I touched on it briefly in the “Residency ‘Match Day’” article, but a lot of shots are being taken at the National Residents Matching Program, the NRMP. It’s being accused of being a monopoly and anti-competetive, and suppressing residents wages, career mobility, and working conditions. None of this was a concern in 1969 when I “matched” with my first choice for internship.
I don’t know who is registering all these complaints, but I get the sense that some entity has found the system unfair to some applicants. In this age of everybody wins and gets a participation trophy, the NRMP has revealed deficiencies that weren’t an issue 57 years ago. Every residency applicant is supposed to match with a residency, but like everything else in life, not everyone matches. Those who don’t are left to find a residency position from those programs with open slots. This forces both parties to accept something they didn’t want in the first place. Dr. Smith didn’t want University Hospital and vice versa.
Then, it is alleged that the NRMP allows hospitals to suppress resident wages and forces applicants to accept jobs that pay a lower than average wage. Applicants are also kept from being able to negotiate a better salary, benefits, and employment terms. Plus, if you accept a position and don’t like it, there’s no process for transferring to another institution. I find all of these complaints/issues a bunch of hooey! Why didn’t you find out about all of these issues during the visiting and interviewing process? Did you not ask questions? You chose a residency based on your visit and the comments about the residency from people who have gone on before.
In my day, a residency was more of a continued educational opportunity than a job. Yes, I worked long hours and lost sleep, but every patient was a chance to learn. I should have paid the hospital for the opportunity to be exposed to a wide variety of disease problems. Hospitals didn’t have large medical education budgets back then so we were paid bare bones money. It was just accepted. No one complained about being underpaid! We didn’t have time to spend money any way.
NRMP is also accused of trapping residents in poor work environments, and programs that are a bad fit. These are also situations the resident should have investigated beforehand. If City General Hospital is a dungeon and unsafe, don’t put it on your list of choices. If you don’t choose it, you won’t match with it. Some applicants claim they are forced to reveal their ranking choices. What the heck? I told everyone my choices. They weren’t a secret. I was not contacted by or bribed by any institution and asked to rank them as my choice. I don’t know of anyone who might have done that, either.
It’s like so many things today—what was once righteous and honest now seems scandalous and corrupt. That may be a little strong, but something is amiss or the government would mind their own business.
Reference: www.google.com/nrmp/overview.
