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Antitrust probe into the residency match.
House Investigating the Match
- Thread starter WildWing
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Too late for me but if this results in residents getting paid more then great. But I have no clue what this committee is bringing up as a gripe against the system.
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The article cites the physician shortage as the driver - that the Match artificially constrains supply.
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Which is a little insane of a thought process. And shows that those initiating this don’t understand medical training pathways or their importance.
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I agree.
If Congress wanted to address the physician shortage, a good first step is indexing Medicare physician reimbursement rates to inflation, which are now 33% lower than they were in the early 2000's. Yet hospital reimbursement is tied to inflation.
It's a wonder that we still have any independent physician practices left over. Without changes, the only independent physicians we'll see in our lifetime will be hospital-based docs/groups (low overhead), high-grossing specialties/cash pay practices, and perhaps those who were savy enough to purchase the property their outpatient practice building sits on.
A lot of docs are just retiring early instead of selling their practice or put up with burnout.
While I didn't vote for Trump, I was hopeful that maybe Musk would make things more efficient/get rid of a lot of the regulations that also contribute to burnout. But instead he seems to just have started a large bonfire in the dumpster out back.
We at least got our act together to increase medical school seats. But as we all know, all that really results in is pushing out IMG/FMGs since the residency cap is the issue. So I guess perhaps that cap on residency funding should be the first thing to address. Medicare reimbursement second.
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By extrapolation, I suspect residency funding is going to be cut like everything else, given the cuts to academic medical center research and ancillary funding. And then it will be suggested that the free market will take care of the physician shortage by paying residents even less.
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The politician's premise “For years, resident wages have remained stagnant while doctor shortages have increased,” U.S. Representative Scott Fitzgerald, R-Wisconsin, said in a statement. “This harms medical students and hospital patients, and forces us to rely on foreign talent to fill the gap.”
is faulty - it's not low resident wages that are responsible for the doctor shortage, it's maldistribution of doctors because so many young doctors want to live in metro areas only. Residencies are the necessary step to train doctors to enter the community. Spending a bunch of money to "investigate price fixing of wages" is nonsense.
is faulty - it's not low resident wages that are responsible for the doctor shortage, it's maldistribution of doctors because so many young doctors want to live in metro areas only. Residencies are the necessary step to train doctors to enter the community. Spending a bunch of money to "investigate price fixing of wages" is nonsense.
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I agree that's the likely outcome. Even if by miracle residency funding isn't cut, I'm sure medical centers will need to move funds around from somewhere.
Another possible outcome is to let residents bill just like PA/NPs. I could see hospitals lobbying for that if residency funds are cut. Whether that's actually a good thing for the resident is unclear, as I'm sure that would result in more exploitation of the resident and less focus on education (which some programs already do). And who knows if hospitals would actually pay the resident more.
Personally I think the current system is ''ok." But residents should be paid more--especially senior residents. If not, the government should go back to classifying residents as students and provide more lenient tax/loan benefits.
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The wheel of time turns, and ages come and pass. What was, will be again, and what is, will be again. Ages come and pass, leaving memories that become legend. Legend fades to myth, and even myth is long forgotten when the Age that gave it birth comes again.
This sounds like a re-hash of the initial lawsuit. It makes no sense at all.
The physician shortage has nothing to do with the match at all. Whether there is a shortage at all, vs a maldistribution, is debatable. And if the issue is "all the baby boomers retiring" -- well that may cause a surge of patients, but once they all pass on, we'd then have a glut of doctors. And whether we're training the right mix of generalists / specialists is anyone's guess. And last is the complex question of whether primary care should be delivered by physicians, or someone else.
The residency cap is often brought up as a block on more spots. But, if a community hospital opens a new residency program, that bypasses the cap and generates new funding. The cap prevents established programs from growing. But perhaps what we need, if we want more PCP's in underserved areas, is more training programs in those areas. And the cap doesn't impact that at all -- no new laws need to be passed.
The statement "physician salaries have been on the rise but residents have remained stagnant" is inaccurate. Resident salaries have certainly increased. As already mentioned, physician payments have decreased over time. Whether salaries have outpaced inflation I can't say.
