Cut the Hours, Not the Match. (Guest Editorial)

By Tulenko, Dr. Christina | Clinical Psychiatry News, July 2002 | Go to article overview

Cut the Hours, Not the Match. (Guest Editorial)


Tulenko, Dr. Christina, Clinical Psychiatry News


On May 7, 2002, three residents filed suit on behalf of all residents against the National Residency Match Program, the American Medical Association, the associations representing and regulating residency programs, and a handful of residency programs. The lawsuit claims the defendants have conspired to keep residents' salaries low and work hours high and, by doing so, have violated antitrust laws. The plaintiffs seek enjoinment from violation of antitrust laws, an action that would probably result in dissolution of the match.

Clearly residents' hours must be reduced and pay must be increased. But as a means to this end, the lawsuit has broader and more concerning implications. Elimination of the match would only exacerbate the problems of low resident salaries and excessive resident work hours that the plaintiffs claim to be addressing.

The match is a well-constructed system that successfully places medical students in the residency training programs of their choice. It allows medical students to interview at numerous residency programs, to closely scrutinize each program with plenty of time for comparison, and to create a rank list of their desired placement without time pressure or undue stress. Medical students retain the upper hand in this process and residency programs must sell themselves to students.

If the plaintiffs succeed and the match is dissolved, the climate would completely change. A residency program could extend an offer and demand an immediate response. Students would be pressured to accept the first offer since there is no certainty that other offers would be forthcoming. This would prevent medical students from interviewing with multiple programs and comparing them. Early interviewing would become essential since choice residency slots would fill first. The educational mission of medical school and residency would become progressively corrupted.

In a free-for-all residency interview season, the most desirable residency programs and universities would have unprecedented control. They could easily offer lower salaries while still requiring long hours and would have no difficulty filling with qualified medical students.

The variations in salaries and signing bonuses among residency programs appear contradictory to the plaintiff's claims. Supply and demand concepts are at work. Primary care programs and rural programs offer higher salaries and larger bonuses. Also, community-based programs are well known for requiring less frequent call and offering more perks and moonlighting opportunities. It is naive to believe that medical students do not consider this information when creating a rank list. …

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