Jung v. Association of American Medical Colleges

The anti-trust class-action lawsuit Jung v. AAMC alleged collusion to prevent American trainee doctors from negotiating for better working conditions. The working conditions of medical residents often involve 80- to 100-hour workweeks.^[1] The suit had some early success, but failed when a law was passed that exempted residency programs from anti-trust law.

Background

In order to obtain accreditation as doctors, American medical graduates are required to enter into a contract to accept whatever residency position they are assigned. They rank available jobs in order of preference; employers rank applicants in order of preference. They are then matched to a job by the AAMC, and told what the working conditions and pay are. It is very difficult to change residency programs.^[2][3]

This system is referred to as the National Resident Matching Program or "Match system".

Lawsuit

The suit was launched on behalf of all current and former medical residents, against defendants that oversaw and participated in the match process and employed medical residents.^[2]

The three doctors who launched the suit allege that the Match system is an anti-competitive practice, claiming that:

• fourth-year medical students have to apply to the Match, and have no opportunity to negotiate its conditions (if they do not apply, they cannot do a residency accredited by the ACCGME, and hence cannot get accreditation as physicians from the ABMS, meaning that they cannot practice their specialty)
• the defendants limited the number of residency positions available through the Match
• the defendants place “substantial obstacles to the ability of a resident to transfer employment from one employer to another during the period of a residency”
• the AAMC encouraged or required participation in the Match as a condition of accreditation for institutions offering residencies.
• the defendants shared information on conditions of employment, and reviewed them in order to keep them low.

^[3]

The defendants challenged the admissibility of the lawsuit with several arguments, including arguiing a lack of jurisdiction ^[4] and arguing that the plaintiffs had not been injured.^[5] The court dismissed the cases against two defendants for lack of jurisdiction, and three because the claims of conspiracy did not involve them. The federal district court did, however, admit the case against 17 defendants, ruling:

...the Court finds that plaintiffs adequately have alleged a common agreement to displace competition in the recruitment, hiring, employment and compensation of resident physicians and to impose a scheme of restraints that has the purpose and effect of fixing, artificially depressing, standardizing and stabilizing resident physician compensation and other terms of employment among certain defendants.

^[4]

Legislative change

The lawsuit ended when a law was passed that exempted residency programs from anti-trust law.

The law change was passed as a rider added to an unrelated bill (the Pension Funding Equity Act). The rider was called “Confirmation of antitrust status of graduate medical resident matching programs” (Section 207). Neither the rider nor the then-ongoing Jung v. AAMC case were debated. The rider was lobbied for by the AAMC and the American Hospital Association, and sponsored by Senator Judd Gregg of New Hampshire and Senator Edward Kennedy of Massachusetts.^[2] Senators Kohl, Feingold, and Bingaman publicly criticized the way in which the rider was added.^[3]

The rider praised the 50-year-old Match program, saying that “[a]ntitrust lawsuits challenging the matching process, regardless of their merit or lack thereof, have the potential to undermine this highly efficient, pro-competitive, and long standing process” and “would divert the scarce resources of our country’s teaching hospitals and medical schools from their crucial missions of patient care, physician training, and medical research”^[2]

The bill containing the rider was signed into law by President George W. Bush on April 8, 2004.^[2]

The new law prohibited “using allegations related to the Match to support any antitrust claim",^[2] retroactively.^[3] The court ruled that the plaintiff's case was dependent on allegations related to the Match.^[2] The case was dismissed under the authority of the new law.^[6]

See also

• Medical resident work hours
• National Resident Matching Program
• Match Day (medicine)
• Medical education
• Jung v. Association of American Medical Colleges et al., 300 F.Supp.2d 119 (D.D.C. 2004)
• Pension Funding Equity Act of 2004 § 207, Pub. L. No. 108-218, 118 Stat. 596 (2004) (codified at 15 U.S.C. § 37b)

References

1. Archived May 27, 2006, at the Wayback Machine.
2. Weinmeyer, Richard (2015-02-01). "Challenging the Medical Residency Matching System through Antitrust Litigation". Virtual Mentor. 17 (2): 149. doi:10.1001/virtualmentor.2015.17.2.hlaw1-1502. Retrieved 2016-05-06.
3. Jung v. Association of American Medical Colleges: A Special Interest Victory, Miranda W. Turner, University of Houston Law Center,November 2, 2004
5. Bierig, Jack R. (2004-01-01). "Jung v. Association Of American Medical Colleges: the lawsuit challenging our system of graduate medical education". Journal of the American College of Radiology. 1 (1): 40–47. doi:10.1016/S1546-1440(03)00007-3. ISSN 1546-1440. Retrieved 2016-05-06.
6. Robinson, S. (August 14, 2004). "Antitrust Lawsuit Over Medical Residency System Is Dismissed". New York Times.