You would never find advertisements for “confirmed admission” to any IIT or AIIMS or one asking you to book a seat in advance in any of these premier institutes. Neither are there advertisements promising you selection for the civil services or placement in an all-India service of your choice. Yet, the media is full of ads for MBBS seats in colleges across the country.How, if the system is merit-based, can anyone promise “direct admission”?Behind this promise is a black market in medical seats in private colleges. With agents and college managements colluding to sell many of the 30,000-plus MBBS and over 9,600 postgraduation seats in private medical colleges, back-of-the-envelope calculations by TOI suggests that about Rs 12,000 crore in hard cash changes hands in this black market every year. Of the 422 medical colleges in India, 224 are private, accounting for 53% of MBBS seats. Many of these colleges are running with little or no facilities, no patients and fake faculty. The going price for an MBBS seat could range from Rs 1 crore in colleges in Bangalore to Rs 25-35 lakh in some in UP. Seats in MD in radiology and dermatology cost up to Rs 3 crore.The prices could escalate or drop depending on how early you approach a college for a seat. If you book in advance, you could get a discount! However, once the medical entrance results have been announced, the same seats at the private colleges will be sold for almost double the advance booking price. The sale of MBBS seats alone is worth almost Rs 9,000 crore annually.Consortia of privately managed colleges and deemed universities that run medical colleges claim to conduct their own entrance examinations to take in students strictly on merit. However, in state after state, the exams have been exposed as a farce with students who pay money to buy seats being accommodated whether they appear for the exam or not and no matter what they score, while the so-called merit students are bumped off the list on various pretexts; with many even threatened and bullied into vacating seats.While the 15% NRI quota seats are allowed to be allotted at the management’s discretion in most states, in reality, even the management quota and a chunk of the so-called merit seats are sold off, bringing the proportion of seats sold to over 50%, the proportion rising to 80% or even 100% in some cases depending on how strict the regulation is in each state. The quota set aside for management varies from state to state. For instance, in MP and Maharashtra, the management quota is about 43%. This, plus the NRI quota brings the seats set aside to almost 60%.With just 23,600 seats available for post graduate medical education, the demand for the same is very high. Thus, there is great demand for the 9,400-plus seats in the private sector, including over 1,300 diploma seats. By a conservative estimate, about 40% of these seats also get sold. All told, the sale of post-graduate seats alone is estimated to be worth about Rs 2,900 crore. Add the highly valued seats for super-specialisation, about 370 in the private sector, of which again at least 40% is sold, and the post-MBBS education black market figure crosses Rs 3,000 crore. Thus, along with the MBBS seat sale, the total amount comes to about Rs 12,000 crore.The bulk of the money is paid in cash, leaving no trace of the transaction. And despite the advertisements giving the game away, the government has not cracked down on this black market or taken steps to arrest the rot in the medical education system.