Time to Enter a 'Do Not Resuscitate' Order on the National Resident Matching Program's Chart

Abstract

This article focuses on the NRMP system and argues that the process is neither efficient nor pro-competitive. This article argues that Congress erred in bestowing an antitrust exemption on the NRMP and the participating institutions.

This article suggests that although the system may have been necessary to check the problem of early recruiting that was pervasive in the 1950s (similar to the one that plagued the federal judiciary until just two years ago), the system has outlived its usefulness. Part II will explain the Match's history and function and will discuss how the system makes participation in the Match inevitable and required. Part III will focus on the economic analysis of the system. It will argue that the Match abolishes the students' ability to bargain by preventing students from receiving several offers of employment. This section will explain that although the student participating in the Match may receive his most preferred choice, his lack of ability to negotiate salary and benefits precludes him from making a proper judgment as to which choice he truly most prefers. Part III will also analyze the procompetitive justifications put forth by the Match proponents and will conclude that these stated benefits are ephemeral.

Part IV will focus on the analysis of relevant case law. The caselaw is useful to this analysis, even though it is moot in light of the Pension Funding Equity Act of 2004, as it suggests that the NRMP's conduct has been viewed as anticompetitive for quite some time, notwithstanding congressional findings. In the next part, the article examines several alternatives to the NRMP and concludes that a free market system, limited only by defined dates of entry and exit from the market, is the appropriate mechanism by which medical students should select their residencies. This part argues that other systems, such as allowing students to match into multiple places only alleviate, but do not solve, the problem raised by Part III. Further, Part V argues that any system other than the free market will wreak havoc on the residency programs by potentially causing them to over-or under-enroll residents. The article's conclusion is in Part VI.

Keywords: medical education, residency, NRMP, National Resident Matching Program, suppression of wages, litigation, Pension Funding Equity Act of 2004, antitrust exemption, medical students, internship

JEL Classification: I18, I19, I21, I28, I29, K19, K29, K32, K49