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Three US doctors have filed a lawsuit calling for changes in the 50 year old system that determines where medical school graduates spend their residencies. They claim that the present system is monopolistic and anticompetitive and results in residents working long hours for artificially depressed pay.

The lawsuit asks for class action status, which if granted would put the number of plaintiffs at more than 200 000. It names as defendants the National Residency Matching Program and the medical organisations and hospitals that support it. Michael Freed, a Chicago attorney who supports the case, says the system “puts patient care at risk and is clearly unfair to resident physicians.”

But Dr David Aron, associate chief of staff for education at the Louis Stokes Cleveland Department of Veterans Affairs Medical Center, says its elimination could make enormous difficulties for medical centres that already have trouble hiring residents. It would also cause problems for primary care, internal medicine, and family practice, he said.

The “Match,” as the system is called, makes mandatory matches between the preferences of senior year medical students and those of directors of the institutions with openings.

The lawsuit contends that this process deprives residents of the ability to negotiate employment terms and allows their wages to be kept below market value. Residents currently work 60-100 hours a week on shifts of 36-48 hours for an average annual salary of $40 000 (£28 000; €44 000). This works out at about $10 an hour—less than the pay of nurse practitioners and physician assistants, the suit alleges.

It also claims that hospitals regularly exchange detailed information on salary and benefits to keep resident compensation roughly the same nationwide.

The programme denies that it illegally restricts trade or is engaged in wrongdoing in matching prospective residents to residencies. Dr David Webster, a healthcare consultant, told an online newspaper for US doctors (http://amednews.comamednews.com) that residents trade off longer hours and low pay for higher wages later.

Residents benefit from a restricted supply of entrants to the system, he says. If this ceased, high quality candidates could negotiate higher salaries and healthcare providers and hospitals would arrange unrestricted entry into the medical profession.

“Ultimately, there’d be more competition among physicians later in their career, and their wages would be lower later on,” Dr Webster says.

Dr Aron says that shorter working hours for residents could reduce errors from fatigue but that more errors are likely to be caused by an increased number of doctors dealing with patients.

Dr Michael Reichgott, associate dean of clinical affairs and graduate medical education at the Albert Einstein College of Medicine for Yeshiva University, Bronx, New York, says that by making all its offers at the same time the Match helps potential residents avoid the stress caused by a number of hospitals demanding quick decisions at different times.

• Spurgeon, D.

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