By John Squiers, Adam Harris and Adam Bennett — Messrs. Squiers, Harris, and Bennett are M.D. candidates in the Class of 2016 at the University of Texas Southwestern Medical School.
Our colleague recently wrote about the National Resident Matching Program (more commonly known as “the Match”), the system by which United States medical school graduates and foreign-trained physicians are assigned training positions as residents in American teaching hospitals. While our colleague delineates several reservations about the Match, she offers no real solutions to the perceived problems. Ultimately, we agree that the Match is not perfect, but we we feel that further analysis of the data paints a different picture of the Match.
The Match isn’t expensive—medical school is
Our colleague’s back-of-the-envelope calculation for the costs of the Match’s interview process estimates that the post-interest bill amounts to $8,789.13 in pre-tax income against $250,000 in existing student debt. Although we too lament the costs of residency applications and interviews, this sum totals only 3.5% of the estimated cost to become a resident physician. Even if eliminating the Match could remove the costs of applying for and securing a residency position entirely (obviously, it wouldn’t), medical students would still graduate with extensive, though nevertheless willingly acquired, debt.
Would a free market benefit resident physicians?
The Match prevents unregulated contract negotiations between hospitals and their newly hired residents. In our colleague’s calculation, this costs resident physicians up to $35,000 annually in salary compared to their peers with other doctorate and professional degrees. Ultimately, this is a problematic comparison because students in other doctorate and professional programs are eligible for certification to work in their fields immediately following graduation. MD graduates, on the other hand, still must complete residency to be eligible for board certification, limiting their earning potential in comparison to other professionals.
Even if we ignore this fact, would medical school graduates be able to negotiate higher resident salaries if contracts were signed in an unregulated market? Residency training is clearly in high demand among US medical school graduates and foreign-trained physicians. Therefore, free market economics suggest that due to this increased demand for training, residents would actually face increased “costs” to obtaining this training, most likely in the form of decreased salaries.
In fact, whether freshly graduated physicians like it or not, their training results in a net cost to the institutions who hire them as residents. Therefore, a free market would dictate that, rather than draw a salary, resident physicians should continue to pay for their training. Perhaps resident physicians should be grateful they receive any compensation at all.
Undue duress or pretty good odds?
Our colleague also cites Match data that only 75% of applicants are ultimately matched. Although this is true on face value, this data is misleading. From the same source, we find that 89% of graduating seniors and former graduates of U.S. medical schools were successful in the Match last year. Foreign-trained physicians comprise more than 7 out of 10 applicants who are unsuccessful in the Match.
The crux of our colleague’s argument is that the multitude of perceived wrongs forced upon medical school graduates by the Match results in less happy, increasingly frustrated physicians. It is true that many medical students do not match into their first choice training program. However in recent years, over 50% have matched into their top choice program (in their desired medical specialty), and over 80% of medical students matched into one of their top three choices. Over 90% of US medical school seniors matched into their medical specialty of choice. Compared to the under-employment facing more than a quarter of law school graduates, those are great odds.
Healing patients, not counting dollars
In the end, medical students must realize we are not simply entitled to train in the field of our choice or in the location of our choice, even though the odds remain fairly high we will be able to. We would be offended if someone were to suggest that we were entitled to our position in medical school. In reality, less than half of all applicants are even accepted into medical school in the first place. Any sense of entitlement towards residency is similarly unfounded–instead we should be not take for granted the chance to continue our education in any capacity.
We all know the costs and sacrifices it takes to become a physician (not to mention to practice as one). If high earnings in a desirable location are why we started this journey in the first place, we have all made a big mistake.
Luckily, we don’t believe that is why most of our colleagues are in medical school. No—most of us are here to treat patients, fight disease, and be present for some who may have no one else. Thank goodness, the Match doesn’t get in the way of that.