurveda. It represents students for whom Ayurveda was the accessible residual.

If the separate registration experiment were implemented, it is entirely possible — this author would argue probable — that the number of students who proactively, explicitly, and voluntarily registered for BAMS consideration at the time of application would be a fraction of the current intake. What would follow is mathematically inevitable: a vast majority of seats in BAMS colleges across the country would remain vacant.

That vacancy would not be a crisis to be managed. It would be a truth to be confronted. It would tell us, with the precision that policy-makers claim to want but consistently avoid, exactly how the student community and their families — who ultimately bear the financial burden — perceive the value of a BAMS degree relative to the investment it requires.

The authorities who would resist this experiment most vigorously are precisely those whose resistance reveals the most about why it is necessary.

The 250-Mark Floor

The second modification is simpler and less structurally radical. Within the existing common NEET framework — no separate registration required — make it a mandatory condition that a minimum score of 250 marks out of 720 is required for BAMS admission.

Two hundred and fifty marks represents approximately thirty-four percent of the total available marks in NEET. This is not a high bar. In any other competitive context, thirty-four percent would be considered a floor so low as to be almost nominal. In the context of BAMS admissions in several institutions across the country, it would represent a significant upward revision of the current effective minimum.

What would happen? Many seats would go vacant. College managements — for whom filled seats are the primary institutional objective, preceding educational quality by a considerable distance — would respond with alarm and lobbying. The argument would be made that this discriminates against students from disadvantaged socioeconomic backgrounds. The argument would be made that Ayurveda has its own way of knowing that does not require conventional academic performance. The argument would be made that potential cannot be measured by a single examination.

All of these arguments have been made before, in similar contexts, by similar interests. None of them engage with the core question: can a student who cannot demonstrate thirty-four percent competence in foundational biological sciences meaningfully study a complex classical medical system and emerge as a safe, competent, and credible practitioner?

The answer to that question is not ambiguous. And the consistent refusal to act on the answer is not a policy position. It is an institutional choice to prioritise revenue over quality, with the consequences borne not by the institutions but by the students, their families, and ultimately by the patients who will be treated by the practitioners they produce.

IV. The Open Secret — BAMS as Backdoor Modern Medicine

There is a conversation that happens everywhere in Ayurveda except in official forums. It happens in faculty rooms, in hostel corridors, in the private communications of practitioners who have been in the field long enough to be honest with themselves. It is the conversation about what BAMS graduates actually do when they leave college.

The answer is known to everyone and acknowledged by almost no one in authority: a substantial majority of BAMS graduates end up practising some form of modern medicine — prescribing modern medicine drugs, conducting procedures within whatever legal latitude their state regulations allow, and building clinical practices that bear almost no resemblance to the classical Ayurvedic practice their degree nominally represents.

This is not a secret. It is observable in virtually every small town and semi-urban area in the country. It is the subject of ongoing legal and regulatory dispute between medical associations and Ayurvedic practitioners. It is the reality that the critics — including TheLiverDoc — point to when they argue that BAMS functions, in practice, as a lower-cost, lower-barrier entry point into medicine rather than as a qualification in a distinct and rigorous classical system.

This author does not state this to condemn the practitioners who have made this choice. The economic pressures are real. The public demand for accessible medical care is real. The inadequacy of their Ayurvedic training to equip them for classical practice is real. These are systemic failures, and practitioners who navigate them pragmatically are responding rationally to the environment the system created.

But the implications must be named plainly.

If BAMS is functioning primarily as a backdoor entry to modern medicine practice, then the entire justification for the degree — the transmission of a classical medical tradition, the development of Ayurvedic clinical competence, the production of practitioners who will advance the science — is not being fulfilled. The colleges are collecting fees, the regulatory bodies are issuing certificates, the universities are conducting examinations, and the output is a cohort of practitioners who are practising a system they were not adequately trained for, under a degree that was meant to qualify them for a different one.

This is not merely an educational problem. It is a public health problem. And it begins with an admissions process that fills seats with students who did not choose Ayurveda and were not equipped to master it.

