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"32. The imperative of giving some incentive marks to doctors working in the State and more particularly serving in notified remote or difficult areas over a period of time need not be underscored. For, the concentration of doctors is in urban areas and the rural areas are neglected. Large number of posts in Public Health Care Units in the State are lying vacant and unfilled in spite of sincere effort of the State Government. This problem is faced by all States across India. This Court in Snehlata Patnaik (Dr.) V/s. State of Orissa, 1992 (2) SCC 26, had left it to the Authorities to evolve norms regarding giving incentive marks to the in-service candidates. The Medical Council of India is an expert body. Its assessment about the method of determining merit 4512/2017, 4526/2017 of the competing candidates must be accepted as final (State of Kerala V. T.P.Roshana, (1979) 1 SCC 572 (para 16); also see MCI V. State Of Karnataka, (1998) 6 SCC 131). After due deliberations and keeping in mind the past experience, Medical Council of India has framed Regulations inter alia providing for giving incentive marks to in-service candidates who have worked in notified remote and difficult areas in the State to determine their merit. The Regulation, as has been brought into force, after successive amendments, is an attempt to undo the mischief.

43. xxx xxx xxx

44. Dealing with this contention, we find that the setting in which the proviso to Clause (IV) has been inserted is of some relevance. The State Governments across the country are not in a 4512/2017, 4526/2017 position to provide health care facilities in remote and difficult areas in the State for want of Doctors. In fact there is a proposal to make one year service for MBBS students to apply for admission to Post Graduate Courses, in remote and difficult areas as compulsory. That is kept on hold, as was stated before the Rajya Sabha. The provision in the form of granting weightage of marks, therefore, was to give incentive to the in-service candidates and to attract more graduates to join as Medical Officers in the State Health Care Sector. The provision was first inserted in 2012. To determine the academic merit of candidates, merely securing high marks in the NEET is not enough. The academic merit of the candidate must also reckon the services rendered for the common or public good. Having served in rural and difficult areas of the State for one year or above, the incumbent having sacrificed his career by rendering services for providing health care facilities in rural areas, deserve incentive marks to be reckoned for determining merit. Notably, the State Government is posited with the discretion to notify areas in the given State to be remote, tribal or difficult areas. That declaration is made on the basis of decision taken at the highest level; and is applicable for all the beneficial schemes of the State for such areas and not limited to the matter of admissions to Post Graduate Medical Courses. Not even one instance has been brought to our notice to show that some areas which are not remote or difficult areas has been so notified. Suffice it to observe that the mere hypothesis that the State Government may take an improper decision whilst notifying the area as remote and difficult, cannot be the basis to hold that Regulation 9 and in particular 4512/2017, 4526/2017 proviso to Clause (IV) is unreasonable. Considering the above, the inescapable conclusion is that the procedure evolved in Regulation 9 in general and the proviso to Clause (IV) in particular is just, proper and reasonable and also fulfill the test of Article 14 of the Constitution, being in larger public interest. "

62. In the case of Dinesh Singh Chouhan (supra) the Supreme Court while restating the aforesaid and upholding the laudable object and purpose of granting incentive marks and reservation contained in Regulation 9, has upheld the grant of such incentive and reservation in para- 33, which has already been quoted in the preceding paragraphs by taking into consideration the fact that such 4512/2017, 4526/2017 incentive and reservation serves the dual purpose, firstly, it would attract doctors to opt for rural services on account of the fact that they would stand a good chance to get admission in post-graduate degree courses of their choice on account of the incentive marks and secondly, the rural health care units would be benefitted by the services of such doctors who are willing to work in notified rural or difficult areas in the State and, therefore, such a provision in the Regulation subserves larger public interest. The same view has been reiterated by the Supreme Court in case of Dinesh Singh Chouhan (supra) in paragraphs 42 to 44 and it has infact been held in paragraph 44 that having served in rural and difficult areas of the State for one year or above, the incumbent having sacrificed his career by rendering services for providing health care facilities in rural areas, deserves incentive marks to be reckoned for determining merit. From a perusal of paragraph 44 quoted in the earlier part of the judgment, it is further clear that the Supreme Court has also taken into consideration the fact that the regulation has vested the discretion in the State to notify areas as remote/tribal or difficult areas which decision has to be taken at the highest level and is applicable for all the beneficial 4512/2017, 4526/2017 schemes of the State for such areas and is not limited to the matter of admission to the post-graduate courses.

72. In the aforesaid document all kind of health care institutions of the State of M.P. i.e. District hospitals, civil hospitals, community health centres and primary health centres have been separately classified and identified as normal/difficult/most difficult and inaccessible areas. It is however, an admitted fact that under the impugned Rule the benefit of incentives marks and reservation has not been given to all the doctors that have rendered services in the difficult/most difficult and inaccessible areas as mentioned in 4512/2017, 4526/2017 Annexure P/6 but has been confined to only those doctors who have rendered services in the 89 notified tribal sub plan areas even if they have been identified as normal in Annexure P/6. It is also an admitted fact that all the areas identified and enlisted in Annexures P/6 are not included or fall within the areas of the 89 notified tribal sub plan areas and that several of the difficult/most difficult and inaccessible areas identified and enlisted in Annexure P/6, fall outside the area of 89 notified tribal sub plan areas.