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The white coat is not a birthright
This article is authored by Dr Ramakanta Panda, cardiac surgeon and chairman, Asian Heart Institute, Mumbai.
The recent controversies over leaked examination papers have reignited a familiar anxiety across India: The fear that merit is losing its meaning. For millions of families, education is not simply schooling. It is the one inheritance a poor parent can realistically pass on to a child; the bridge between a life of hardship and one of dignity. When that bridge is compromised, it is not just an exam that suffers. It is a promise. And this promise is tested on the journey to becoming a doctor.
Medicine has always occupied a special place in the public imagination. A stethoscope does not ask where a child was born. It does not check the size of a parent’s bank balance before it listens to a heartbeat. A doctor from a humble background, is seen as proof that a society rewards intelligence and effort, that a farmer’s daughter or a labourer’s son can, through sheer diligence, become someone entrusted with human life. In principle, this remains true. In practice, the road to a medical degree has become one of the most expensive and unevenly lit corridors in the education system.
Competitive entrance examinations for medical colleges are, on paper, blind to privilege. In reality, an entire industry of coaching centres has grown up around them, and access to that industry is anything but equal. Families now routinely spend years of savings, take loans, or sell land and jewellery to fund coaching for their children. A student from an affluent city can enrol in structured, expert-led preparation almost as a matter of course. A student in a remote village, no matter how naturally gifted, must often fight simply to access a functioning science laboratory or a teacher qualified to explain it. The unequal entry point itself becomes the greatest barrier. Intelligence, as the saying goes, does not choose its birthplace. Opportunity does.
This matters beyond individual fairness. A health care system draws its strength from the range of people who enter it. Doctors who grew up in under-resourced villages, urban slums, or economically fragile households often bring something that cannot be taught in a classroom: An intuitive understanding of the communities most in need of care, and a willingness to serve there. Countries facing shortages of rural doctors have long recognised this: Expanding the pool of applicants beyond the privileged few is not merely a matter of fairness, but of public health strategy. A nation that draws its physicians from a narrow social band risks leaving large portions of its own population underserved by people who understand them least.
None of this is an argument against those who come from comfortable backgrounds. Many privileged students work with genuine seriousness and go on to become excellent, compassionate physicians; ambition is not the exclusive property of the poor, and it would be a mistake to romanticise hardship as though struggle alone confers merit. Yet, for countless young people from economically disadvantaged families, the desire to succeed is often fuelled by something even more powerful: The urgency to change the course of their family’s future. They may possess the greatest hunger, the fiercest fire in the belly, but they begin the race from far behind classmates whose families can afford to spend crores of rupees on medical education and years of expensive preparation. Talent is distributed evenly across society; opportunity is not. It is that unequal starting line, not unequal ability, that a fair system must correct.
Correcting this does not require lowering standards. It requires ensuring that every deserving student begins the race from a more equal starting line. Well-funded government schools with reliable science teaching, transparent and secure examinations, scholarships that specifically cover the cost of coaching and entrance preparation, rural quotas linked to service commitments, and mentorship programmes connecting first generation aspirants with practising doctors are not radical interventions. They are investments in equal opportunity. Several already exist in fragments across the country. What is missing is the political will to scale them, so that a child’s economic circumstances no longer determine how close they can get to the starting line, insulated from the electoral cycle that too often treats education as a five-year promise rather than a generational commitment.
There is also a quieter cost to inaction, one rarely discussed in policy debates: the scientists, surgeons, and researchers a nation never discovers, because opportunity never found them. Every leaked paper, every unaffordable coaching fee, every underfunded rural school represents not just an individual disappointment but a potential contribution to human health that the world will simply never see.
A medical degree should certify competence, not privilege. Building a system where that is reliably true is simply the basic contract a society owes its most capable children, regardless of where they were born. Until that contract is honoured fully, the white coat will remain, for too many, a birthright rather than an achievement.
(The views expressed are personal)
This article is authored by Dr Ramakanta Panda, cardiac surgeon and chairman, Asian Heart Institute, Mumbai.
