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AAMC Strives for Improved AMCAS Residents' Lawsuit Takes Aim at the NRMP Confronting "Unequal Treatment"
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Residents' Lawsuit Takes Aim at the NRMPEvery year since 1952, the National Resident Matching Program (NRMP), managed by the AAMC, has conducted an annual spring rite of passage essential to the training of newly minted M.D.'s: successfully matching medical school graduates and physicians with the residency programs they choose to complete their training. But in its 50th year, this mainstay of the U.S. medical system faces a new challenge. On May 7, three physicians filed suit against the NRMP, the Accreditation Council for Graduate Medical Education (ACGME), and the Match's five joint sponsors: the AAMC, the American Medical Association, the American Hospital Association, the American Board of Medical Specialties, and the Council of Medical Specialty Societies. Also named were 29 hospitals and health care systems. The suit charges that the "Match" and activities related to it are anti-competitive and thus a violation of anti-trust laws. Seeking unspecified damages, the plaintiffs allege that the defendants "all have contracted, combined, and conspired to restrain competition in the recruitment, hiring, employment, and compensation of resident physicians, and to fix, depress, standardize, and stabilize compensation for resident physicians and to impair other terms of their employment." In its specific complaint against the NRMP, the suit alleges that the program "exists 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." The three principal plaintiffs, doctors from Maryland, Florida, and California, asked the U.S. District Court in Washington, D.C., to grant them class-action status, which they claim could swell the number of plaintiffs to more than 200,000 current and former resident physicians who have participated in the Match since May 1998. Members of the academic medicine community were swift to respond to the suit's charges, maintaining that the Match was in fact established to ensure fair competition among medical school graduates and physicians for available residencies by setting a common date on which new residents and resident programs find out who is matched where. Medical students in their fourth year are encouraged to interview with various residency programs and accordingly rank them in order of their preference; residency programs in turn get the opportunity to rank the students they prefer. Through a mathematical algorithm, the NRMP matches students and programs based on the "Rank Order Lists" both of them submit to the program. Before the Match was established, students were often pressured into making early commitments to hospitals without knowing whether a more desirable position would be offered later. Jack Gladstein, M.D., associate dean for student affairs at the University of Maryland School of Medicine, alma mater of one of the plaintiffs, was quoted in the Baltimore Sun as affirming that the Match "levels the playing field. It makes everything fair. … Before the Match, there were deals made under the table. People were picked based on who they knew. If you destroy the Match, you're going to Neanderthal times." Alvin Roth, Ph.D., an economics professor at Harvard University who helped refine the algorithm used by the NRMP in 1997, agrees that the pre-Match system amounted to little more than "chaos." He told The Chronicle of Higher Education, "The Match is actually pro-competitive because it allows all of residents' preferences to be considered." Roth added in his comments to Modern Physician that doctors complete their education during residency, putting them in a different category than other employees. "Think of residency training as another stage in their education," he said. Consulted by The New York Times, Kevin Jon Williams, M.D., a professor of medicine at Thomas Jefferson University, agreed with Dr. Roth. "It's not exactly a job," he said of residencies, "It's a continuation of a medical education." Hospitals named as defendants in the suit were also quick to defend themselves against accusations of conspiring to control residents' wages. "We don't talk to other hospitals; there aren't secret meetings or secret handshakes," said Richard Schwartzstein, M.D., director of graduate education at Beth Israel Deaconess Medical Center, one of the 29 hospitals named as defendants in the suit. In his comments to The Boston Globe, Dr. Schwartzstein emphasized that his institution "absolutely does not" conspire with other hospitals to set salaries or collude to depress wages. The NRMP itself released a statement in which it "categorically denies that it illegally restrains trade or is engaged in any wrongdoing in the matching of prospective residents to residency programs." In another statement released in the wake of the unprecedented lawsuit, AAMC President Jordan J. Cohen, M.D., stressed the "valuable public service" provided by the Match and its role in maintaining "the high quality of physician training in the United States." "The Match is an orderly system that helps both students and health care institutions find the best fit between professional aspirations and educational opportunities, respectively. The AAMC believes the NRMP, as well as the Accreditation Council for Graduate Medical Education (ACGME), are crucial components of America's medical education system, which is acknowledged to be the best in the world," declared Dr. Cohen. "We intend to challenge this lawsuit with the utmost vigor." |
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