Matching Program Charged With Violating Antitrust Law

For future doctors, the resident matching program is an expected—if sometimes dreaded—part of the right of passage to becoming a medical specialist. If three young physicians succeed in a recently filed legal challenge to the match program, medical students may eventually face a far different system when they arrange their residencies.

Last month Paul Jung, M.D., a research fellow at Johns Hopkins University in Baltimore, along with residents Luis Llerena, M.D., of Orlando, Fla., and Denise Greene, M.D., of Rancho Cordova, Calif., filed a class-action suit in federal court alleging that the national matching program is so anticompetitive that it violates federal antitrust law.

The National Resident Matching Program exists, they charge, “for the sole purpose of illegally restraining trade by eliminating competition in the recruitment and employment of resident physicians by assigning prospective resident physician employees to medical residency positions.”

It does so, the plaintiffs charge, through a system in which hospitals and other residency training programs conspire to force residents to work very long hours for very low pay. They do this by sharing salary data and other employment terms, the suit alleges, and “by establishing and complying with” rules of the Accreditation Council for Graduate Medical Education (ACGME) that stifle competition among the programs and the residents.

With the vast majority of graduates from U.S. medical schools landing residency positions through the match program, and more than 80 percent of residencies listing training slots through the match, the program exerts considerable influence over graduates’ residency choice. In 2002 about 23,400 medical school seniors entered the match, and about 18,400 found positions through it (Psychiatric News, May 3).

Once a resident-to-be is matched with a position, he or she cannot choose another position or apply through the match program again.

According to the Association of American Medical Colleges (AAMC), which cosponsors and conducts the resident matching program, most first-year residents earn salaries of less than $40,000 for their 80- to 90-hour workweeks. Their salaries increase slowly during succeeding years. The other cosponsoring organizations are the American Board of Medical Specialties (ABMS), AMA, American Hospital Association (AHA), and Council of Medical Specialty Societies (CMSS).

The plaintiffs maintain that the goal in establishing the national match program was to stifle competition. In 1952 the hospitals that employed residents realized that “continuation of free competition in recruiting, hiring, employing, and compensating resident physicians was undesirable because the number of available residency positions outpaced the number of available candidates. . . . Creating the matching program enabled employers to obtain resident physicians without a bidding war, thereby artificially fixing, depressing, standardizing, and stabilizing compensation. . . .”

Those salaries and the absence of opportunities for residents to negotiate them and working conditions with the hospitals that employ them are the crux of the suit, which was filed May 7 in U.S. District Court for the District of Columbia.

The three residents are suing much of the medical-education establishment, including the AAMC, National Resident Matching Program, ACGME, AMA, AHA, ABMS, CMSS, and 29 large hospitals that employ resident physicians.

They are suing for unspecified monetary damages and injunctive relief on behalf of themselves and all residents and fellows employed in ACGME-accredited programs since May 7, 1998. If the court certifies this suit as a class action, it could include more than 200,000 physicians.

Jung and his colleagues believe that federal antitrust charges are warranted because the activities that they allege caused the restraint-of-trade practices affect interstate commerce, a criterion that must be met before federal charges can be brought. The defendants, the suit says, exchange information via interstate telecommunications networks, “induce residents to cross state lines to interview for and accept employment positions,” and obtain “millions of dollars in payments and funding from out-of-state sources. . . .”

The AAMC does not believe the charges have any merit and has vowed to fight the suit “with the utmost vigor.”

“The AAMC knows that [the match] program provides a valuable public service that helps maintain the high quality of physician training in the United States,” said AAMC President Jordan Cohen, M.D., in a press release issued soon after the suit was filed. “By ensuring a smooth transition from medical school to residency, the National Resident Matching Program is an important link in the continuum of medical education.”

Deborah Hales, M.D., director of APA’s Department of Education and Career Development and a former residency training director, agrees with the AAMC that the match is a valuable process. It has for many years resulted in the “fair and orderly assignment of medical students to residency programs,” she told Psychiatric News. “Each year, because of the match, there is minimal disruption to patient-care activities during this time of transition,” when medical students become resident physicians. Patient care, she added, is not just a “business” and should not be treated as such.

The National Resident Matching Program said in a May 9 statement that it “categorically denies that it illegally restrains trade or is engaged in any wrongdoing in the matching of prospective residents to residency programs.”

[Paul Jung, M.D., et al., v. Association of American Medical Colleges, et al., filed in U.S. District Court for the District of Columbia.] ▪