Students line up outside a National Eligibility cum Entrance Test (NEET) PG exam centre in Thiruvananthapuram. File photo
| Photo Credit: The Hindu

Citing lack of transparency and alleged disparity between exam shifts doctors have approached the Union Health Ministry seeking urgent intervention and revision of the move to conduct this year’s National Eligibility-Entrance Test for Postgraduate (NEET-PG) exam in double shift.

The National Board of Examination in Medical Sciences (NBEMS) announced that it would conduct NEET PG 2025 in two shifts on June 15, 2025. While the first shift is scheduled from 9:00 AM to 12:30 PM, the second shift is scheduled from 3:30 PM to 7:00 PM.

In their letter to the Health Ministry doctors under the Indian Medical Association Junior Doctors’ Network (IMA-JDN) said that the decision to hold NEET PG 2024 in double shifts was taken citing lack of sufficient time to allocate the centres and ensure security protocols — “no such problem exists this year,’’ they said.

Doctors also pointed out last year even though NBEMS and the National Medical Council (NMC) brought in a normalisation process after doctors pointed out disparity between shifts the process was flawed.

Referring to the PG medical entrance exam held last year, IMA-JDN said that in NEET PG 2024 there were allegations regarding the disparity between the two shifts of the exam. “The primary issue with the two-shift model is the lack of transparency in the normalisation process. Last year, it was widely observed that Shift 2 was significantly more difficult, leading to disparities in scores and relative rankings. This not only affected the performance of deserving candidates but also created a sense of uncertainty and demoralisation,” the group noted in its letter.

National secretary of IMA-JDN standing committee, Indranil Deshmukh, explained there is serious concern for the 2 lakhs NEET-PG aspirants who may be subjected to the same issues as last year.

“NEET-PG 2025 is again being held in two shifts, despite the absence of any logistical urgency this year. The lack of transparency in the normalisation process, unequal difficulty levels across shifts, and denial of access to answer keys and response sheets have raised genuine concerns among candidates regarding the fairness of the process. We urge the authorities to consider conducting the exam in a single shift, ensure transparency in score calculation, and expand centres to all districts. A just and transparent process is essential to uphold the credibility of medical education and protect the aspirations of our young doctors,” said Dr. Deshmukh.

Doctors add that the reasons given to hold NEET-PG 2024 in two shifts last year included lack of sufficient time for centre allocation and ensuring security protocols, especially when the exam was rescheduled and over 2 lakh doctors were involved. “However, in the current year, there has been no such logistical constraint or last-minute change, and yet the exam is scheduled in two shifts—raising genuine concerns among aspirants,” the doctors noted, warning that these actions diminish the credibility of the examination process.

A few candidates who appeared in the second shift of the NEET PG 2024 exam had questioned the normalization formula adopted by NBEMS and further claimed that the board had scammed them in the name of a competitive exam. They pointed out that the Shift 2 paper was tougher compared to Shift 1 and further termed the process of calculating scores as debatable. These concerns were also raised before the Supreme Court, where the aspirants sought transparency in the NEET PG 2024 exam.

Meet Rinku, also known as Dr. Dog, who works with children at Saraswati Kendra, a school for children with special needs, in Chennai. 

These children face challenges such as learning disabilities, autism, and dyslexia, and the school uses animal-assisted therapy to help them develop social and behavioral skills.

When Rinku, who has been the Dr. Dog for two years now, walks into the room, the kids light up with excitement. The ‘doctor’ comes in, looks at everyone, goes around sniffing and wagging her tail. “What does Rinku like?” a psychologist asks. “Biscuit,” one student replies. Then comes the follow-up: “But are biscuits healthy?” “No,” the children answer. 

Through moments like this, the children are gently encouraged to speak, learn lessons, communicate, and build social skills — all with Rinku as the medium.

How it all began

“I first read about pet therapy being done in the United States. But that involved using horses. Where could we get horses in Chennai? So I tried it with my own dog, Cleo. And then Sachin, my dachshund,” says Nanditha Krishna, president, C.P. Ramaswami Aiyar Foundation, and founder of Saraswati Kendra.

One of the first children to try this therapy was a nine-year-old with autism who hardly spoke. One day, he surprised everyone by saying, “Sachin, I had upma for breakfast. What did you have?” For the educators, this was a huge breakthrough, says Ms. Krishna.

According to Ms. Krishna, Saraswati Kendra was the first place in India to introduce pet therapy, back in 1996. A major turning point came in 2001, when Jill Robinson, an animal welfare activist and founder of Animals Asia Foundation, a non-profit working in animal welfare, visited. She taught them how to assess dogs for therapy and how to interact with them. Ms. Krishna learned these techniques and has been using animal-assisted therapy at the school ever since.

Screening the ‘doctors’

Dr. Dog comes in for 40 minutes a day. Each session has one or two students. 

All the therapy dogs are rescues adopted by Ms. Krishna. She personally assesses them to make sure they are friendly and calm, traits that are important for working with children. “The dogs must be at least two years old,” she says. Only sterilised dogs become “doctors.”

