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Lawsuit...Wanted to hear your thoughts on this topic...

Discussion in 'Medical Students - MD' started by joojoobeware, May 14, 2002.

  1. joojoobeware

    joojoobeware Member
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    I'm not sure if this topic is brought up yet, but this is an article from the NY times. I figured it would be very relevant to us in the future and may change the Match, how competitive residencies will be, and how limited it might be. Let me hear your thoughts. Thanks.

    Medical Students Sue Over Residency System
    New York Times, May 7, 2002

    Every March, graduating medical school students wait anxiously for
    Match Day, when a computer tells them where they will spend the next
    several years as medical residents in teaching hospitals.
    A class-action lawsuit to be filed in Washington today challenges the
    matching program on antitrust grounds. The suit says the defendants,
    including seven medical organizations and more than 1,000 private
    hospitals, have used the program to keep residents' wages low and
    hours long. Almost all first-year residents make less than $40,000 a
    year and often work 100-hour weeks.
    If the suit is successful, the nation's health care system faces an
    enormous financial liability and the prospect of being forced to
    change the way that generations of doctors have been trained.
    More than 80 percent of first-year residency positions are offered
    exclusively through the program, known formally as the National
    Resident Matching Program. The matches are based on ranked lists
    submitted by hospitals and the 15,000 or so students, and both sides
    agree in advance to accept the match.
    There is no room for negotiations about wages, hours or other terms
    of employment. As a consequence, the plaintiffs say, the hospitals,
    which share detailed salary information with each other, can force
    residents to accept below-market wages for the three to eight years,
    depending on specialty, of their residencies.
    "The match basically controls where you are going to spend the first
    part of your professional life," said Dr. Paul Jung, one of the
    plaintiffs, who is now a fellow at Johns Hopkins University. Yet, he
    said, "you're expressly forbidden from having any kind of agreement
    about any kind of salary or anything."
    Lloyd Constantine, who was New York's top antitrust official for a
    decade and is not involved in the suit, said the case raised
    important issues. "If this were coal or steel or autos, it would flat
    out be a felony and would probably be prosecuted criminally," he said
    of the matching system.
    Alvin Roth, an economics professor at Harvard, redesigned the system
    in 1997. He said it merely ensured that medical students obtain the
    best residencies they could. This fosters competition, he said, which
    the antitrust laws are meant to protect.
    But James F. Blumstein, an expert in health care regulation at
    Vanderbilt Law School in Nashville, said that the matching
    program "does prevent competition in the sense that you can't
    entertain competing offers."
    "It's not only salaries but also access to opportunities," he
    said. "It's hard to see what the pro-competitive justification is
    here."
    Defenders of the matching program say that it is a mistake to think
    about it in purely commercial terms. They say residencies serve an
    important social purpose in training doctors and providing care for
    patients. Whether the antitrust laws should take account of these
    kinds of arguments is the subject of debate.
    "It's not exactly a job, it's a continuation of a medical education,"
    said Kevin Jon Williams, a professor of medicine at Thomas Jefferson
    University in Philadelphia, who has written extensively on the
    matching program.
    Sherman Marek, a Chicago lawyer whose law firm, along with 14 others,
    represents the plaintiffs, said there was nothing special about jobs
    that educate. "In any employment, the employee is acquiring skills
    that can then be taken elsewhere, so there is always an education
    element," he said. "Nevertheless, market forces are allowed to
    operate."
    Lawyers for the plaintiffs declined to speculate on how much
    residents' salaries might change if the matching program were
    eliminated.
    Representatives of the medical organizations declined to comment on
    the lawsuit or did not return calls.
    Residents' wages are certainly both low for the profession and
    uniform. According to the Association of American Medical Colleges,
    which operates the program and is a defendant in the suit, the
    average first-year resident, having completed four years of medical
    school, is paid $37,383. In the Northeast, the average is $39,060; in
    the South, the average is $35,552.
    Hundred-hour workweeks for residents are common, meaning that they
    often make less than $10 an hour.
    "They get less money than nurses and physician's assistants," said
    Michael J. Freed, a lawyer for the plaintiffs.
    The plaintiffs' legal papers say the uniformity of the wages proves
    that something is wrong.
    "Employers pay residents standardized salaries, regardless of such
    factors as program prestige, medical specialty, geographic location,
    resident merit and year of employment," the papers argue. "With few
    exceptions, employers pay salaries very close to the national average
    and very close to each other. By contrast, post-residency physicians
    earn widely varying compensations based on these factors, especially
    geographic location and medical specialty."
    But Professor Roth, the system designer, said the similarities in
    wages by themselves prove nothing. "If you're looking at prices, both
    competition and collusion look similar," he said. Moreover, "people
    would be willing to pay to take these slots," he said, referring to
    the most desirable positions.
    George L. Priest, a professor at Yale Law School who was a consultant
    to the plaintiffs, disagreed. "The salary data is highly suspicious,"
    he said. "There is no good reason why doctors after four years of
    graduate school should make a quarter of what lawyers make."
    The low wages and long hours have serious consequences, Dr. Jung
    said. "I had to constantly battle fatigue as a factor affecting the
    quality of my life and the lives of my patients," he said.
    Dr. Jung, 32, said his residency at the MetroHealth Medical Center in
    Cleveland was dispiriting.
    Hospitals "use residents as cheap labor," he said. "I had the
    expectation, maybe na?vely, that a lot of time would be spent with
    patients."
    Instead, Dr. Jung said, he performed many menial and administrative
    tasks. "It was a lot more hours and a lot less patient care than I
    expected," he said.
    He added: "Residents want to be treated fairly, and patients want to
    be treated well. Patient care will improve if you let residents have
    more say in their working conditions."
    The Justice Department looked into the residency matching program in
    the mid-1990's. It reached a settlement with an association that
    administered a separate program for family practice residencies, but
    did not challenge the main program. Professor Roth said this meant
    the government had given the hospital matching program "a clean bill
    of health."
    Mr. Constantine said that the professional training aspect of
    residents' work made it difficult to predict the outcome of the
    case. "There is a level of sentimentality" among judges, he
    said. "They will listen to excuses they would not listen to in the
    context of a purely commercial situation," he said.
    Professor Blumstein said those excuses should not play a role in
    antitrust analysis. "The better view and the correct view is that
    antitrust law does not allow for worthy purposes to offset the
    anticompetitive actions," he said.
    The closest analogy, Mr. Constantine said, is the civil suit that the
    federal government brought a decade ago against the eight Ivy League
    colleges and the Massachusetts Institute of Technology challenging
    their cooperation in setting student financial aid. The case ended in
    settlements that limited the amount of information the institutions
    could share.
    Such information sharing is even more problematic when salaries are
    involved, he said. "The medical world really is closer to coal, steel
    and autos than to colleges giving out financial aid," he said.
    Critics compare the residency matching program to early decision
    programs at colleges. They say that colleges accepting applicants
    through early decision can offer less attractive financial aid
    packages because there is no competition for those students, just as
    hospitals can pay residents low wages because they have nowhere else
    to go.
    The stakes in the new suit are high. The complaint does not specify
    how much money the plaintiffs seek, but they claim to represent a
    class of 200,000 residents. If residents' fair market salaries were
    determined to be $100,000, say, the sums at issue for a single year
    would exceed $12 billion, and since this is an antitrust case, the
    damages would be automatically tripled.
    "It's not obvious that it's in the interests of the plaintiffs to
    bankrupt every hospital in the country," Professor Priest said. "But
    it's going to change the nature of medical care. They are going to
    have to bid for the services of these medical residents, and they
    won't be able to work them 120 hours a week."
     
