The False Choice at the Heart of The Match

This past week, a congressional report pulled back the curtain on something physicians have quietly known for years: something is deeply wrong with the way we approach our medical training system.

A new report from the U.S. House Judiciary Committee describes the Match as a monopoly over the residency labor market, one that “strips applicants of their ability to negotiate” and forces them into fixed salaries and conditions. Let’s be clear about what this means. This is a labor market where:

• wages are artificially suppressed

• mobility is restricted

• negotiation is effectively eliminated

Residents are not paid based on the value they provide. They are paid based on what a non-competitive system allows.

The defense has always been the same, “Residents are learners, not employees. They’ll make plenty when they become an attending.” But the data (and anyone who has been through residency, who is being honest with themselves) tells a different story. Residents work 60-80 (often more) hours per week and generate hundreds of thousands of dollars in value annually. They are also responsible for teaching medical students and other residents, yet “[r]esidents generally earn less, on both an annualized and hourly basis, than other hospital employees such as nurse practitioners and physician assistants, and resident wages have been stagnant since the 1970s.” This is the definition of a controlled wage structure, only made possible because residents cannot negotiate, cannot walk away and still become a board-certified attending, and cannot compete in a competitive market.

This is not just a resident problem. The biggest mistake is that physicians think that these issues end after training. With costs ballooning across the board from medical school, to travel costs for interviews, cost of living, insurance, etc, current residents are more likely than ever to finish training with a significant amount of debt. This means that graduating residents are entering the workforce and a labor market at a significant disadvantage. Which doctor would be more willing to negotiate with their prospective employer - one who is $200k in debt in their 30s, or one who has little to no debt?

And the money is just one piece of the problem. Without negotiating power, residents and later, attendings, will continue to be forced to endure deteriorating work conditions and a lack of autonomy. If you normalize lack of negotiation, institutional control over labor, and the idea that your work is not yet worth full pay, you don’t suddenly unlearn that on July 2nd after graduating residency. You carry that forward, and the system benefits from it.

A workforce in debt, burnt out, and conditioned not to push back is easier to manage, easier to underpay, and less likely to advocate for structural changes.

This report makes something clear - this system was no accident. The Match was designed, in part, to eliminate competition between hospitals. “[I]n 2004, Congress granted the Match an antitrust exemption that immunized its anticompetitive conduct and barred the use of Match-related evidence in antitrust proceedings.”

No Competition —> No Bidding

No Bidding —> No Wage Pressure

No Wage Pressure —> Suppressed Salaries

This is basic economics and the known outcome of a monopolistic environment, yet in medicine we’ve been told that this is just how it is.

The most limiting part of this conversation is the assumption that reform means completely abandoning structure. It does not. There are countless models between monopoly and free market:‍

• Non-binding Match system that forces institutions to incentivize

• Regional or specialty-based matching systems

• Standardized contracts with negotiable components

• Mobility pathways between programs and specialties

• Transparent salary bands with competition above a floor

Other industries and countries already use variations of these approaches and they have not collapsed the system.

Congress is now openly questioning whether the Match’s antitrust exemption should be repealed. This is not the finish line, but it is an important step. Yet, doctors and medical students need to be prepared. This may be a years-long fight, and now is the time to discuss and advocate for better solutions.

Physicians are what create this market - do not let the institutions tell you otherwise. Or for that matter, other physicians who dismiss the idea that things need to change.

We are not suggesting that all physicians need to agree on one solution. But we do need to reject one thing unequivocally - that the current system is fair or inevitable. Because it is not. And just because The Match may have improved some aspects of the transition from medical school to residency, does not mean that we should be satisfied. The Match has not snuffed out favoritism, institutional bias, racism, sexism or any number of violations that this ‘perfect algorithm’ was designed to do. And nothing will improve if we do not advocate for ourselves.

If you are trained in a system where you cannot negotiate your value, you will spend your career trying to relearn how.

And by the time that you do, it may already be too late.

A Few Of Our Favorite 'Progress Notes' From March

Sleep Reform for Physicians Parts II & III

By Laura Vater, MD, MPH

I share this blueprint today with the hopes of empowering trainees who wish to advocate for sleep reform at their own programs and institutions. When I was in training, I wish I’d had a resource outlining the harms of sleep deprivation. Here is a detailed summary, formatted as a letter, that can be presented to program leadership.

