The MATCH Monopoly: Evaluating the Medical Residency Antitrust Exemption
2025-05-14
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Source: Congress.gov
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Transcript
Subcommittee will come to order without objection. The chair is authorized to declare recess at any time. Welcome everyone to today's hearing on medical residency antitrust exemption. I will not recognize myself for an opening statement. Before I do that, I want to wave on. We have one member, Mr. Onder, Dr. Onder. who will be waving onto today's hearing. Without objection, Mr. Ronder will be permitted to participate in this hearing to question the witnesses if a member yields him time for that purpose. When America's future doctors apply for residency, they enter a closed market controlled by a single accreditation monopoly. The Accreditation Council for Graduate Medical Education, or ACGME, and the centralized hiring system called the match, quote unquote, the match. Together, those two gatekeepers dictate who trains, where they train, and at what wage. Through mountains of red tape, the ACGME alone decides which programs survive. and how they operate. And because most opportunities are filled through the match, the algorithm wields unrivaled power over resident hiring. 23 years ago, residents tried to challenge this setup under America's antitrust laws. They argued that the ACGME and match and the programs operating under them colluded to restrict slots, limit choice, and keep wages low. But before the case could be heard, Congress kowtowed to the hospital lobby and slid an antitrust exemption for graduate medical resident matching programs into the unrelated pension bills. As a result,
There's no competition now, and it decides the fate of more than 50,000 residents and fellows each year. Applicants cannot negotiate pay. They must accept whatever slot the logarithm hands them or whatever terms they are given. The command and control model eliminates competition and flattens salaries. Last year, the average first-year resident earned just $66,000. That's roughly $60,000 less than a physician assistant or $100,000 less than a nurse practitioner, despite working long hours and holding more advanced credentials. The match monopoly doesn't just pinch paychecks, it worsens the doctor shortage. Each cycle, thousands of graduates fail to match with the program. Last year alone, 8,869 applicants, about one in five were left without a slot. Because every state requires a residency to become a licensed doctor, those unmatched doctors can get a license or board certification. Thus, the match acts as a bottleneck for the training of American physicians precisely when we need more doctors, not fewer. And this oppressive process discourages smart young students from pursuing medical degrees. The squeeze also comes as America's population ages and demands more care. Today, over 77 million people already live in areas with a shortage of primary care doctors. That figure is projected to climb sharply in the years ahead, but as a result of the monopoly power given to the teaching hospitals, our future doctors are not choosing primary care. Instead, they're turning to more specialized medicine, hoping to more quickly recoup their investment with the higher salary of specialized practices like orthopedics, cardiology, and anesthesiology. According to Medscape 2024 Physician Compensation Report, the average salary for a primary care physician in the United States is $277,000.
By contrast, specialists earn an average of over $394,000. This leaves our communities with fewer family doctors, longer wait times, and a decreased level of care. A second choke point is the ACGME's accreditation monopoly. The ACGME is the sole gatekeeper for the residency program approval in the United States. Without its blessing, programs lose access to billions of dollars in Medicare and Medicaid funding. Doctors must graduate from an ACGME accredited program to practice medicine. The organization uses that leverage to impose one-size-fits-all rules that crush community hospitals and rural programs. Many small rural residency programs have closed their doors under the weight of the costly mandates. When programs close, residents lose positions and patients lose access to care. Two decades after Congress granted the carve-out for this system, the market is more conclusive and less competitive than ever. Resident wages are completely stagnant. And America is producing fewer practicing doctors even as demand for affordable, high-quality care grows at a rapid pace. Today's hearing asks a simple question.
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