And the match doesn't depress resident salaries. All programs must publish their salaries prior to the match, and residents are free to choose programs with higher salaries or better benefit packages if they wish. Even without a match, residents will not be in any position to try to demand higher pay "or I'll just go elsewhere".
It remains an open question about whether resident salaries are too low. Some residents bring great value to their programs in the form of coverage, and often the costs of replacing those residents are used as a metric to assess whether their salary is fair or not. But in some programs that doesn't really hold true -- we have a 1 resident / 1 intern team with 10 patients, or a 1 resident / 2 intern team with 14-16 patients. Each team has a single faculty supervising. Should all those residents disappear, the faculty would just care for the patients alone. We already have non-teaching teams that are faculty only, so this wouldn't be any different than what we already do (although I certainly admit that working with residents is more fun than working on my own). Same with night coverage -- we have night floats at night, but also faculty and NP/PA's at night covering our non-teaching service, and the teaching service is much smaller than the non teaching service. And then our residnts have a good amount of elective time -- which generates no income for the hospital at all. So for sure there are some programs / institutions where resident services are critical to operations, and there are some where they are not. (All of this ignores the CMS payments, which certainly help hospital bottom lines).
Don't get me wrong - I strongly support residents and their well being. I'd love to have their pay increase. They do good work, and work hard. But resident salaries are more driven by the gatekeeping function of training (you can't get a job as a physician without completing a residency) and the difficulty in switching programs. These distort the free market - and I don't see an easy solution to address that. Other than some regulatory / central price fixing (which seems problematic), or allowing a national union for residents (which has it's own set of problems).
This sounds like a re-hash of the initial lawsuit. It makes no sense at all.
The physician shortage has nothing to do with the match at all. Whether there is a shortage at all, vs a maldistribution, is debatable. And if the issue is "all the baby boomers retiring" -- well that may cause a surge of patients, but once they all pass on, we'd then have a glut of doctors. And whether we're training the right mix of generalists / specialists is anyone's guess. And last is the complex question of whether primary care should be delivered by physicians, or someone else.
The residency cap is often brought up as a block on more spots. But, if a community hospital opens a new residency program, that bypasses the cap and generates new funding. The cap prevents established programs from growing. But perhaps what we need, if we want more PCP's in underserved areas, is more training programs in those areas. And the cap doesn't impact that at all -- no new laws need to be passed.
The statement "physician salaries have been on the rise but residents have remained stagnant" is inaccurate. Resident salaries have certainly increased. As already mentioned, physician payments have decreased over time. Whether salaries have outpaced inflation I can't say.
And the match doesn't depress resident salaries. All programs must publish their salaries prior to the match, and residents are free to choose programs with higher salaries or better benefit packages if they wish. Even without a match, residents will not be in any position to try to demand higher pay "or I'll just go elsewhere".
It remains an open question about whether resident salaries are too low. Some residents bring great value to their programs in the form of coverage, and often the costs of replacing those residents are used as a metric to assess whether their salary is fair or not. But in some programs that doesn't really hold true -- we have a 1 resident / 1 intern team with 10 patients, or a 1 resident / 2 intern team with 14-16 patients. Each team has a single faculty supervising. Should all those residents disappear, the faculty would just care for the patients alone. We already have non-teaching teams that are faculty only, so this wouldn't be any different than what we already do (although I certainly admit that working with residents is more fun than working on my own). Same with night coverage -- we have night floats at night, but also faculty and NP/PA's at night covering our non-teaching service, and the teaching service is much smaller than the non teaching service. And then our residnts have a good amount of elective time -- which generates no income for the hospital at all. So for sure there are some programs / institutions where resident services are critical to operations, and there are some where they are not. (All of this ignores the CMS payments, which certainly help hospital bottom lines).
Don't get me wrong - I strongly support residents and their well being. I'd love to have their pay increase. They do good work, and work hard. But resident salaries are more driven by the gatekeeping function of training (you can't get a job as a physician without completing a residency) and the difficulty in switching programs. These distort the free market - and I don't see an easy solution to address that. Other than some regulatory / central price fixing (which seems problematic), or allowing a national union for residents (which has it's own set of problems).
Has there ever been a time when Congress wasn't investigating the Match, since it started? Congress literally protected it from antitrust issues by law. I fully anticipate they have been appropriate remunerated to continue to do so.
