Skip to content 
For decades, the National Resident Matching Program (NRMP) – better known simply as “the Match” – has decided where most new doctors begin their careers. It’s a system that promises fairness, structure, and consistency on a national level. Each spring, tens of thousands of medical graduates (41,000 in 2024) submit their preferred training programs, and hospitals list their own rankings.
A computer then aligns the two, and within seconds, lifelong trajectories are set. But now, after years of relative quiet, that system is under scrutiny once again.
But now, this decades-old system is facing renewed scrutiny.
Congress Opens Antitrust Investigation Into the Match
In March 2025, the U.S. House Judiciary Subcommittee on Antitrust initiated a formal investigation into the Match system, questioning whether it violates free market principles and limits opportunities for new doctors.
Representative Scott Fitzgerald (R-WI), who chairs the panel, described the Match system as one that “has distorted the American medical residency market, undermining free market principles to the detriment of that nation’s doctors and the patients who rely on them.”
The probe revisits a fundamental question: Has the NRMP, protected from antitrust lawsuits since 2004, created a bottleneck that hurts medical students and contributes to the country’s physician shortage?
A History of Legal Challenges to the NRMP
It’s not the first time this system has come under fire. In 2002, a group of residents filed a class-action lawsuit alleging that the Match violated antitrust laws by limiting their ability to negotiate wages and working conditions.
The suit named several major hospital systems and medical associations as defendants. Plaintiffs argued that centralized matching made it nearly impossible for residents to seek better terms or explore other offers.
The lawsuit was ultimately dismissed — but not before Congress stepped in. In 2004, lawmakers passed an amendment to a labor bill explicitly exempting the Match from antitrust laws.
Lawmakers argued that the system preserved order and fairness in residency placements, avoiding the chaos of the job market that existed prior to the Matching founding in 1952.
Back then, medical students often received offers early in their final year and were pressured to accept before fully exploring their options. This led to rushed decisions and an uneven distribution of talent.
The NRMP was designed to eliminate that chaos and bring consistency to what had become a nationwide problem. Over time, it became a pillar of graduate medical education — so entrenched that few imagined a viable alternative.
Yet, the healthcare environment has changed significantly since then. In the 1950s, training slots were more abundant relative to the number of graduates, and the same financial pressures or workforce dynamics didn’t shape the system.
Today, however, with medical school debt climbing into six figures and physician burnout rising, critics say the rigid structure no longer fits the economic reality young doctors face.
Modern Pressures and Outdated Structures
While the number of U.S. medical graduates has surged, the number of residency positions has remained relatively flat – largely due to one complicating factor: funding.
Most residency positions are financed through Medicare, which pays teaching hospitals to train new doctors. However, that funding has been largely capped since 1997, when Congress froze the number of positions it would subsidize. Hospitals can still create new slots, but doing so without federal support is costly. As a result, the number of available residencies has not kept pace with the growing number of medical school graduates.
According to the Association of American Medical Colleges, the U.S. could face a shortage of up to 86,000 physicians by 2036. Yet every year, thousands of qualified graduates are left without a place in the system—not because they failed to meet standards, but because the structure itself has no space for them.
In 2024, more than 8,800 medical school graduates failed to secure a residency spot through the Match. That number represented nearly 20% of applicants—many of whom are now unable to practice medicine in any state, since licensure requires completing an accredited residency.
Resident Salaries vs Inflation
Resident salaries have increased by a mere 27% over the past decade, while inflation has gone up by 33% in the same period. Medical school debt often exceeds $200,000, and burnout among trainees is widespread.
The House Judiciary Subcommittee, aware of this disparity, has asked for documents and internal communications from major players in the medical education system, including the American Medical Association, the National Resident Matching Program, and institutions like Duke Health and Stanford Medicine.
They want to know whether hospitals or residency programs have exchanged salary data, coordinated hiring practices, or discouraged residents from moving between programs. They’re also asking looking into complaints from students who felt locked into placements or were unable to negotiate their pay.
“For years, resident wages have remained stagnant while doctor shortages have increased,” Fitzgerald said. “This harms medical students and hospital patients, and forces us to rely on foreign talent to fill the gap.”
Medical Labor Market vs. Free Market Principles
The institutions under review argue that the Match is not only fair, but necessary. They say it removes the chaos that once plagued the system, when hospitals would offer positions early and pressure students to commit before they were ready.
The committee has requested that all relevant materials be submitted by the end of March, but there’s no deadline for when findings or recommendations might be released. The investigation doesn’t mean immediate changes are coming, but it does mark a shift in how lawmakers view the balance between structure and freedom in medical education.
Congress acknowledged the Match’s merits when it passed the antitrust exemption in 2004. The law stated that the Match helped students make more informed decisions, and that it kept the process orderly, predictable, and free from coercion.
But the current investigation suggests a growing skepticism. The Judiciary Committee noted that the Match is effectively the only way to enter most accredited residency programs, and that the groups overseeing it – namely the ACGME and NRMP – hold monopoly-like power over who gets to become a practicing physician.
If those groups also influence how much residents are paid and where they can work, as the argument goes, then the system may be functioning more like a syndicate than a neutral marketplace.
One thing is for certain: the once-untouchable Match system is now facing a level of federal scrutiny it hasn’t seen in two decades.
The Road to Residency Reform
David Skorton, president of the Association of American Medical Colleges, responded cautiously, saying the organization was preparing a formal reply to Congress. Other institutions named in the inquiry have not yet commented publicly.
In the meantime, many in the medical community are watching closely. For current residents, the Match is a lived experience — not an abstract policy.
Most remember the nerves of Match Day, the months of uncertainty, the feeling of handing over control to a mysterious algorithm. Some defend the system as the best of many imperfect options. Others see it as a one-shot deal with little recourse for those who don’t land a spot.
Physicians further along in their careers may not feel the effects immediately, but the implications are real. A system that restricts negotiation can influence everything from where future doctors choose to train, to whether they stay in the field at all.
When early-career physicians are denied flexibility or fair compensation, the long-term cost is felt not just by individuals, but by clinics, hospitals, and ultimately, patients.
There’s also the question of how these constraints influence the broader healthcare labor market. In other industries, newly trained professionals can weigh offers, negotiate pay, or pivot into different roles if their first job doesn’t suit them.
Residents have no such luxury. Even lateral movement between programs is rare, and often discouraged. For those who discover their interests evolve — or find themselves in difficult work environments — the options are limited.
The Case for Rewriting the Rules
Of course, the Match wasn’t designed with modern labor economics in mind. It came into being at a time when medicine was less commercialized and training slots were more plentiful. Today’s healthcare landscape is different. Consolidation among hospital systems, rising student debt, and national conversations about equity and burnout have reshaped expectations.
Whether the Match can keep up – or whether it should – is what Congress now hopes to determine.
For most medical students, Match Day is a moment of excitement and anxiety – marking the culmination of years of study, and the beginning of their clinical careers. But for thousands each year, it’s also a dead end.
The stakes of reforming the Match are enormous. Not only for students and hospitals but for healthcare systems that cannot afford to waste talent or tolerate inefficiencies.
At a time of rising demand and falling morale, the question is no longer whether the Match is functional; it’s whether it’s fair and whether it’s still fit for the future of American medicine.
For now, the Match remains the gatekeeper. But as with any gate, once its mechanics are examined too closely, someone may start asking, “Isn’t it high time we made an upgrade?”