Over the years, many dogs have taken on the role of Dr. Dog.

Jill Robinson, an animal welfare activist visited the school in 2001 and taught the authorities how to assess dogs for therapy and how to interact with them.

The therapy offered

So, how does Dr. Dog help the children?

Psychologists at the school explain that the dog is used as a bridge to teach and encourage children to open up. There’s no special training given to the dogs, other than thoroughly ensuring that they are healthy and comfortable being around children. 

“For children on the spectrum who suddenly stop speaking, we use Dr. Dog to gently encourage them to talk, like saying, ‘Dr. Dog had curd rice. What did you have?’” says S. Niraja, the chief psychologist, adding that dogs are amazing at picking up cues, even before someone gives a command. “They develop a soul connection.” 

Children are chosen for therapy based on their needs and ability to bond with the dog. Over time, they become more open, and some even develop a sense of responsibility for the dog. “The Dr. Dog makes them feel important, like someone needs them in their life,” she says. For children with ADHD who tend to run around, the therapists tell them the dog is tired and wants to sit. So the children come and sit beside the dog, calming down in the process.

Ms. Niraja explains that there’s also a gradual weaning process when it’s time to wrap up therapy. It begins by gently asking the child if they’re okay “sharing” Dr. Dog with another student. Once they agree, a new child is introduced. “We make sure the first child still feels important,” she says. They are encouraged to talk to each other, and over time, as the child becomes more comfortable, the therapy is gradually concluded.

During sessions, the children are asked to write about Rinku. On Thursday, one child wrote, “Rinku is a happy dog.” Another wrote, “Rinku best friend is Maya.” Everyone was surprised. Maya is another dog at the campus, and the child had noticed them spending time together. The therapists were pleasantly surprised at the keen observation by the student.

Tulasi, the previous Dr. Dog at Saraswati Kendra
| Photo Credit:
AKHILA EASWARAN

Sudeep Kumar Kapalavai, senior consultant at the paediatric intensive care unit of the Kanchi Kamakoti Childs Trust Hospital in Chennai, who was part of a pilot project to use pet therapy to facilitate early mobilisation of patients, said that dogs can help with emotional stability. “Pet therapy, to an extent, can be a mood stabiliser. In fact, we think, it can also help in adult ICU,” he said.

After each session at Saraswati Kendra, Rinku often has a little fan club waiting outside with kids eager to pet her, say hi, or spend a moment with their favourite four-legged doctor.

Are healthcare systems prepared to handle the rising number of patients with end-stage kidney disease requiring dialysis? Over the years, dialysis services have undoubtedly expanded — at least in some parts of the country — but there are critical gaps and shortcomings that need to be addressed to meet the growing demand for dialysis services among patients, say experts.

According to the Pradhan Mantri National Dialysis Program, which was rolled out in 2016 to provide free dialysis to the poor, about 2.2 lakh new patients with end-stage renal disease get added in India every year, resulting in an additional demand for 3.4 crore dialysis sessions. There are however, only 11,148 haemodialysis machines in the country. Among these, three States have over 1,000 machines each: Tamil Nadu (1,258), Kerala (1,259) and Gujarat (1,278).

What is driving the surge in renal failure?

Diabetes, hypertension and Chronic Kidney Disease (CKD) of unknown origin are the main causes for the rise in the number of persons requiring dialysis. While there is better awareness among most, some patients still arrive at healthcare facilities only when they already have serious complications, says M. Edwin Fernando, head, Department of Nephrology, Government Stanley Medical College Hospital (SMCH).

N. Gopalakrishnan, former director, Institute of Nephrology, Madras Medical College and Rajiv Gandhi Government General Hospital, adds: “Metabolic syndromes (diabetes, hypertension and obesity) and environmental factors (pollution, heat stress and probably exposure to chemicals) can cause kidney failure,”. He also notes that a recently-concluded survey (randomised, cluster sampling method) found that 50% of patients (adults) with CKD in Tamil Nadu were neither diabetic or hypertensive. “This shows that there are causes beyond diabetes and hypertension. Unorganised workers such as agricultural and construction labourers are at risk of increased exposure to heat stress and environmental pollution. There is a need to work out strategies to protect them.”

Expansion of services in TN

While pointing out that there has been an exponential rise in the number of patients requiring dialysis for end-stage kidney disease over the years, Dr. Fernando says that Tamil Nadu has adequate number of dialysis machines including at medical college hospital and taluk-level hospitals. “The government has done a lot of work over the years to ensure that people requiring dialysis need not travel long distances. Not to forget that haemodialysis is also covered under the Chief Minister’s Comprehensive Health Insurance Scheme (CMCHIS), enabling many to access dialysis services easily,” he notes.

At SMCH, the number of dialysis machines has increased from 10 a decade ago to 35 presently. On an average, 100 dialysis sessions are conducted on a day here.