V. The Financial Trap — What Families Were Never Told

BAMS is not inexpensive. Private college fees across the country range from several lakhs to figures approaching what some families would consider a generational financial commitment. The families who make this investment — in many cases, families of modest means for whom the word “doctor” carries enormous social significance — are making it on the basis of an implicit promise.

The promise is that this degree will produce a doctor. That the investment will yield professional standing, economic security, and the social capital that comes with a medical qualification. That the five and a half years of study, the fees, the hostel costs, the examination expenses, will result in a career of genuine professional viability.

For the ten to twenty percent of students with genuine aptitude, genuine vocational commitment to Ayurveda, and the analytical capacity to master its complexity — this promise has some possibility of being fulfilled. For the eighty to ninety percent who arrived via residual selection, whose relationship with the subject is at best ambivalent, whose training will be delivered by a system this article will describe in the next section — the promise is not being kept.

They will graduate. They will register. They will either attempt to practise Ayurveda with inadequate preparation, or they will attempt to practise modern medicine under regulatory frameworks that were not designed for them, or they will leave medicine entirely and seek livelihoods in sectors that have nothing to do with the degree their families sacrificed for.

None of this is disclosed at the point of admission. No college prospectus carries an honest account of graduate employment outcomes. No counselling session at the time of NEET seat allotment addresses the question of what a BAMS graduate’s career trajectory actually looks like in the current healthcare landscape. The financial commitment is solicited on the basis of a social aspiration — the aspiration of having a doctor in the family — that the degree, for most students, will not fully deliver.

This is a form of institutional dishonesty that has been normalised by its ubiquity. It does not make it less dishonest.

VI. What Is Actually Being Taught in BAMS Colleges

Even if the admission problem were solved tomorrow — even if every student entering a BAMS programme had cleared NEET with a score of 300 or above, and had chosen Ayurveda with genuine vocational conviction — the curriculum delivery crisis would remain. It is a separate and compounding failure, and it requires its own honest accounting.

Contact Hours: The Paper Reality and the Classroom Reality

On paper, the BAMS curriculum is extensive. The prescribed contact hours across five and a half years of study, if actually delivered, would constitute a substantial education in classical Ayurvedic theory and clinical practice. In practice, the gap between prescribed hours and delivered hours is significant in a large number of institutions. Classes are cancelled without substitution. Faculty vacancies persist unfilled for extended periods. Clinical postings are conducted in name more often than in rigorous supervised practice. The schedule exists as a regulatory compliance document. Its relationship to what actually occurs in the institution is, in many cases, approximate at best.

Teaching by Dictation

The dominant pedagogical method in a significant proportion of BAMS colleges across the country is dictation. The faculty member reads from notes — often the same notes used for years or decades — and the students copy. What is being transmitted is not understanding. It is not the capacity for clinical reasoning, epistemological analysis, or the integration of classical knowledge with clinical observation. It is text. Text that will be reproduced in examination answer sheets and then, for the most part, forgotten.

Charaka’s method — observation, inference, debate, peer examination, systematic reasoning — is described in the Vimana Sthana. It is not practised in the institutions that teach the Vimana Sthana.

Clinical Training: Watching Without Doing

The clinical training component of BAMS — the outpatient departments, the ward postings, the internship — is, in many institutions, structured as observation rather than supervised practice. Students attend. They watch. Senior practitioners conduct examinations and prescribe. The student’s role is passive. They are not asked to conduct a full clinical examination and defend their findings. They are not asked to formulate a differential diagnosis in classical terms and justify it. They are not asked to construct a treatment plan and explain the reasoning behind each component. The transition from classroom knowledge to clinical competence — which requires precisely the kind of active, supervised, corrected practice that builds skill — is not systematically happening.

The result is graduates who can define Nadi Pariksha but cannot reliably perform it. Who can recite the Samprapti of a condition but cannot construct a classical clinical examination. Who have memorised formulations but cannot explain the reasoning behind their selection in terms that connect to both classical pharmacology and the individual patient’s presentation.

