ON BEHALF of medical residents across the country, two other doctors and I filed a class-action lawsuit recently challenging as antitrust violations practices that limit competition among hospitals employing resident physicians.
These practices keep wages artificially low, inflate resident work hours and hurt the quality of patient care. We have asked the court to enforce federal antitrust laws and remove these restraints for the protection of both residents and patients. We have also requested financial damages to reimburse residents for lost wages as a result of these practices.
One restraint is the National Resident Matching Program ("the Match"), a computerized processing system that assigns graduating medical students a single, non-negotiable employment opportunity. Resident physicians are forced to take the position and accept all conditions of employment. The Match reduces competitive pressure on hospitals that employ residents and enables them to pay reduced salaries while demanding long and unsafe work hours from residents.
We also challenged as illegal the exchange of detailed wage information among these hospitals.
The routine exchange of this information facilitates price-fixing by providing a baseline to which employers add or subtract a small amount for regional cost-of-living differences. Hospitals also use other price-fixing tools that are even more direct.
For example, employers have been provided with worksheets to help them calculate the "average" wage paid by an employer in their region. On another occasion, hundreds of employers were asked whether they favored establishing rigidly fixed prices in the form of a "national uniform salary schedule." Nearly 70 percent said yes.
Our lawsuit also challenges regulations that make it effectively impossible for resident physicians to change hospitals that employ residents. When residents have no leverage, not even that of quitting, these employers have no incentive to treat them humanely with fair wages and normal work hours. The results can be devastating for both physicians and patients.
A resident's life is physically, emotionally and mentally draining. Many residents work 60 to 100 hours a week, or even more. They are often forced to work 36- or even 48-hour shifts. Why? Because they are the cheapest labor in the hospital.
They are often forced to take on tasks that have nothing to do with patient care - such as transporting equipment and doing clerical work - simply so hospitals can save money on other employees. Sadly, the training process may even weed out people who would make good doctors but who are unwilling or unable to endure the abuse of residency.
The long hours are dangerous to residents.
Numerous studies have shown the increased rate of motor vehicle accidents, obstetric complications and depression among residents. One study, according to a 1997 article in Nature magazine, found that a resident who stayed up for 24 straight hours had the motor skills of someone with a blood alcohol content of 0.10, well above the legal limit for driving.
At least three residents died in one-car accidents in New York alone in the 1990s after working all-night shifts, according to the May 24-31, 1999, issue of American Medical News.
Long hours are also dangerous to patients and reduce the quality of patient care.
Fatigued residents are impaired and cannot be expected to make patient care decisions or perform procedures with efficiency and effectiveness. Study after study confirms the dangers of sleep deprivation, something we all know from common sense.
To protect the public, airline pilots and truck drivers have limits on the number of hours they can work. Yet employers of resident physicians demand double or triple the normal work week, with dangerous repercussions for patient safety.
For the benefit of residents and patients alike, antitrust laws should be enforced and these abusive practices stopped.
Paul Jung is a Robert Wood Johnson Clinical Scholar at the Johns Hopkins University.