From seeing a paucity of dialysis services during the 1990s as a result of which patients had to travel far and wide, Dr. Gopalakrishnan says, “There has been tremendous progress in the availability of dialysis services in the State over the last decade. It has percolated to tier 2 and tier 3 cities. In the government sector, not only medical college hospitals have dialysis services but district headquarters and many taluk hospitals also offer dialysis services now.”

The magnitude of dialysis services availed of in a State like T.N. can be explained with one piece of information. “Dialysis tops the CMCHIS spending. The State government spends more than ₹150 crore for haemodialysis under the scheme in a year, making dialysis the top procedure,” a senior nephrologist, who did not want to be named, points out.

In fact, Tamil Nadu, through its flagship scheme Makkalai Thedi Maruthuvam for home-based screening and door delivery of drugs, provides Continuous Ambulatory Peritoneal Dialysis bags to patients at their homes. So far, 426 beneficiaries have been reached, according to health officials.

Availability versus accessibility

Sreejith Parameswaran, professor and head, Department of Nephrology, JIPMER, Puducherry, says that availability of dialysis machines differs across the country. “Considering the south – Tamil Nadu, Puducherry, Kerala, Karnataka, Telangana and Andhra Pradesh – I will say that the availability of dialysis services is not an issue. Dialysis services are available every 50 kilometres in many places. In many places in northern and north-east India however, dialysis services are unavailable for 100-200 kilometres and patients need to travel twice a week. States such as Punjab and Haryana are better off, but dialysis services are located far apart in some north Indian States,” he points out.

Noting that there has been a tremendous expansion in terms of infrastructure in some States, he says that a number of NGOs have also stepped in to provide dialysis services in States like Tamil Nadu and Kerala. For instance, in Kerala, NGOs offer highly subsidised dialysis services, while TANKER Foundation offers dialysis services in Tamil Nadu.

Dialysis services are covered under insurance schemes such as CMCHIS (Tamil Nadu) and Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), Dr. Sreejith Parameswaran notes. “So accessibility, not availability, is more of an issue in the south as the majority of the services are largely in the private sector. Dialysis services are more in the private sector than under the government sector in every State in India. That is where accessibility issues come in. Government dialysis services cannot accommodate everyone. Therefore, patients need to depend on the private sector, which is expensive,” he says.

He further explains: “In Tamil Nadu and Puducherry, all government medical college hospitals offer dialysis services. It is the same in Kerala. The problem is that government institutes cannot accommodate all persons in need of dialysis. This is where empanelling of private hospitals comes in. But there are certain issues; under CMCHIS, not enough is paid for dialysis services, while in Puducherry, empanelled hospitals face issues of delayed payments under AB-PMJAY. It is important for governments to ensure that dialysis services are viable for private hospitals with adequate remuneration that match the expenses. So, the package rates under CMCHIS for dialysis should be revised. This is important because dialysis services in the government sector are running full, and private hospitals will serve as the additional capacity.”

Gaps, shortcomings and path forward

In patients with end-stage kidney disease on dialysis, the first 100-day death rate is nearly 40%, another senior nephrologist says, adding, “Dialysis through central venous catheters has a high risk of infections for patients. So, creating an arteriovenous fistula – an artificial connection between an artery and a vein – for dialysis at the level of the elbow/wrist is a crucial step. This requires vascular expertise, and is insufficient to meet the demands.”

Dialysis, in itself, is a stigma for many patients, he observes. “Some try to postpone initiation of dialysis. This is why educating patients is important, but this is lacking now. It should also be understood that socio-economic factors play a big role in CKD and dialysis, as it affects the family’s finances,” he adds.

It is not an easy journey for many patients. “Most patients require dialysis two to three times a week. Many of them find it difficult to meet their expenses towards travel and food and face challenges at their workplace and end up losing the day’s pay. To help patients undergoing haemodialysis, governments can provide ₹200 to ₹300 per session to support them. Telangana, for instance, announced a pension amount of ₹2,000 per month for patients, in addition to providing bus passes to travel to the nearest dialysis facility,” Dr. Sreejith Parameswaran points out.

Nutrition is a key component for patients on dialysis. “Patients belonging to Below Poverty Line face challenges in meeting nutritional needs. Patients on dialysis require a high protein diet but many of them sustain themselves on a rice-based diet and take little protein. It is important to give nutritional support to them. Similar to financial assistance towards nutrition for patients with tuberculosis, governments should come up with a plan to provide nutritional support for patients on dialysis. This will definitely make a difference,” he further stresses.

Doctors also raised the need for a CKD registry at the primary health centre level.

In a step towards improving the services, T.N. is looking at establishing a hub and spoke model of networking dialysis units with the aim of integrating services at the secondary and tertiary level. There are also plans to train general surgeons in performing the AV fistula procedures, officials say.

Dr. Gopalakrishnan emphasises the need to focus on prevention. Screening for diabetes and hypertension is being carried out through MTM, and anti-diabetic and anti-hypertensive drugs are delivered at the homes of patients. This, in fact, addresses the gap between diagnosis and control, and improves adherence to drugs, he adds.