Sunday, March 14, 2004

Will fall on Wednesday (sorry,Thursday actually, eds.)this year. Not St. Patrick's day (the most important day of the year for some) but the annual day of medical student anxiety, where some will laugh and some will cry, many will get intoxicated for reasons good and bad, I am referring of course to Match Day. Match day at my medical school was a grand affair with all of the class assembling in the main lecture hall with the Dean of Students solemnly calling our names in alphabetical order. At least we didn't have to open the envelopes and read it out in front of everybody as had been done in the past, and is still done at some schools, I have heard. Of course the rumors had been floating around about who had gotten a call from the Dean's office on Black Monday, and sent Tuesday in the Scramble.
This will be the second year that the Match has been conducted while the NRMP has been fighting a lawsuit alleging that the Match violates anti-trust laws and artificially holds down the wages of residents. The NRMP has, of course, denied this and the suit has been going on for about two years now. Db posted on this a few months ago, and I thought it would be a good thing to revisit the issue given the proximity of Match Day.
Both the NRMP and the plaintiffs in the Match lawsuit have websites up which makes for interesting reading..
The NRMP has their "Save the Match" site which lays out their case for keeping the match as it is. The section of the site describing the bad old days before the match give the picture of a chaotic system under which applicants and programs were not well served. The NRMP claims that their program is fair and free of bias. I will give them credit for bringing order to a disorganized system and eliminating the abuses that had some medical students accepting internship positions as early as their second year. The claim that the match eliminates the "old boy's network" I find difficult to accept, as far as surgery goes. I had faculty of my school make phone calls for me and others would say, "Dr. So-and-so called me from State U., how did your interview go?"
The plaintiff's site RESIDENT PHYSICIANS' ANTI-TRUST CLASS-ACTION in my opinion does not do as good of a job at making their case. They allege that the current system artificially depresses wages and enforces dangerous work-hour requirements (a moot point with the new work-hour restrictions in place). The plaintiffs also allege that the Match is discriminatory against minorities and women. They blame this on bias felt to be in the computer system itself, as well as the fact, to quote:

The NRMP was designed and implemented during an era in which large segments of society were not only insensitive to racial issues but intent on preserving racial divides. The NRMP predates even the true awakening of racial issues in the 1960's. It is not unreasonable to believe that the designers of the match were not cognizant of how it
might impede the opportunity of minorities in medicine.

They opine that these circumstances are ongoing today because the programs are able to hide their discrimination by claiming "the machines did it":

The match provides a ready-made excuse for such hospitals and specialties to conceal discrimination; they can blame the distorted ethnic composition of their incoming residents on vagaries of a computer assignment and absolve themselves of responsibility.

They also view the Match as an impediment to a remedy for discrimination since programs cannot hire minority candidates outside the Match. Given that women now outnumber men in medical school classes, the sexism argument may no longer apply. I am very wary of any attempt to promulgate social engineering through medical residency slots. The plaintiffs put forth a system they call the Voluntary Match in which programs may split their slots between Match and non-match. I can understand their point about the pressure on applicants to hedge their bets and apply to many programs because of the nature of the Match. This can be an expensive endeavor for students who embark on multiple interviews (1/03). But a return to the "free agent" market could lead to more "corruption" today than existed in the pre-match era. The heavy Medicare funding in graduate medical education today, that did not exist in 1952 would create a strong financial incentive to ensure their program filled. This could lead to programs to ignore any voluntary deadlines and limitations in effect.
I welcome your comments and your own match experiences.
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