What Could Possibly Go Wrong When Doctors Are Forced to Work 28-Hour Shifts? Part 2

Yesterday I blogged about how medical residents are being forced to work 24-28 hour shifts.  Today, let’s look at how the National Resident Matching Program (the Match) devised a system to create residents programs that enables hospitals to pay low salaries while demanding double or triple the hours and not have to pay overtime. Wow. Resident work hours and conditions are considered worse than the horror stories you hear about Chinese factory workers. Really?
 
I vividly remember Match Day at Stanford Medical School in 2013. 80+ med students gathered with their parents in a large auditorium in March.  The med students had interviewed all over the country to rank their top~10 hospitals where they hoped to do their residencies. The president of SMS handed out white envelopes to each medical student and asked them to wait until all of the students had received theirs.  Then, all of the students opened their envelopes at the same time (across the nation) to see where they were going to spend the next 3-7 years of their lives (depending on specialty). What happened next surprised me. Some screamed with excitement, others burst into tears, while others stood in shock.  I was appalled by this seemingly inhumane and unprofessional way for a medical student to select the best residency program. These students had previously chosen their colleges and chosen their medical schools. Every other profession gives more fluidity in making these important decisions.  So why does the Match have this arbitrary protocol that gives residents no say in where they’ll be doing their residency?
 
It’s always about the money.
 
The Match is a computerized processing system that assigns each medical student graduate to the hospital where they will do their residency.  The system is supposed to allow med students to rank the hospitals and the hospitals to rank the students to create this fair match based on who wants whom the most.  Although it might sound fair on the surface, it really isn’t.  Here’s why:
 
First, this decision is non-negotiable.  The students sign the contract before the Match to accept all employment conditions such as position, schedule, pay, and benefits - whatever is inside that envelope. 
 
Second, the hospitals collude in salary-setting across the nation.  They make some exceptions only for cost-of-living increases in different cities.  
 
Third, residents can’t change hospitals. This gives hospitals no incentive to offer fair wages or humane work schedules.
 
Fourth, residents are required to work 80+ hours per week and 24+ hour shifts. Hospitals use residents to do non-patient care (clerical work or transporting equipment and patients) to save money on more expensive employee wages. 
 
The consequences are dangerous – for everyone.