March 17, 2004

Match Day

March 18, 2004 is a seriously huge day for almost all 4th-year medical students. It's Match Day.

At 1:00 pm (1300 hours) Eastern Standard time, most every senior medical student in the country will open an envelope, and in that envelope will be the name of a residency program. The students opening these envelopes won't know until then which program they've been matched with. A program on the East Coast? West Coast? Unknown.* The only thing the students do know is that they've already committed themselves, contractually, to whichever program in in their envelopes. When the students sent in their rank order lists, they agreed to begin their residencies at whichever program they were matched with.

No wonder most of them are nervous, anxious, and excited.

No wonder that this system is the target of a lawsuit.

The suit alleges that the Match process is an illegal anticompetitive scheme that allows hospitals to keep wages for resident physicians well below market rates. Supporters of the Match claim that it benefits both hospitals and medical students by eliminating the chaos that occurred before the adoption of the Match.

My opinion? It's probably both.

Wages for residents across the country are essentially uniform across geographic regions and specialties. And they are much, much lower than the wages a resident can command while "moonlighting," or performing work outside of the residency. When you figure in the hours residents work, their wages can sometimes be as low as $10 an hour, making them the cheapest source of medical labor in the entire hospital.

There are generally more residency positions than there are medical school graduates to fill them. If the hospitals weren't conspiring to keep wages low, this undersupply of graduates of American medical schools would cause hospitals to bid up wages and sweeten their working conditions to attract scarce applicants. But wages aren't in danger of going up anytime soon. Working conditions may or may not have improved with the passage of new work-hour restrictions, but the plain fact is that hospitals are not competing for residents on the basis of wages.

On the other hand, there are undoubtedly some benefits which residents receive under the Match. Exploding offers? Nonexistent. Third-years inking employment contracts with the choice residencies? Doesn't happen. People familiar with the market for judicial clerks, which until recently was chaotic in just these kinds of ways, will certainly appreciate the benefits of the Match system.

Like AMSA, I haven't taken a position on the lawsuit yet. I'm sympathetic to the argument that resident wages are too low, and I don't buy the hospitals' line that residencies are "training" and not employment (they are both training and employment, much like the early years at a big firm for a law school graduate). But I also remember how few of my classmates in medical school really resented the Match process, and how smooth and trouble-free that process seemed to be.

So at this point, I'll just wish everyone a HAPPY MATCH DAY!!!

(More from blogborygmi and A Chance to Cut.)

* Not completely unknown. If you didn't put a program on your rank order list, it won't be in your envelope on Match Day.

Posted by Carey at March 17, 2004 09:24 PM

wow...that is really interesting. i didnt know any of that. and now i do. thanks. excellent.

Posted by: shahriar at March 18, 2004 12:39 AM

My sister is getting matched today. My mom is playing hookie from work to go see it. Should I be there? Do families usually go? Not that I could get to Wisco by then, anyway.

Posted by: jkrasch at March 18, 2004 10:32 AM

Your description makes it sound like a medical grad is guaranteed to get one of the residencies s/he puts on her/his rank order list. This doesn't sound quite right to me.

Let's say, hypothetically, I'm the student ranking dead last in my class in the worst medical school in the United States; in May/June I'm going to be entitled to put the letters "M.D." after my name, but just barely. What if I fill out my rank order list with the n (where n = "the number of slots in the rank order list") most prestigious and competitive residencies in the U.S. Does that mean that one of them is obligated to take me? Or does it mean (more likely) that I've just struck out, and I'm not matched with any residency I've requested?

Your statement "If you didn't put a program on your rank order list, it won't be in your envelope on Match Day" logically precludes that a random match with an open residency in the specialty area you're focusing in that you didn't put on your rank order list. So I guess you get to scramble looking for an open residency somewhere after match day. Then again, at least you imply it's a seller's market for graduating medical students.

Posted by: Len Cleavelin at March 18, 2004 12:52 PM


What specialty? Congratulations to her!


Sending in a rank order list doesn't guarantee you anything. Your hypothethetical med student would probably have been informed a few days before Match Day ("Black Monday") that s/he hadn't matched at all. Then, like you said, they're in the scramble.

Although there's an oversupply of spots relative to students overall, this isn't true for some specialties, like dermatology or orthopedic surgery. Your hypothetical med student would probably not be able to scramble for a residency in either of these specialties.

That said, if you sent in your rank order list, and you didn't hear anything on Black Monday, you're going to get an envelope on Match Day with the name of a program in it...

Posted by: Carey at March 18, 2004 07:34 PM

This is a test. If it didn't have any information, it wouldn't be a test. So there.

Posted by: Heidi at March 18, 2004 07:50 PM

Ah so many more reasons to be scared of what I'm doing.
Thanks for the comment by the way. It helps to have someone remind me that it's not just me.
How's school going? And when/are you coming back for the summer?

Posted by: Amy at March 19, 2004 12:28 AM