The first-round seat allotment data of the National Eligibility-cum-Entrance Test-Post Graduation (NEET-PG) 2020 was published in April 2020 [1]. Apart from a few institutions having their own selection processes, this competitive examination has acted as the sole entrance to the majority of residency positions in India, since NEET-PG 2017. Additionally, since NEET-PG 2019, ranks here have served as the basis of Diplomate of National Board (DNB) counseling, adding even more significance to the outcomes of this exam. As of 2020, there are 299 institutions in India imparting the training and degree of Master of Surgery in Otorhinolaryngology [MS (ENT)] across 1151 seats [2]. We note with concern that students with the highest all-India ranks (AIRs) in the NEET-PG, a metric that only takes examination score into account, have continued to completely forsake ENT, similar to the previous years (Fig. 1). Amongst top-100 AIRs, not a single student chose ENT, as has been true for the past years. Over 89% of the top-100 AIRs this year gravitated towards ‘medical’ specialties. Similarly, amongst the top-500 AIRs, only one examinee chose ENT, with 78.8% of candidates preferring these four ‘medical’ fields: internal medicine, radio-diagnosis, pediatrics, and dermatology. Even amongst the top-2000 AIRs, merely four candidates chose ENT [1].

1. OTHER ARTICLES
Why are India’s Best Medical Graduates not Preferring ENT
for Postgraduate Training Through NEET-PG?
Ahmad Ozair1 • Abhishek Bahadur Singh2
Received: 20 April 2020 / Accepted: 20 June 2020 / Published online: 30 June 2020
Ó Association of Otolaryngologists of India 2020
Keywords NEET Postgraduation
Graduate medical education Otolaryngology ENT
Residency
Dear Editor,
The first-round seat allotment data of the National Eligi-
bility-cum-Entrance Test-Post Graduation (NEET-PG)
2020 was published in April 2020 [1]. Apart from a few
institutions having their own selection processes, this
competitive examination has acted as the sole entrance to
the majority of residency positions in India, since NEET-
PG 2017. Additionally, since NEET-PG 2019, ranks here
have served as the basis of Diplomate of National Board
(DNB) counseling, adding even more significance to the
outcomes of this exam. As of 2020, there are 299 institu-
tions in India imparting the training and degree of Master
of Surgery in Otorhinolaryngology [MS (ENT)] across
1151 seats [2].
We note with concern that students with the highest all-
India ranks (AIRs) in the NEET-PG, a metric that only
takes examination score into account, have continued to
completely forsake ENT, similar to the previous years
(Fig. 1). Amongst top-100 AIRs, not a single student chose
ENT, as has been true for the past years. Over 89% of the
top-100 AIRs this year gravitated towards ‘medical’ spe-
cialties. Similarly, amongst the top-500 AIRs, only one
examinee chose ENT, with 78.8% of candidates preferring
these four ‘medical’ fields: internal medicine, radio-diag-
nosis, pediatrics, and dermatology. Even amongst the top-
2000 AIRs, merely four candidates chose ENT [1].
Meanwhile, 7 out of the top-10 AIRs chose internal/general
medicine, lending further credibility to the fact that this
field has become the most preferred specialty in India.
To put this data into perspective, the NEET under-
graduate examination (NEET-UG) picks out the top 3–5%
of the 1.3 million exam takers for MBBS seats in gov-
ernment-funded medical colleges. After this selection of
the cream, NEET-PG further selects amongst 1,40,000
candidates sitting for it each year for approximately 30,000
MD and MS positions available [2]. Thus, high rankers on
the NEET-PG represent the finest students offered by the
medical education system in India; and the majority of
these are, unfortunately, not at all preferring ENT.
This non-preference for ENT in India is in stark contrast
to the situation in developed nations, where otolaryngology
residency positions are amongst the most competitive ones.
In the UK, ‘competition ratios’, i.e. the number of appli-
cants per available trainee position, serve as a critical
measure of competitiveness. For 2019, the competition
ratio for ENT was 2.57, compared to 1.43 for internal
medicine [3]. In the US, the average US Medical Licensing
Examination (USMLE) Step 1 scores of candidates
accepted to a specialty act as a high-quality, objective
surrogate of that specialty’s competitiveness. As per the
last-available data of 2018, the mean score in USMLE Step
1 was 230 (SD = 19). Candidates accepted to ENT had a
mean score of 250, which is more than one standard
deviation above the mean, and is the second-highest
Abhishek Bahadur Singh
drabhishek_kgmu@yahoo.co.in
Ahmad Ozair
ahmadozair@kgmcindia.edu
1
Faculty of Medicine, King George’s Medical University,
Lucknow, Uttar Pradesh 226003, India
2
Department of Otorhinolaryngology and Head Neck
Surgery, King George’s Medical University, Lucknow,
Uttar Pradesh 226003, India
123
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(Oct–Dec 2020) 72(4):535–537; https://doi.org/10.1007/s12070-020-01926-6