What Happens When You Have to SOAP or Scramble

By Kate Buhrke, DO & Megan Jenkins-Turner, DO

Not matching can feel like a judgment of your worth. It is not. It is an unfortunate outcome inside a constrained system. There are more qualified applicants than there are residency positions, and spots are not growing at the same pace as medical school seats. So, if you don't match, then what comes next? SOAP week can feel like a maze. Let’s walk through it together chronologically.

When Incentives Become Instinct

By Mel Thacker, MD

Physicians are fiduciaries. We are taught that our obligation is singular: act in the patient’s best interest. But when we are incentivized—by dollars or by RVUs—we intervene in ways to maximize our compensation. The question is, how often do we admit that to ourselves? We are trained to recognize disease, not how to recognize distortion in ourselves. I knew how to identify obstruction on imaging, but I was completely unskilled at detecting the invisible pressures shaping my own judgment.

The Things They Carried

By Latha Panchap, MD

At 2:37pm, three pagers went off at once. There was a new pain consult from SICU, a polytrauma arriving in the ED, and a code occurring on the medical oncology floor upstairs that would need an airway. Fries and half-eaten meals were abandoned with intent to return, although unclear what hour that would be, and the team quickly and dutifully dispersed to attend to their patients.

How to Budget for Away Rotations Without Losing Your Mind

By Iya Agha, DO

Away rotations are expensive. Let’s just say it plainly. Flights, rent, food, transportation, application fees. It adds up fast. And when you are a medical student already living on loans, the financial stress can feel overwhelming. First, you need a real budget. Not a vague idea. A spreadsheet. Before you even apply, estimate how much each rotation will cost. Look at average rent in the area. Check flight prices. Calculate food and transportation. When you see the full number, it feels scary, but clarity is power.

Philosophical Physicians: Aristotle

By Kate Buhrke, DO

I believe that by Aristotelian standards, modern residency training stands in direct conflict with human flourishing. The traits Aristotle identified as essential to a good life are frequently treated as liabilities rather than aims: wisdom and contemplation as hesitation, fairness as softness, moderation as lack of commitment. If the goal of professional formation is excellence, not only in technical skill, but in character, then the problem is not that residency is hard: it’s that we’ve lost clarity about what that hardness is for.

Not Carried Alone: Traumatic Grief in Hamnet

By Sacha McBain, PhD

Hamnet does not argue that grief becomes lighter. It suggests something more modest and more useful: that it becomes more shareable. And in that redistribution, the work of carrying it changes. Not because the loss is repaired, but because it is no longer held in isolation.

Artist in Residency

A quick update about our Spring 2026 Artist in Residence. Thank you to everyone who submitted their work - we were truly overwhelmed with the sheer amount, quality, and diversity of works from so many talented residents and medical students. This cycle’s A.I.R. has been chosen, and we will make a formal announcement soon.

In the meantime, many of you will have the opportunity to showcase your work in our creative arts magazine, Ex Vivo. Be on the lookout for an email, or if you would like to submit something else, now is the time!

Your Podcast Binge List

We linked some YouTube and Spotify pages for you, but click here to listen to any of our shows on the platform of your choice.

• Social Rounds - Tony Chin-Quee, MD, Frances Mei Hardin, MD with Kate Buhrke, DO- Speaking Up In Surgical Residency & Paying The Price

• Fem MD - Lauren Umstattd, MD & Brooke Martin - Inside the Life of a Female Plastic Surgeon Founder (Interview with Dr. Lauren Umstattd)

• Surgeons with Purpose - Mel Thacker, MD & Cornelia Griggs, MD - Women Are Leaving

• Surgeon, Interrupted - Frances Mei Hardin, MD - Choosing Locums Straight Out of Residency with A.YoungDoctors.Journey

• The Other Human in the Room - Joan Chan, MD - Crazy Busy Doctor Wisdom with Dr John Crosby

Explore Our Growing Podcast Network

Here’s what’s live and ready for your next commute, call-room break, or coffee run:

• Social Rounds - Tony Chin-Quee, MD + Frances Mei Hardin, MD

• Fem MD - Lauren Umstattd, MD

• Surgeons with Purpose - Mel Thacker, MD

• The Other Human in the Room - Joan Chan, MD

• Surgeon, Interrupted - Frances Mei Hardin, MD

Want to Get Involved?

Since launching, we’ve been blown away by how many physicians have reached out asking, “How can I get involved?”

Here’s how:

• Submit your writing for consideration on our blog

• Pitch us a creative idea or original column

• Apply to be a guest on a podcast

• Follow us and share our content on Instagram, TikTok, and YouTube 

The Collective only works because of voices like yours, and there’s always room for more.

Until next month,
The HC Team

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