- The new House Judiciary Committee report finds that the National Resident Matching Program (NRMP), known as MATCH, operates as a monopoly on the medical residency hiring market, driving resident salaries down to an average of $66,712, while physicians make $374,000 and nurse practitioners make $132,050.
- Medical students graduate with an average of $190,000 student loan debtThen enter a system where they can’t negotiate wages, can’t change jobs, and work 80+ hours per week for 3 to 7 years at wages that have declined in real terms since 1971.
- Congress granted Match a special antitrust exemption in 2004, and the committee recommended repealing it. A Bill to do so, Restoring the Rights of Medical Residents Act (HR 3018)Was reintroduced in April 2025.
After four years of medical school and an average of $190,000 in student loan debt, every aspiring doctor in the United States must complete a residency, a supervised training period lasting three to seven years where they practice medicine under experienced physicians before receiving licensure or board certification.
To get into a residency program, virtually all medical graduates must go through a centralized system called MATCH, which is operated by. National Resident Matching Program (NRMP). Students and hospitals each submit secret rank-order lists of their preferences, and an algorithm assigns the binding pairs.
Students cannot negotiate salaries, compare offers, and reject results without risking being blacklisted from future matches. Match Day, the moment when students find out where they will be training, is one of the most important days of a medical career. Those who fail to match are effectively locked out of medical practice for at least a year, unable to earn a physician’s salary or make meaningful progress on their student loans.
New one House Judiciary Committee report released last week (PDF file) concludes that this system operates as a entrenched monopoly that suppresses wages, restricts freedom of choice, and traps young physicians in a cycle of low pay and rising student loan debt.
The investigation reviewed 1,580 documents from five standard-setting organizations and four teaching hospitals, and included transcribed interviews with two doctors who described the system as one of “indentured servitude”.
How does the match process govern residency admissions?
The National Resident Matching Program (NRMP), commonly referred to as MATCH, is a private nonprofit organization that has regulated the placement of medical residents for more than 70 years.
In 2025, 52,498 applicants registered for Match and 40,764 residency positions were filled through its algorithm. The system requires both applicants and programs to submit confidential rank-order lists, then uses an algorithm to assign pairings that both parties must accept as binding.
The report details how Match achieved its monopoly through an “all in policy” adopted in 2013, which forces participating residency programs to fill all positions exclusively through Match. It then merged with the National Matching Services (NMS), a competing system used by osteopathic medical students, effectively eliminating the last option. As of 2020, nearly all residency programs, positions, and applicants in the United States go through the match.
Match explicitly prohibits applicants from demanding employment commitments or negotiating salary during the process. Applicants who reject their assigned pairing may be labeled “match violators” and banned from future matches for one to three years or permanently.
As one doctor testified to the committee, “It is an effective blacklisting to withdraw from the match.”
Financial toll: Student loans offset depressed wages
According to the report, the financial impact on aspiring doctors is severe. According to data cited in the report, the average total cost of a four-year medical school is $244,000 at public institutions and $323,000 at private schools.
Nearly 75% of all graduating medical students have student loan debt averaging $190,000. Many people also take out residence-relocation loans to cover the cost of the interview and the cost of moving to wherever they are hired by Match.
After accumulating that debt, graduates enter a residency system where first-year residents earned an average salary of only $66,712 in 2024. Adjusted for inflation, resident salaries were actually higher in 1971 than they are today.
Meanwhile, fully licensed physicians are expected to earn an average of $374,000 in 2024. Even under conservative estimates, the average physician salary is still three and a half times the average resident salary.
The pay gap is particularly stark for residents nearing the end of training. According to testimony from Dr. Amir Hussain, a former dermatology specialist at Georgetown University, residents in the fifth and final year of residency, despite doing “almost the same” amount of daily clinical work, earn between $160,030 and $294,830 less than fully licensed physicians.
Residents’ salaries are also significantly lower than other healthcare providers who did not attend medical school. In 2024, nurse practitioners earned an average salary of $132,050 and physician assistants earned $133,260, both nearly double the average salary of residents, despite residents having more advanced degrees.
The report presents data that shows resident salaries are unusually similar across hospitals, specialties and geographic regions. There is only a $9,000 difference between the 25th and 75th percentile of first-year resident salaries nationally, and virtually no difference between geographic areas beyond cost-of-living adjustments.
More than 95% of hospitals pay the same starting salary to every resident regardless of specialism, qualification or expected workload. The American Medical Association (AMA) acknowledged in documents presented to the committee that resident pay “is related to training years rather than specialty.”
The federal government provided $29 billion for graduate medical education (GME) residency programs in 2023, averaging $178,303 per resident. Yet teaching hospitals are not required to spend GME funds on residents or their training.
According to the report, hospitals finance more than 70% of residency training programs from patient care revenue generated by the residents themselves. This means that GME subsidies largely flow into hospital general revenues rather than improving resident compensation.
Emphasis on exemption from antitrust and reform
The conduct of the match shall generally be subject to investigation under Section 1 Sherman Act. In 2002, a group of residents filed a class-action lawsuit arguing that the match violated federal antitrust law. A federal court allowed the case to proceed.
But in April 2004, just two months after that decision, Congress added a last-minute clause to the Pension Funding Equity Act that gave Match full antitrust immunity. The waiver not only ended the lawsuit but also barred the use of any match-related evidence in future antitrust proceedings.
Representative Victoria Spartz re-introduced the Medical Residents’ Restoring Rights Act (H.R. 3018) in April 2025, which would repeal the match’s antitrust exemption by removing Section 207 of the Pension Funding Equity Act of 2004. The committee’s report states that repealing the exemption would not eliminate Match itself, but would restore the courts’ ability to evaluate its practices under existing antitrust law.
What does this mean for future doctors
For medical students managing six-figure student loan balances, the match creates a financial dilemma. They cannot negotiate salaries. They can’t shop around for competing offers. They certainly cannot choose their geographical location. And if they fail to match at all, they are effectively denied any status for the entire year.
In 2025, at least 11,734 applicants (22.6%) remained unmatched on match day. An additional 2,308 positions were secured through the Supplemental Offer and Acceptance Program (SOAP), a four-day scramble for the remaining spots.
That’s still the minimum left 9,426 applicants, or 17.9%, with no known place of residence. Unmatched applicants cannot practice medicine, cannot make meaningful progress on student loan repayment, and face lower odds of matching in future cycles because hospitals view prior failure to match as a “black mark”.
The report argues that the broader result is that suppressed resident salaries are discouraging qualified students from studying medicine. In a survey of medical students in 2023, 69% said they were concerned about their income, 63% expressed concern about burnout, and 60% were concerned about a shortage of physicians.
The AMA itself warns medical students that “it takes years to realize your earning potential.” Northeastern University professor Kristin Madison explained to the committee that low wages could push talented graduates toward other careers, reducing both the quantity and quality of the physician workforce.
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