Mass. Medical Students Weigh-In on Residency Match Lawsuit

As the antitrust case against the National Resident Matching Program (NRMP) labors through the legal system, Massachusetts medical students and residents seem unsure of the case's merits.

"This lawsuit has sparked a very serious debate within the Medical Student Section. Most agree that it is a wise idea to reexamine the entire match process, but a lawsuit is not the appropriate means to an end," explained Trish Kavanagh, chair of the MMS Medical Student Section Governing Council and fourth-year medical student at Boston University School of Medicine.

The case, filed by three resident physicians in May, seeks to eliminate NRMP. They claim that the program allows hospitals and medical organizations to illegally share salary information and set wages below competitive levels. It also charges that the system conspires to deprive medical students of any choice of where they will work as residents and compels them to endure unreasonable working conditions.

Uncertain Outcome
While medical students do not relish the long hours and low salaries typical of residency programs, those active in the Medical Society do not necessarily believe the antitrust case will effect change. In fact, most fourth-year students are relieved that they have the match program to assist them in obtaining a residency.

"Look at law students. They don't have a match, so instead they have to endure months of gaming to get their clerkships. I don't think anybody wants to go back to that kind of system," said Mark Friedberg, a fourth-year student at Harvard Medical School and an MMS Medical Student Section Governing Councilor.

Prior to the NRMP, some medical students were forced to commit to residency positions as early as their second year of medical school.

Additionally, students seem skeptical about the accuracy of the charges being made. "Salary is only one small part of resident compensation. The much larger part is the valuable training residents obtain," said Friedberg. "If you factor in doctors' high lifetime earnings, it's not at all clear that residents are undercompensated. And that doesn't even include the nonfinancial rewards of being a doctor."

Who Wins?
The lawsuit seeks class action status. If granted, all residents enrolled in ACGME-accredited residency programs and subspecialty fellowships since 1998 -- approximately 200,000 people -- would be eligible to participate. The plaintiffs are seeking monetary damages and an injunction on the program. The defendants include the Association of American Medical Colleges, NRMP, the American Medical Association and the American Hospital Association. The suit also names numerous institutions, including Beth Israel Deaconess Medical Center, Boston Medical Center and Massachusetts General Hospital as defendants.

If the plaintiffs prevail, they will be eligible for treble damages under antitrust regulations. This potential outcome, and the resulting financial implications, also raises concerns among students and residents.

"The law firms stand to gain the most out of a successful lawsuit against the match -- far more than individual physicians," said Gregory Previte, MSS vice chair and a third-year medical student at the University of Massachusetts Medical School. "If the match program is dismantled, it could have significant impact on the field of medicine, but I'm not sure that it would be good for residents or our patients."

- Emily R. Hopkins