Monopoly

by Jason Zengerle | May 10, 2004

There once was a time, not long after I gave up my dreams of being a firefighter, but well before I settled on a career as a writer, when I wanted to be a trustbuster. I was in sixth grade, if I recall correctly, and my class was studying Teddy Roosevelt. That meant readings on the Rough Riders and lectures on the National Park system. But, while most of my classmates lapped up Roosevelt's physical exploits, I was drawn to one of the comparably drier facets of TR's career: his administration's efforts to break up giant financial and industrial trusts. Why I found this more interesting than the charge up San Juan Hill is still a bit of a mystery to me. It probably had something to do with the word trustbuster, which, to my young ears, conjured up images of Bill Murray and Dan Aykroyd doing battle with the moustached Mr. Monopoly. Eventually I discovered that, to be a trustbuster, I'd have to go to law school- -something that, even at that young age, I knew was not in my future--and I moved on to other career goals, such as playing professional basketball. But my short-lived trustbuster dreams did leave me with an inherent sympathy for anyone who claims to be battling a monopoly, whether it's the government taking on Microsoft or Maurice Clarett suing the NFL. Which is why it's surprising that I was not at all outraged last month when I witnessed my wife, Claire, a medical student here at the University of North Carolina, fall victim to a monopolistic conspiracy.The monopolistic conspiracy is the National Resident Matching Program (nrmp), otherwise known as "the Match," which, for the past 52 years, has placed graduating medical students in residency programs at teaching hospitals across the country. For a conspiracy, the Match is pretty straightforward. In their fourth year of medical school, students apply to residency programs in their chosen specialties, and the programs then decide whether or not to offer those students interviews. After the interview process is completed, the medical students rank these programs in order of their preferences, and the programs rank the students they've interviewed in theirs. The students and the programs then submit their respective lists to the nrmp, which uses a computerized algorithm to match medical students with their highest-ranked choice of the programs interested in them. At noon on the third Thursday of March, "Match Day, " about 25,000 medical students assemble at their respective schools to learn the results of the Match--which are legally binding. In other words, whichever program the student matches into, that's where that student will do his or her residency. This would seem a blatant violation of antitrust laws. By not allowing medical students to field offers from multiple employers, the Match deprives them of the opportunity to negotiate pay and benefits. And the pay and benefits residents currently enjoy are nothing to write home about--especially for people who have, at a minimum, four years of graduate education. Most residents make in the neighborhood of $40,000 per year, which, with their typical 80-hour workweeks, comes out to about $10 per hour. So it wasn't surprising when, in 2002, three former residents filed an antitrust suit against the nrmp and a number of teaching hospitals, seeking to abolish the Match. The plaintiffs also asked for compensatory damages, which, if they had gotten their wish and their suit were made into a class action, could have topped billions of dollars. But the case likely won't ever make it to trial. The defendants in the suit, not content to wait for their day in court, aggressively lobbied Congress for an antitrust exemption for the Match. And, this month, in a last-minute provision that Senators Ted Kennedy and Judd Gregg stealthily slipped into a massive pension relief bill, Congress gave them just that. I, for one, was glad they did, because, while the Match does have its drawbacks, it's still the best way to place newly minted doctors in their first jobs. Before the Match was instituted 52 years ago, medical students engaged in a desperate scramble to find a residency program, frequently accepting, on the spot, the first offer they received, lest the program offer the position to someone else. That meant students oftentimes didn't even get a chance to find out whether their top choices were interested in them. And, while today's graduating medical students probably do pay a price--in the form of lower resident salaries--for their ability to optimize their choice of programs, it's worth remembering that a medical residency is not only a young doctor's first job. It's also a continuation of his or her medical training, so the lower salary is not altogether inappropriate. What's more, that trade-off--lower pay for continued training--is crucial to America's health care system, in that it ensures better doctors and helps keep health care costs down. So, when Claire and I arrived at her medical school's Match Day ceremony last month, the butterflies in our stomachs weren't from any worries about labor exploitation; we were just anxious to find out where she'd be doing her residency in internal medicine. The details of Match Day vary from school to school, but they tend to be remarkably public affairs for such an intensely personal moment. (Imagine getting your college admissions letter or first job offer in a room full of people.) At the University of North Carolina, Match Day is a bit like "The Price is Right": The students gather in a large lecture hall, and, at high noon, two people from the dean's office begin reading off names. One by one, the students make their way down to the front of the room, where, after dropping a dollar in a bedpan--a good-luck gesture that also serves as a contribution to the bar tab the class will rack up a few hours later--they're handed a sealed white envelope that, literally, holds their future. Some tear open the envelope that instant. Others wait until they're back in their seats. But, either way, the result isn't a secret for long, and soon the room is filled with screams and sobs. After Claire's name was called, she brought her envelope back to her seat so we could open it together. With her hands shaking, she unfolded the paper and we read that she--we--were going to Boston. For a moment, the two of us reveled in this news. Then we got up to tell our friends and join the celebration. Being the victim of a monopolistic conspiracy never felt so good.\t

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