Vanderbilt Law Review

First Page



People outside the medical profession have likely heard of the long hours that doctors keep, but are probably unaware of the low salaries and nonnegotiable contracts that medical school graduates must accept upon entering a residency program. In fact, young doctors are among the few professionals who do not find postgraduate employment in the open job market. Currently, fourth-year medical students seeking postgraduate residency training participate in a process that matches them to a single residency program. This match dictates where the new doctor will spend the next three to seven years of her career. Upon receiving a match, the doctor must enter the particular program. This system has been in place for over fifty years without any significant challenges. But, does the matching process actually work well, or have residents simply failed to consider whether they had any other choice?

In May of 2002, a group of former medical residents filed a class action lawsuit alleging that the National Resident Matching Program (NRMP or the Match) illegally prevents residents from enjoying competitive compensation and employment terms. The case, Jung v. Association of American Medical Colleges, which has been consolidated as In re Resident Physicians Antitrust Litigation, spotlights the heated issue of how medical residents are treated on the job and how the medical community should be treated under the law. The outcome of the case has far-reaching implications both for all United States medical residency programs and for United States graduate medical education. Much has been written about resident working hours, leading to recent notable reforms. For the first time, however, Jung opens the door to discussion about resident remuneration and the legality of a binding employment process unique to the medical profession. This controversial case has polarized members of the medical community. In part, the controversy represents a power struggle between the medical establishment and young doctors-in-training.

The central issue in Jung is whether the current system violates antitrust laws by depressing medical resident wages below fair market value. This Note contends that it does and advocates facilitating competition by providing a limited number of matches from which residents may choose. With the proposed reforms, the resident placement process will not only better serve the needs of both residents and programs but will comply with antitrust laws. This Note examines where medical resident placement has been, where it is now, and where it should go. Part II explains the mechanics of graduate medical education and then discusses the NRMP and how it facilitates student placement. Part III documents the chronological development of residents' efforts to improve their working conditions. Part IV analyzes the relevant antitrust principles governing the Jung case.