As a program director more than a decade ago, Jordan Cohen, M.D., helped create an 80-hour workweek for residents in internal medicine--long before accreditors imposed the limit for all residents this summer.
Now Cohen is the leading official in what The New York Times calls the "medical establishment." As president of the Association of American Medical Colleges, he is defending the 50-year-old National Resident Matching Program against a slow-moving antitrust lawsuit.
Filed by former residents in May 2002, the suit is not scheduled for trial until 2006. While Cohen asserts that the AAMC and other defendants will win, he says he is trying to remove a cloud of legal uncertainty the lawsuit has created.
The AAMC, the most prominent sponsor of the match, is asking Sen. Edward Kennedy (D-Mass.) and other senators to create an antitrust exemption for the process, which detractors see as "paternalistic" and exploitative of residents.
Kennedy staffers have said during the summer and into the fall that they have been crafting a bill. But they have not released anything other than the somewhat cryptic statement that "if the match is in jeopardy, Congress has to protect it in a way that meets the needs of both teaching hospitals and medical students."
Among senators whom the AAMC has approached, the office of Sen. Hillary Clinton (D-N.Y.) has had no comment on a possible exemption. Meanwhile, Sen. Jon Corzine (D-N.J.), is "concerned about the effect it might have on working hours and patient care," says aide Darius Gore.
Sherman Marek, a Chicago attorney representing plaintiffs in the lawsuit, says residents are "captives" of the monolithic match system, which keeps pay low (about $37,000 for first-year residents) and discourages transfers between programs.
A recent poll shows most medical students think the match process could be improved, according to the American Medical Student Association, which takes a neutral stance on the lawsuit and the exemption.
Cohen asserts the system is fair and represents "an orderly way of matching the preferences of students with the preferences of programs."
Salaries are low because "this is an educational stipend for graduate students," he says. "These are students who are getting a tremendous advantage."
Meanwhile, Cohen says defendants in the lawsuit, including several teaching hospitals, expect to spend tens of millions of dollars in legal fees on the case, "a huge, huge burden."
At a time when single programs have to spend millions to comply with an 80-hour workweek limit, "this is money that is desperately needed by these teaching hospitals," he says.