Medical residency system target of class action suit

Matching process breaks antitrust laws, it claims

May 08, 2002|By Michael Stroh | Michael Stroh,SUN STAFF

Soon after arriving at the MetroHealth Medical Center in Cleveland for his medical residency, Paul Jung quickly found he was doing as much dirty work as doctoring.

Putting in as many as 90 hours a week, Jung schlepped paperwork, drew blood, wheeled patients to X-ray - all the while earning the equivalent of $10 or so an hour. And he says he was one of the lucky ones: His hospital has a reputation for being easy on residents.

Now Jung, a research fellow at the Johns Hopkins University, is a plaintiff in a class action lawsuit filed yesterday in Washington that contends the system violates federal antitrust law.

At the heart of the lawsuit is the National Resident Matching Program, which pairs the approximately 15,000 medical school graduates with hospitals seeking residents who spend as many as eight years refining their craft under the supervision of senior physicians.

Selections are made by computer, based on lists of choices submitted by candidates and institutions. Once the computer has chosen, students are stuck with it.

Lawyers for residents contend that the seven medical organizations and more than 800 hospitals named as defendants in the class action suit have used the system to force residents to work long hours at low wages. Applicants, they say, have no say over where they go, what they do, or how much they make once they get there.

"Hospitals in the U.S. think they can use residents as cheap labor, and I find the process offensive," says Jung, 32, who graduated from the University of Maryland School of Medicine.

A spokeswoman for the National Resident Matching Program said its lawyers had not yet finished reviewing the lawsuit and so were not prepared to comment on it yesterday.

While the lawsuit doesn't specify damages, plaintiffs' lawyers would seek to have all residents since 1998 compensated for wages they should have earned but didn't. They estimate the lawsuit could benefit as many as 200,000 physicians.

The average first-year resident earns $37,383, according to the Association of American Medical Colleges, which manages the program and is a defendant in the lawsuit. Although program rules stipulate residents cannot work more than an average of 80 hours a week, some residents have been known to put in as many as 100.

"What we want out of this and what the resident physicians want out of this is a competitive system," said Sherman Marek, an attorney representing medical residents in the lawsuit.

Times have changed since the match system was first put into place in 1952, Marek says. Some medical students graduate from medical school with debts of as much as $100,000 and are unable to afford to pay them back on a resident's salary.

But if the lawsuit succeeds, health care officials say, it could mean a crippling explosion in medical costs, not to mention the loss of a system that they contend only benefits students.

The match system "levels the playing field. It makes everything fair," said Jack Gladstein, associate dean for student affairs at the University of Maryland School of Medicine.

"Before the match, there were deals made under the table. People were picked based on who they knew. If you destroy the match, you're going to Neanderthal times."

At the University of Maryland Medical Center, the 655 residents and fellows constitute nearly a quarter of the staff. If the university had to significantly boost salaries, "it would be catastrophic," says David Rorison, who directs the hospital's residency program.

Legal experts say the lawsuit might have merit when it comes to for-profit hospitals. "On the surface, residents have a very interesting case," said Robert Litan, a former litigator in the Justice Department's antitrust division.

Litan said there's a legal precedent that might give nonprofit hospitals with resident programs an out. Hospitals could argue that the social benefits of the National Resident Matching Program outweigh its anti-competitive effects, he said.

Private hospitals, however, would not be able to make that argument, said Litan, now an economist at the Brookings Institution in Washington.

Jung said he received nearly three dozen supportive e-mails yesterday from residents and doctors around the country who had heard of the lawsuit. He concedes that some of his co-workers, while agreeing that the match system is flawed, don't believe a lawsuit is necessarily the answer.

Still, he's decided to continue as a matter of principle.

"I'm not pushing for a 9-to-5 job where we get paid a lot," said Jung. "I'm just here to make sure that residents have more choice and more of a say in how they get trained. I want to make the system as fair as possible."

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