The Classical-Clinical Disconnect

Perhaps the most fundamental curriculum failure is the disconnect between what is taught in the first three years — the classical Samhita content, the theoretical frameworks of Dosha, Dhatu, Mala, Srotas — and what is done in the clinical years. The theoretical foundation is taught in one register. The clinical training, to the extent it occurs, happens in a different register. The integration — the explicit, taught, practised skill of taking a classical theoretical framework and applying it to a specific patient in a specific clinical situation — is assumed rather than taught. Most students graduate without ever having explicitly performed that integration in a supervised setting.

Examination as the Only Feedback Mechanism

The only structured feedback that most BAMS students receive about the quality of their understanding is the university examination. This is an extraordinarily blunt instrument. It measures the capacity to recall and reproduce content under timed conditions. It does not measure clinical reasoning. It does not measure the capacity to construct and defend an argument. It does not measure the ability to evaluate evidence. It does not measure, in any meaningful sense, whether the student is developing into a competent practitioner of the system whose degree they are pursuing.

A student can score adequately in every university examination across five and a half years — and emerge from the programme unable to conduct a rigorous classical clinical consultation.

VII. The Compounding Effect — When Two Failures Multiply

The admission crisis and the curriculum delivery crisis are not independent failures. They interact and compound each other in ways that produce outcomes significantly worse than either would alone.

A student with limited analytical capacity, admitted through minimal eligibility criteria, placed in a curriculum that does not challenge or develop that capacity — this student is not merely receiving an inadequate education. They are being actively trained in a set of habits: passive reception of information, reproduction over reasoning, authority over evidence, confidence over competence. These habits are not neutral. They are anti-educational. They actively work against the development of the critical thinking that the practice of any medical system requires.

The faculty who deliver this curriculum are, in the majority of cases, products of the same process. They were admitted under similar conditions. They were taught by dictation. They passed examinations that measured reproduction. They conducted research — many of them, at PG and PhD level — in the same methodologically compromised environment described in previous articles in this series. They were appointed to faculty positions in institutions that evaluated their credentials, not their pedagogical capacity. They teach the way they were taught, because that is all they have been equipped to do.

This is not a criticism of individuals. It is a description of a self-replicating system. Each generation trained in conditions that undermine intellectual development trains the next generation in the same conditions. The output degrades progressively. And the admission of progressively lower-scoring students into this progressively degraded system accelerates the deterioration.

The ten to twenty percent who arrive with genuine capacity and genuine vocational commitment are not served by this system. They survive it — some of them. They find their own path to genuine competence through individual effort, self-directed study, exposure to better mentors wherever they can find them. They represent the future that Ayurveda could have, and they are produced almost in spite of the system rather than because of it.

VIII. The Exceptions Do Not Define the System — But They Reveal What Is Possible

This point deserves its own section because it is always raised in response to arguments of this kind, and it deserves a direct and honest answer rather than a dismissal.

Yes, there are BAMS graduates of extraordinary calibre. There are practitioners who have mastered the classical tradition with genuine depth. There are researchers conducting methodologically rigorous work. There are educators who are developing the kind of critical thinking culture in their students that this series has been arguing for. They exist. They are visible to anyone looking honestly at the landscape of Ayurvedic practice and scholarship.

They are not evidence that the system is functioning. They are evidence of what individuals of exceptional talent and commitment can produce in spite of a system that is not designed to support them. The existence of remarkable individuals within a failing system does not vindicate the system. It indicts it — because it demonstrates that the system is failing to produce, at scale, what individual excellence proves is achievable.

A system should be evaluated by its typical output, not its exceptional output. The typical output of the current BAMS admission and curriculum system is a graduate who is inadequately prepared for classical Ayurvedic practice, inadequately prepared for modern clinical practice, carrying a financial burden that their career prospects may not justify, and entering a professional environment that is increasingly hostile to the system they nominally represent.

That is not an acceptable outcome for a tradition of this depth, this antiquity, and this genuine intellectual richness.