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  3. Thumper

    Thumper Senior Member
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    I hope this goes into effect. I honestly don't mind the long hours, because we need to 'toughen up' and be able to perform under pressure, but the whole salary thing is WAY too extreme. I mean, I have friends who are physics and Chem Eng. majors, and they are actually getting paid to go into graduate school (obviously with the idea that they will return the nice act with their services). However, I don't see how we, as to-be doctors who are embarking on a very expensive journey ($120,00 for me, just for tuition!) are seen as unworthy of a pay increase. I'm sure I would have less worries and be able to perform better knowing that my bills could be paid and my student loans repaid in a timely fashion. I don't know, but shouldn't doctors be held to a higher standard than what we have been dealing with? haven't we paid/aren't we going to pay our dues to society? I just can't understand why it is even an issue. $40,000/year means about $30,000 after taxes (most of us will be single and childless) and averages to less that $3 G's a month. Subtract student loans, housing, expenses, and you are left with close to nothing. THAT, fro people who have invested more than 20 years in the persuit of education inorder to achieve their lifetime goal of becoming a doctor. I seriously hope they amend the rules and give us a break, cause we truly do deserve it!
     
  4. edmadison

    edmadison 1K Member
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    There are at least 3 or four active threads on this topic

    Ed
     
  5. The Pill Counter

    The Pill Counter Senior Member
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    you were a bit slow on the uptake joojoobeware
     
  6. Future_Doc

    Future_Doc Senior Member
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    There's a good thread on the PreAllo forum. Lots of takes on this issue. But while I'm here - I'm hopeful that this will bring some change.
     

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