Last week, the House Judiciary Committee released a report detailing monopolistic practices in the Medical Residency hiring process. The investigation found that the “Match” placement system harms residents, impedes access to medical care, and places constraints on the workforce.
“Through this oversight, the Committee and Subcommittee have uncovered evidence that the ‘Match,’ a placement system for resident physicians, operated by the National Resident Matching Program (NRMP), exercises monopolistic control over America’s medical residency market, resulting in anticompetitive conduct and burdensome restraints on medical residents,” reads the report.
On March 14, 2025, the Committee opened the investigation into “anticompetitive conduct and monopoly power” within the medical residency program. After reviewing more than 1,580 documents from five standard-setting organizations, interviewing doctors, and assessing the impact on patients, the Committee concluded that the program caused serious harm.
“Medical institutions created the Match to eliminate competition in the residency hiring market,” reads the House Judiciary press release.
“The Match achieved its monopolistic power over the residency market by instituting an ‘All In’ policy that requires Match-participating residency programs to register and fill all positions through the Match or another national matching plan, and then merging with its largest competitor.”
Because of this uncompetitive market, residents lack the usual opportunities to negotiate the terms of a position that are standard in many jobs. According to the report, once a resident is ‘matched,’ they are stripped of negotiation rights and often face poor working conditions.
“As a result, residents are forced to accept low salaries and endure long hours and poor working conditions without a meaningful opportunity to obtain new employment…At the same time, residents suffer from widespread discrimination and abuse as well as alarmingly high rates of suicide and depression.”
The report’s conclusion urges a prompt review of the “Match” system to determine whether a repeal would be necessary to restore competition in the residency job market. The process is currently protected by an antitrust exemption, but the Committee notes that Congress has the authority to overturn it.
“The Committee will continue to conduct its oversight to inform potential legislative reforms that could help restore competition in the medical residency market and relieve the bottleneck that contributes to America’s growing physician shortage.”
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