House Judiciary Report Exposes Medical Residency Hiring Monopoly
“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.”
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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The cost of health insurance is increased by the cost of healthcare, which is increased by the gigantic hospital lobby.
Once you get rid of the match program, the next thing to tackle is board recertification every 10 years
Almost all hospitals require you to be board certified, and this recertification system is a huge money maker for the various American boards of anesthesia, cardiology, dermatology, etc.
The questions on the exams have very little or nothing to do with every day practice and keeping up your medical education
And everything to do with making you take their courses so that you can know the answers to the obscure questions and are forced to take their continuing education courses.
Competing boards shove created if continuing recertification is going to be required
( which should not be required at all)
The promise of the Match was that every med students got the highest choice (not the top but the best that they could get) on their list of applications and the same for the residency programs. For those that didn’t match, I am uncertain about today…. but in the past that required each student calling up the programs that didn’t fully match and see if anything was available. Not matching was considered as being not a good candidate or that the programs were bad, extremely tough or abusive. All of this promised a pathway, but with it came total control. What? Do we unionize med students? Unions for internal med applicants, unions for surgery applicants? Ugh.
Full disclosure: I didn’t match. I didn’t inform the surgery department of my university….and my mentors within the department of this…shell shock and “shame”. They did not take their own med students as they felt it was being too inbred. That said, I found an internship at a not fully matched program…quasi-begging. When I eventually was asked how I matched…. they were shocked and said that if they had known, they would have kept me. Tough uphill for a while. But wound up chief resident and later assistant professor at another major university…before private practice. It’s a challenge as it is…. having a monopoly with the fix in…. not good.
thx. My daughter is at the front end of planning her career.
Local high school has a program with Ballad Health which gets them to nurse status by the time they graduate high school and this path is encouraged for those wanting to become Dr as well.
Along with dual enrollment this seems pretty good. So looks like we’ll be footing 2 years of BS degree and then med school. I am hoping she stays local for residency and can capitalize on living at home. Lots of focus needed before this is a reality, but watching the politics of residency and med school a lot between now and then.
I think TN has a residency path the encourages supporting rural areas- not sure how that plays into the monopoly match status.
There are many rural residencies available, especially in the south, but many of those are considered “leftovers” and aren’t considered desirable.
Hopefully times have changed. In years past, anyone with nursing background was trashed by med schools. Anyone over 26, any allied healthcare history….all excluded. Unless your parents found $50k for donation or parent an alumnus. That is why UW was so good… Nurses, over 26…those qualified were accepted.
In some Med Schools people who don’t match stay an extra year and take rotations that will make them more “qualified” for the area that they want to match. Then they go through the Match process a second time. I don’t think I have heard of anyone not matching after the 2nd go round.
Seriously, Bob, I was a full professor’s grandkid. My trouble was that I was in-state from a “home state” perspective, but I went to an out of state school undergrad. I had a reverse problem-they wondered why I didn’t go to UTAustin, or Texas Tech, or A&M, or wherever in Texas. I went to Hillsdale. I did the MSTP, so my residency/fellowship(s) were built-in, but if I were to do it over again: NO WAY. Cries of “Nepo-baby” were all over the place, even though my granddad retired a decade earlier and nobody knew him except the older profs. Didn’t help anyway.
I’m all for ditching to money grab of the recertification process. In one of my specialties, the test becomes so stilted … each little sub-specialty wanting “got-chas” in the test.
My grandfather was, and no pun intended, “grandfathered” into his dual boards in psych/neurology. He only had to go MOC on his electrophysiology sub-board every so many years. I’m internal med, infectious diseases, and critical care. These MOC costs and the time commitments are killing me. I just don’t know why we bother, except to enrich ABMS and their AMA-like monopoly.
A Monopoly by any other name……
Every time the Dhimmi-crats get involved in the healthcare system (or, in anything else, for that matter), they make it more onerous, more inefficient, more expensive and less competent/effective. An axiom as immutable and as predictable as any law of physics.
government takes over>>>higher costs>>less quality of care>>more public sector unions>>>middle class toppled
Imagine the disparate impact on the chilluns, and the trans and the LGBTQEIEIO peoples.
So Republicans are today’s trust-busters.
My, how the Democrats (“progressives”) have fallen.
The d/prog coalition and their corporatist (faux capitalist) allies love them some big organizations and entities. Much easier for their allies in the permanent bureaucracy to ‘regulate’ and far easier for their big labor allies to unionize. The ‘professional’ certification racket benefits as well. Big govt gets its taxes and it is easier to impose regulations (usually drafted by big players being regulated to harm their smaller competitors) big Unions get dues, the bureaucracy is happy b/c their job is easier, the Politicians are happy b/c they get donations.
You forgot regulatory capture.
Thought I addressed that by describing how big corporations use regulations and bureaucracy to stifle smaller competitors., but yes absolutely regulatory capture is a component of the faux capitalist system.
Not a medical person – closest is having a few nurses in the family. But overwork and abusive working conditions for residents has been widely known about for generations. Read “Making of a Surgeon” or other alto-biographical books for a peek.
Current system encourages OTJ training of doctor graduates where they practice medicine while sleep-deprived – because supposedly that Trial By Fire using fake emergency / crisis conditions trains them for actual emergency / crisis conditions better.
Ask yourself – in a life v death situation do you want your treatment done by a doc who’s had (say) 4 hours of uninterrupted sleep in the last 48 hours?
Worse, they are blatantly discriminating against US citizens in favor of foreigners nationwide.
In 2024, roughly 9,500 doctors, US citizens, did not get residencies – but foreigners did.
A lawsuit was filed on this yesterday.
“Three internal medicine residency programs are being accused of favoring foreign-trained doctors over American-trained doctors, with more than 90% of the most recent cohort of residents across the three programs coming from overseas, according to a civil rights complaint.”
Its bad enough that even lefty outlets like “newsweek” are covering it:
https://www.newsweek.com/there-are-limited-spots-doctors-medical-schools-were-giving-them-away-foreigners-opinion-1789324
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