Fed up with low wages and poor working conditions, 3 American physicians have launched a class-action lawsuit on behalf of some 200 000 fellow residents training in American hospitals. They are challenging the National Resident Matching Program (NRMP) on anti- trust grounds in a suit that names 7 medical organizations and 28 hospitals (see page 1501). It was filed May 7.
It alleges that the defendants have restrained competition by assigning residents to a single, mandatory employment position through the NRMP, by “artificially depressing and standardizing wages” below competitive levels, and by establishing and complying with anticompetitive rules and regulations of the Accreditation Council for Graduate Medical Education. Most first-year residents earn less than US$40 000 annually and frequently work 100-hour weeks. Many earn less than US$10 an hour while carrying debt loads of more than US$100 000.
“It's an anticompetitive system,” Tilden Katz, spokesperson for the plaintiffs, told CMAJ.
If successful, the suit could cost the US health system $12 billion annually in increased residents' salaries. It could also lead to the dismantling of the match system, which has been in place since 1952 and now matches students to more than 80% of first-year residency positions. Under the NRMP, residents cannot negotiate wages, length of the work week or other terms of employment.
Dr. Paul Jung, one of the plaintiffs, said hospitals use residents as cheap labour. Jung, 32, is a fellow in health policy at Johns Hopkins University who began investigating the possibility of a class-action suit 3 years ago. The suit includes everyone who has been a resident since May 7, 1998. Fifteen US law firms are acting on their behalf.
In addition to NRMP, the defendants include the Association of American Medical Colleges, the American Medical Association, the American Hospital Association, the American Board of Medical Specialties, the Council of Medical Specialty Societies and the Accreditation Council for Graduate Medical Education.
The president of the Canadian Association of Internes and Residents (CAIR) says Canadian residents don't face a similar problem with the Canadian Resident Matching Service. Dr. James Clarke, a radiology resident in Halifax, says provincial house-staff organizations set maximum working hours and on-call frequency. This varies somewhat among specialties and across the country. In the Maritimes, for example, a surgical resident works about 55 hours a week and has a 1-in-4 on-call schedule. The average work week across Canada is about 80 hours, and salaries range from $32 000 for a first-year resident to a maximum of about $65 000 annually for some final-year residents.
Physician well-being remains a key issue at CAIR, says Clarke. “We want a more reasonable call schedule and fewer hours if possible. We don't want people to burn out.”
The US lawsuit could have serious implications for that match system, says Clarke, and the ripples may be felt in Canada, too. For instance, elimination of that system could make the matching process more complicated for Canadians applying for positions in the US. — Barbara Sibbald, CMAJ