In this well-researched book, P. Sesh Kumar studies the problems facing India’s medical education system. The book, Under the Scalpel, shows how issues such as student stress, empty hospital posts and delayed medical careers are linked to policies and institutions, not just individual failure.
The author writes with authority because of his background. Kumar is a former officer of the Indian Audit and Accounts Service. He also served as Secretary to the Supreme Court–appointed Oversight Committee on the Medical Council of India during 2016–17. This role allowed him to closely observe how medical education is regulated. His experience helps him explain how good policies often get weakened by political pressure, lack of resources and administrative limits.
A major focus of the book is the mental stress caused by the National Eligibility cum Entrance Test (NEET). Kumar explains that preparation for NEET often starts at a very young age. Students spend years in coaching centres, studying for 12 to 14 hours a day. The city of Kota is used as an example. According to media reports quoted in the book, at least 26 students died by suicide in Kota in 2023, the highest number in ten years. Most were preparing for NEET or engineering exams. The author says these deaths point to a wider mental health crisis, especially among students from poorer families.
The book does not suggest removing NEET. Kumar accepts that the exam has reduced corruption and created a common national standard. However, he criticises the heavy dependence on a single exam. He argues that medical admissions have become too competitive and unfair to students with fewer resources. He suggests a wider admission process that includes school marks, aptitude tests, interviews and proper mental health support. The book also highlights the gap between CBSE and state board syllabi, which makes many students rely heavily on costly coaching.
Problems continue even after students complete MBBS. India produces over one lakh MBBS graduates every year, but there are only about 74,000 postgraduate MD and MS seats. Only half of these are in government colleges. Private colleges charge very high fees, sometimes up to one crore rupees, for popular subjects. According to Kumar, this shuts out many talented students from middle-income and lower-income families. NEET-PG becomes another stressful exam where even a small mistake can affect a doctor’s future.
The author argues that increasing seats alone has not solved the problem. Many new seats are in colleges with poor facilities or in remote areas. Super-speciality seats are very limited, with fewer than 3,000 across the country. There is also a shortage of teachers. As a result, some seats remain vacant not because of a lack of students, but because of poor quality and location.
Regulation is another key issue in the book. The Medical Council of India was criticised for its strict rules and outdated inspections. Its replacement, the National Medical Commission, has made rules more flexible. While this helps new colleges, Kumar warns that it can also lead to cutting corners. Inspections are now often paperwork-based, and lower experience requirements for teachers may affect training quality.
There has been progress. India now has about 1.3 million registered doctors, and health spending has increased. The government plans to add 75,000 MBBS seats over five years. Still, India has fewer doctors and weaker training systems compared to many developed countries.
Kumar ends with a clear warning. Under pressure to approve more seats, the National Medical Commission, he says, is starting to act like the old Medical Council of India. Without better planning and stronger oversight, reforms may repeat past mistakes.
Overall, the book is a serious and informative study of medical education in India. It highlights important issues of quality, fairness and responsibility. For students interested in healthcare and education, it shows why growth without standards can weaken the system instead of improving it.
Title: Under the Scalpel
Author: P. Sesh Kumar
Publisher: White Falcon Publishing
Pages: 320
Price: Rs 549