2. amongst scores of all specialties, along with being far
higher than internal medicine’s score of 235 [4].
We thus conclude that the most meritorious medical
graduates in India do not choose ENT, unlike developed
nations. Past studies in India have found a significant role
of socio-demographic, academic, and motivational factors
in choosing a specialty [5]. Data from the same should be
utilized in crafting a multi-modal approach so that we can
encourage the brightest students and graduates to choose
ENT, with both being separate populations to be tackled.
For instance, surveys done abroad have found ENT to be
amongst the top-five most preferred fields of medical stu-
dents [6]. However, just as past surveys from India, Anand
and colleagues’ recent work from Christian Medical Col-
lege, Vellore indicates a non-preference for ENT amongst
students [5, 7]. They report that ENT ranks very low on the
list of clinical specialties selected as the ‘most likely’
future choice of students, from first-year till final-year. This
is unlike the state of general surgery in India, where even
amongst students, a high degree of preference for the
specialty is indicated. This preference manages to carry
over into the results of the NEET-PG as well, albeit much
less than internal medicine. Similarly, the work of Garg
et al. from Lady Hardinge Medical College, New Delhi
finds that female medical graduates categorically rank ENT
below most major surgical disciplines [8].
As otorhinolaryngologists, it is incumbent upon as a
profession to urgently mitigate the reasons for the non-
preference of ENT in India, which is evident in both stu-
dent surveys and results of centralized admission tests. Our
professional organizations like the Association of Oto-
laryngologists of India (AOI) need to take the lead in
publicly promoting the immense value of our field, the
incredible gratification obtained in healing patients in ENT
through our own hands, the expanding scope of practice,
and of course, the adequate compensation herein. We must
also make widely known the expanding super-specialty
horizons of our field, including pediatric otolaryngology,
head and neck oncology—reconstructive surgery, facial
plastic surgery, neuro-otology, and skull base surgery.
Just as our counterparts in the US and Canada, we must
appoint social media editors for our journals and our pro-
fessional bodies, who would manage their Twitter and
LinkedIn pages. They would put out curated content and
engage regularly with both the early-career and the
potential otorhinolaryngologists, thus generating interest in
our specialty. The time has come for us to be present where
our future trainees have long existed. If we do not take
heed, we shall continue to not receive the brightest can-
didates. Since long-term affirmative changes take years to
percolate, we must therefore begin today.
Data availability The manuscript is not an original article. Hence,
this is not applicable.
Code availability None.
Compliance with ethical standards
Conflict of interest The authors declare that they have no conflict of
interest.
Ethics approval Not applicable.
Consent to participate/publish Not applicable.
References
1. Medical Counselling Committee. India: Medical Counselling
Committee. Final Result Round 1 PG 2020 (Medical): PG Medical
Counselling. https://mcc.nic.in/PGCounselling/Home/ShowPdf?
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Accessed 19 Apr 2020
Fig. 1 Number of students choosing otorhinolaryngology (ENT) for
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amongst a the top-500 all-India ranks (AIRs) and b the top-2000
AIRs. Importantly, the NEET-PG 2017 was held in December 2016
for admissions to the year 2017. Note that no student amongst the top-
100 AIRs in these four years has ever chosen ENT
123
536 Indian J Otolaryngol Head Neck Surg (Oct–Dec 2020) 72(4):535–537

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Publisher’s Note Springer Nature remains neutral with regard to
jurisdictional claims in published maps and institutional affiliations.
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