IX. What Honest Reform Would Look Like

This article has been a diagnosis. It is appropriate — as has become a pattern in this author’s writing — to sketch the outline of what honest reform would require. Not utopian reform. Not the reform that would satisfy every stakeholder. The reform that intellectual honesty demands.

A genuine minimum cognitive floor for BAMS admission. Whether through a 250-mark NEET threshold or an equivalent mechanism, the principle must be established that the study of a complex classical medical system requires a demonstrable baseline of foundational analytical competence. This is not negotiable on educational grounds. The negotiation that has been occurring is entirely on economic grounds — the economic interest of institutions that need to fill seats. That interest is real. It should not determine the minimum standard for medical education.

Honest public disclosure of graduate outcomes. Every BAMS college should be required to publish, in its prospectus and on its website, accurate data on what its graduates are doing five years after graduation. What proportion are in active Ayurvedic clinical practice? What proportion are in other medical practice? What proportion have left the field entirely? Families making significant financial investments in a BAMS degree are entitled to this information. The current absence of such disclosure is an information asymmetry that works entirely in favour of institutions and entirely against students and families.

Curriculum reform that prioritises competence over coverage. The BAMS curriculum carries an enormous content load — much of it delivered in ways that produce neither understanding nor clinical skill. A curriculum designed around the development of demonstrable competencies — the capacity to conduct a classical clinical examination, construct a reasoned differential diagnosis, formulate a treatment plan with explicit reasoning, and communicate clinical evidence honestly — would be a significantly different curriculum from the one currently in operation.

Faculty development as an institutional requirement, not an optional aspiration. The pedagogical quality of BAMS teaching cannot improve without systematic investment in the development of teaching faculty. This means training in the skills of clinical supervision, in the facilitation of structured debate and case discussion, in research methodology, and in the epistemological foundations that every Ayurvedic teacher should be able to model for their students.

The revealed preference experiment, at minimum as a research exercise. Before any of the above reforms can be argued for with full conviction, the data that would be revealed by a transparent registration experiment should be generated. Even as a voluntary pilot — institutions willing to participate in an honest assessment of what their applicant pool looks like when preference is explicitly registered — the results would be illuminating. The resistance to generating that data is itself data.

X. The Real Status of Ayurveda — On Our Own Terms

TheLiverDoc has said that Ayurveda should be relegated to the history books. That patient safety cannot be entrusted to Ayurveda doctors. There are people within and outside the system who share this view, and the Neuronz debate gave them considerable new evidence for it.

This author does not share that conclusion. But this author is not willing to defend Ayurveda’s current institutional reality in order to defend the tradition’s genuine intellectual depth. They are not the same thing, and conflating them is the deepest form of disrespect to the tradition.

Ayurveda as a classical system of knowledge — its epistemological frameworks, its clinical observation tradition, its pharmacological insights, its understanding of the relationship between lifestyle, constitution, and disease — has genuine and significant value. That value deserves to be developed, evaluated rigorously, and transmitted honestly. It deserves practitioners who chose it with conviction, who were equipped with the cognitive tools to master it, who were trained by a curriculum that demanded competence and not merely attendance, and who entered a professional environment that rewarded genuine excellence rather than institutional compliance.

The current NEET minimum eligibility crisis is not a peripheral administrative problem. It is the point at which a series of deeper institutional failures become visible: the failure to define what BAMS is actually for, the failure to demand the cognitive baseline its complexity requires, the failure to deliver the curriculum that its depth deserves, the failure to be honest with students and families about what the degree currently delivers.

Until these failures are named honestly — not in private faculty room conversations but in official forums, by people with the authority to act on them — the falling floor will continue to fall. And every time it falls, Ayurveda as a science falls with it.

The tradition is worth more than the institutions currently serving it. It is time the institutions were made to demonstrate that they understand this.

The author has been engaged in Ayurvedic education and clinical practice for nearly three decades. The views expressed here are those of the author and reflect a sustained commitment to the reform and strengthening of Ayurveda as a rigorous clinical discipline.

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