Here we are once again talking about student doctors and matching them into residencies. I've talked about this process the last few days and now the House GOP Judiciary Committee seem to agree with some of my concerns.
#BREAKING: New Report Exposes How Medical Residency Hiring Monopoly Harms Patients and Doctors
— House Judiciary GOP 🇺🇸🇺🇸🇺🇸 (@JudiciaryGOP) March 27, 2026
Newly obtained documents reveal how the Match placement system for resident physicians operates as a monopoly in the medical residency hiring market.
Its monopolistic practices harm… pic.twitter.com/4ji6o4i1b7
Medical institutions created the Match so that residency programs would not “have to compete as hard . . . as they otherwise would have in a free market.”11 By design, “the Match severely constrains competition, resulting in feeble wage growth, and inflat[ing] expenses for medical residents.”12 As a result, the Match “exacerbate[s] the physician shortage, leading to overworked and burnt out healthcare providers, long wait times for patients, and a growing sense of dissatisfaction with the American healthcare system.”13
Basically, the report thinks this system is making it more difficult for medical students and harming the medical system as a whole.
The Match exercises monopolistic power over the medical residency market. 14 The Match achieved its power over the residency market by instituting an “All In” policy that requires Match-participating residency programs to “register and attempt to fill all positions through the Match or another national matching plan” and then merging with its largest competitor.15 According to one doctor, this policy “harms residents by locking them into a system where programs face no competitive pressure to improve salaries or working conditions, as they are guaranteed a pool of applicants through the Match.”1
Medical students have to participate in this system. There are no other options. The GOP House Judiciary believes that is creating a monopoly.
By prohibiting employment commitments and forcing residents to accept whatever position they are assigned, the Match prevents applicants from negotiating the terms of their employment.17 Doctors explained to the Committee and Subcommittee how these restrictions “create[] a lot of ambiguity in the [hiring] process”18 and “directly incentivize programs to provide less information about what they’d like in an applicant.
Students aren't allowed to negotiate the terms. They have to accept the hours, the pay, and whatever assignment they receive.
The Match even controls the process for hiring “unmatched” applicants, known as the Supplemental Offer and Acceptance Program (SOAP). 23 Evidence shows that the SOAP, too, distorts the medical residency market and causes real harms to residents. In an email to the American Osteopathic Association (AOA) shortly after the 2021 Match, an individual who “endured” the process for seeking a position as an unmatched applicant vividly described the system’s harms, writing that the SOAP was “a week we hope to forget, filled with disappointment, regret, let downs, and a myriad of other depressing adjectives to describe how the most important day of your life gets ripped out from underneath you.”24 The applicant described the “emotional toll” that Match week has on aspiring residents and the “[f]eelings of hopelessness and inadequacy” felt by applicants “that were ‘stuck’ in the SOAP.”2
Students who don't 'Match', go into the SOAP system a week after Match. Then, they all compete for whatever was left over that didn't get filled. They do tons of interviews and redo their applications and personal statements in hopes of getting anything at all. Many still do not.
The Match’s monopoly power compels residents to endure long hours and poor working conditions without a meaningful opportunity to obtain new employment.34 Residency programs do not always comply with the “mandatory” maximum of 80 hours a week required by the Accreditation Council for Graduate Medical Education (ACGME), 35 and it is “fairly common” for residents to “work more than the official cap number of hours that a resident[] [is] allowed to work.”36 In fact, “almost half of all residents report working more than allowed by the ACGME and falsifying duty hour reports,”37 and residency programs often “pressure residents to report compliance with 80 hour workweek rules established by ACGME, hiding the dangerous work environment these violations foster.”38 • The Match’s monopoly power requires residents to remain in their job placements, even though incidents of “physical, sexual, and emotional abuse are common and gender and racial discrimination are rampant.”39 Medical residents are nearly three and a half times more likely to experience depression than the average American,40 and “suicide rates are the highest amongst all professions due to the lack of control or negotiation of fair salary and working conditions.”41 As a result of the “low pay, long hours, and a lack of mobility due to the Match and structural impediments to transfer, residents are increasingly turning to collective bargaining to address workplace conditions.”42
Students are not to work over 80 hours per week, but many places do not heed those restrictions. Furthermore, when students complain about abuse by their superiors in these assignments, they are not allowed to move or leave that assignment without risking their career. These are the major highlights of the report.
Break it all down. It’s a system shrouded in secrecy that boxes out over a thousands American medical students a year while giving a leg up to foreigners.
— Mary Talley Bowden MD (@MaryBowdenMD) March 27, 2026
The Match, shielded by a medical residency antitrust exemption, controls where future doctors train and what they’re paid. This monopoly leaves thousands of qualified applicants without a residency slot each year. ⬇️ https://t.co/3sCgMQsta7
— Rep. Scott Fitzgerald (@RepFitzgerald) March 27, 2026
Now that politicians have taken notice, let's hope they actually enact change.
