Senate Judiciary Committee calls out ‘monopoly’ on medical resident matching 

Senate Judiciary Committee calls out ‘monopoly’ on medical resident matching 

In a report released Friday, the Senate Judiciary Committee found that the U.S. system for matching resident physicians to programs is monopolistic and anticompetitive. 

Every year, resident physicians in the U.S. learn which program they’ve been placed in. This is operated through the National Resident Matching Program (NRMP), commonly referred to as the “Match.” 

The Senate Judiciary Committee determined in its investigation that the way residency programs are matched is the result of an “entrenched monopoly shielded from scrutiny by government protectionism.” 

The committee held a hearing on this issue last year in which expert witnesses told lawmakers that the Match was overly burdensome on graduating medical students.

A rider attached to the Pension Funding Equity Act of 2004, lobbied for by the Association of American Medical Colleges and the American Hospital Association, explicitly protects graduate medical education residency matching programs against antitrust litigation at both the state and federal level.

This monopoly, in place for more than 70 years, is causing detrimental effects on early-career physicians according to the Senate Judiciary’s report. 

“Real resident wages were higher in 1971 than they were in 2024. On average, residents make significantly less than their fully licensed physician counterparts, even though their job duties are nearly identical, and half as much as both nurse practitioners and physician assistants, despite holding more advanced degrees,” noted the report. 

“Additionally, incidents of ‘physical, sexual, and emotional abuse are common and gender and racial discrimination are rampant,’ but residents effectively cannot switch jobs because of the Match’s rules.” 

The committee found that the Match prevents residents from being able to negotiate employment terms and tamps down on career flexibility. 

The report did not include suggested actions to change this situation, but the committee indicated it will maintain continued oversight to inform future legislative reforms. 

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