Hospitals lobby to block suit
Ask Congress to stop bid to end program that assigns residents
Teaching hospitals in Boston and around the country are lobbying Congress to block an antitrust lawsuit that threatens to overturn the centralized system they use to assign medical students to their first job.
In the lawsuit filed last year, three medical residents charged that the program, which matches medical school graduates to hospital residency programs where they complete their training, keeps residents' working hours long and their salaries low by limiting their ability to negotiate. Hospitals counter that the National Resident Matching Program, known as "the match," benefits residents and hospitals by streamlining a potentially chaotic application process.
Senator Edward M. Kennedy, Democrat of Massachusetts, plans to take a lead role in passing legislation that would shield the match program from antitrust lawsuits, Kennedy staffers said yesterday. They added that the senator was responding to telephone lobbying from top officials at Boston hospitals, including Massachusetts General and Boston Medical Center, both named in the lawsuit. No bill has been filed, but the staffers said they are working to determine how broadly to word the proposed exemption from laws that foster market competition.
The lawsuit is the latest battleground in the debate over the workload of medical residents who have traditionally worked weeks of 100 hours or more and earned about $40,000 a year. Both sides argue that they are on the side of patient safety. And the ongoing fight shows that the issue was far from settled by new guidelines mandating work weeks of no more than 80 hours, introduced this summer by the professional association that oversees residency programs.
Frustrated that the lawsuit in federal court in Washington, D.C., is expected to last until at least 2006, the defendants, which include 29 teaching hospitals and seven professional associations, opened a political front. Led by the Association of American Medical Colleges, they hired as lobbyists two former Kennedy staffers, Carolyn Osolinik and Jeffrey Blattner. Blattner is a former deputy assistant attorney general who worked on the government's antitrust lawsuit against Microsoft.
That prompted an outcry from the plaintiffs, including Dr. Paul Jung, medical officer of the Food and Drug Administration, who yesterday accused the defendants of "trying to subvert the judicial process."
Said Sherman Marek, a Chicago lawyer who represents the plaintiffs and is seeking class-action status for the lawsuit: "Our concern is they're going to try to tack this on to a bill and avoid any sort of hearing or public discussion of this issue,"
He said ending the match would ultimately benefit patients. Currently, 15,000 US medical graduates apply for 23,000 residency slots, with the remainder filled by foreign graduates. In a freer market, he said, residents would have more negotiating power to limit the long hours that he said can lead to medical errors that harm patients.
"Utter nonsense," said Dr. Jordan M. Cohen, president of the American Association of Medical Colleges, which represents the nation's 126 medical schools. He said residents are more like graduate students receiving stipends than workers negotiating salaries, and said the legislative campaign was an effort to avoid disrupting a system that helps match the skills of medical school graduates to their future specialties, resulting in better doctors. "The ultimate beneficiary is the public," he said.
In the match program, medical students rank in order their preferred residency programs. The nation's 7,000 residency programs then rank the students they would like to hire and a computerized system makes the matches. By entering the system, medical students agree to accept whatever job they are offered, and cannot negotiate salaries or other aspects of the job.
But many residents say they like the program because it simplifies their job search and allows couples to match together so they can be in the same city. Match Day -- the day most medical school seniors find out their assignments -- is a day of excitement and ceremony at most schools.
The hospitals have made some inroads, said a spokesman for the group pushing for an antitrust exemption: "Teaching hospitals from around the country have been in touch with members of the House and Senate from both political parties. We have been encouraged by the response."
Also expected to support the hospitals are Senators Hillary Rodham Clinton and Charles Schumer, both Democrats of New York. Like Kennedy, they are not usually known for taking the side of management over workers.
But that's the wrong way to look at it, a Kennedy staffer said, noting the senator's support for striking nurses and for the 80-hour guidelines for residents. "He has a long record of fighting for good safe working conditions for people in the healthcare field," the staffer said. "He's viewed that as kind of a separate battle from the mechanics of the match."
In a statement released yesterday by his office, Kennedy called the match "a crucial part of an educational system that has produced the best physicians in the world. If the match is in jeopardy, Congress has to protect it in a way that meets the needs of both teaching hospitals and medical students."
Residents' organizations have not wholeheartedly embraced the lawsuit. The Committee of Interns and Residents, a national labor union that represents medical residents at Boston Medical Center, has not taken a position on the suit or the legislation.
The American Medical Student Association opposes the antitrust exemption, but stops short of endorsing the lawsuit strategy.
"We feel that the exemption would close the door on our ability to make the match better for medical students," said Dr. Lauren Oshman, president of the group, who is currently entering the match in hopes of joining a residency program in family medicine. But she added: "The uncertainty of the lawsuit makes it difficult to tell what kind of system would be the end result . . . but certainly there is lots of room for improvement."
Anne Barnard can be reached at abarnard@globe.com.
