The Indian medical education system faces complex challenges arising from social inequities, reservation policies, and merit-based entrance examinations. The National Eligibility cum Entrance Test (NEET) serves as a standardized gateway for medical admissions; however, its implementation has highlighted disparities in access and outcomes. Reserved categories, including Scheduled Castes (SC), Scheduled Tribes (ST), Other Backward Classes (OBC), Economically Weaker Sections (EWS), and Persons with Disabilities (PwD), benefit from affirmative action policies, providing quota-based opportunities in both state and All India Quota (AIQ) seats. Despite these provisions, students from disadvantaged socio-economic backgrounds often face barriers due to unequal schooling, limited access to coaching, and high competition, which impacts their medical career progression. Social determinants of health (SDH), encompassing conditions in which individuals are born, grow, live, and work, significantly influence both the distribution of healthcare professionals and health outcomes. Studies indicate that SDH can contribute to over half of health outcomes, underscoring the need for inclusive policies in medical education. Affirmative action programs, modeled globally and in India, aim to improve social representativeness among healthcare professionals, particularly physicians. Furthermore, geographical disparities in medical college distribution exacerbate healthcare inequities, with rural, tribal, and remote areas underserved. Policy interventions, including district-level medical colleges and NEET reforms, seek to mitigate these gaps while maintaining minimum competency standards. Understanding the intersection of reservation policies, SDH, and medical education is essential for creating equitable and effective healthcare delivery systems in India.