House Judiciary subcommittee examines 2004 antitrust exemption for residency match, witnesses disagree on causes and fixes

At a House Judiciary subcommittee hearing on medical residency antitrust exemption, witnesses and members debated whether Congress should repeal a 2004 statutory carve‑out that shields the National Resident Matching Program (the match) and related practices from antitrust liability and whether that carve‑out is a primary cause of suppressed resident pay and constrained physician supply.

The exchange centered on three questions: whether the match and Accreditation Council for Graduate Medical Education (ACGME) accreditation fostered anti‑competitive labor conditions; whether repeal or narrower reform would increase residency slots or resident pay; and whether broader federal funding decisions are the central barrier to training more physicians.

Why it matters: federal Medicare and Medicaid funding channels, ACGME accreditation and the match together shape how more than 40,000–50,000 new physicians enter training each year. Policy changes could affect resident wages, program availability—especially in rural and underserved areas—and the pipeline of physicians available for licensure and practice.

Witnesses' testimony

Dr. James Lynn, identified in the hearing as a clinical professor affiliated with the Lake Erie College of Osteopathic Medicine (LECOM), told the subcommittee that ACGME’s accreditation standards are “increasingly detrimental” to residency and fellowship programs in rural and underserved areas and that a “one‑size‑fits‑all” accreditation model has forced closure of smaller community programs. Lynn said the closures reduce local access to care and cited LECOM’s experience: he said the institution had trained hundreds of physicians who remained in the region but that multiple programs were closed or denied flexibility because ACGME rules favor large academic centers. “This rigidity stifles innovation, penalizes lean and effective community models, and directly contributes to the loss of training pathways for future physicians,” he said.

Attorney Sherman Merrick, who represented residents in earlier litigation seeking antitrust relief, urged repeal of the 2004 exemption. Merrick said his 2002 lawsuit (referred to at the hearing) demonstrated anticompetitive restraints in the matching system and that hospitals pushed the 2004 legislative carve‑out into law. Merrick testified repeal would “restore the authority of courts to examine [the match’s] merits” and could prompt hospitals to reform or face antitrust scrutiny.

Thomas Miller, a resident fellow at the American Enterprise Institute, argued for a more calibrated approach: he described the match algorithm itself as mathematically efficient for its purpose but said the broader set of practices and rules that attach to the match create market power and wage compression. Miller recommended a review of the exemption and possible conditional reforms to preserve useful features of the match while addressing labor market problems.

Dr. William Feldman, an assistant professor at Harvard Medical School and Brigham and Women’s Hospital, warned that eliminating the match would not automatically produce more residency slots or higher resident pay. He told the committee that “in 2024, 99.6% of the more than 40,000 advertised positions were filled,” and said the central constraint to increasing physician supply is a lack of funded residency positions—funding that largely flows through Medicare and Medicaid. Feldman said other policy levers—expanded federal funding for graduate medical education, support for unionization, loan forgiveness, or targeted incentives—could address shortages and compensation independent of antitrust status.

Points of contention and common ground

- Causes of low pay and shortages: witnesses disagreed about whether the match exemption is the dominant cause. Merrick and Dr. Lynn emphasized anticompetitive effects and accreditation rigidity; Feldman and Miller pointed to funding shortfalls and recommended a broader policy toolkit.

- Rural programs and accreditation: multiple witnesses and members said ACGME standards and consolidation after the ACGME–AOA merger have disproportionately affected smaller community and rural programs. Dr. Lynn described programs that closed after failing to meet uniform criteria and asked Congress to consider alternative accreditation pathways or more flexible standards for rural tracks.

- Remedies discussed: repeal of the 2004 exemption; narrowing the exemption and imposing conditions (for example, limits on wage suppression or bans on anti‑transfer practices); increased federal funding for new residency positions; support for resident collective bargaining; and creation or recognition of alternative accreditors for specific rural or consortium models.

Administrative and broader policy context

Several witnesses and members linked the residency debate to larger federal priorities. Dr. Feldman and other members expressed concern about proposed cuts to NIH, CDC and NSF funding and said deep research and public health cuts would harm medical education and patient care. Witnesses also noted that Medicare and Medicaid provide the bulk of funding for graduate medical education and that any proposal to expand residency positions would likely require additional federal appropriations or statutory changes.

What the committee record shows

No legislation was voted on at the hearing. Members submitted additional materials for the record and the chair said members would have five legislative days to submit written questions and materials. Witness statements and documents referenced at the hearing will be included in the committee record.

Ending

The hearing presented sharply different diagnoses of how to expand physician supply and improve resident compensation: some witnesses urged restoring antitrust review of the match and reforming accreditation, while others urged Congress to focus first on funding more residency positions and other incentives. The committee has requested stakeholder materials and left multiple reform options on the table for further consideration.