A Word From the President

An Unqualified Victory

As I’m sure many of you know by now, the academic medicine community won a huge legal victory on August 12th. On that date, U.S. District Judge Paul L. Friedman dismissed all of the claims in the antitrust lawsuit (Paul Jung, M.D., et al. v. AAMC, et al.) that had been filed over two years ago against the National Resident Matching Program (NRMP), its five organizational sponsors, 29 hospitals and healthcare systems and the Accreditation Council for Graduate Medical Education.

Recall that the lawsuit had alleged a conspiracy, centering on the Match, to deny medical students the opportunity to negotiate their “salary and working conditions” before accepting a residency position. Specifically, the three plaintiffs in the case, all former residents, argued that the Match exists solely “for the 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.”

Convinced that the Match is, in fact, manifestly procompetitive, we and the other defendants in the case appealed to Congress to affirm that the Match is and always has been a lawful activity. Responding to the leadership of Senators Judd Gregg, R-NH, and Edward M. Kennedy, D-Mass., Congress earlier this year passed the “Match provision,” as part of the Pension Funding Equity Act. In the words of the legislation, "it shall not be unlawful under the antitrust laws to sponsor, conduct, or participate in a graduate medical matching program." President Bush signed the pension bill into law last April and the Match provision took effect immediately, applying to all pending judicial and administrative actions.

In issuing his decision, Judge Friedman cited the Match statute as the basis for granting the defendants’ motion to dismiss the plaintiffs’ case. Because the NRMP had, much earlier in the legal process, appealed the denial of its motion to order arbitration and, hence was no longer before the District Court, it is not entirely clear whether Judge Friedman’s ruling applies directly to it. Thus, while all the other defendants were clearly dismissed from the case, the NRMP must await further judicial rulings, which I am confident will be favorable.

Although it’s always possible that the plaintiffs could prolong the agony and force further misallocation of resources by filing an appeal, Judge Friedman’s ruling handed our com-munity an unqualified victory. In his comprehensive and well-written opinion, he noted that the passage of the Match statute was indicative of Congress’s support for the Match, which it found to be an “efficient, valuable placement system.” He went on to say that Congress had sought to “protect the financial resources of teaching hospitals and programs from the cost of antitrust litigation” against the Match and that it was not the court’s role to second guess the reasoning of the legislative branch of government.

What lessons can we learn from this experience? First of all, this victory, like so many others before it, would never have happened without the combined efforts of our members and of virtually the entire academic medicine community. So, we learn yet again that when we speak “With One Voice” (as the title of the AAMC’s recently published history suggests), we can achieve great things. And this victory was truly a great thing, not just for academic medicine but for the entire country. Preserving the Match means that we can keep faith with our students, who pressed hard over fifty years ago for the establishment of a fair, impartial, efficient system to replace the chaotic and patently unfair process that had been in place before then.

I would like to draw attention to another lesson we can learn from this experience, one that may not be so obvious. And that is the importance of remembering that our residents are primarily learners, not employees. Only by keeping that distinction clearly in mind, and more important, only by ensuring that our residents’ educational needs remain paramount in the design and implementation of our residency programs, can we minimize the likelihood that future challenges of this kind will arise. The allegations in the Jung lawsuit were based on the theory that residents are primarily employees and should be treated like any other workers in a commercial marketplace. To the extent that we allow non-educational service needs to drive residency curricula, we foster the misperception that residents are hired to help shoulder the patient care responsibilities of our GME faculty and sponsoring institutions.

We can surely be thankful that this litigation has come to a relatively quick end. But we dare not assume that our current GME practices are now immune from criticism or challenge. We still have a lot of work to do to optimize the educational experiences of our resident trainees and to structure their learning environments and working conditions in accordance with their true status as our most junior and vulnerable professional colleagues.

Jordan J. Cohen, M.D.
AAMC President

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