For decades, medical school graduates entering a residency program only had a vague idea about what to expect in the way of benefits, hours and salary when they selected a site for their advanced clinical training.
That's because few of these young physicians received detailed contracts before compiling a list of their preferred training programs with the National Resident Matching Program. And when the NRMP matched students with one of the residency programs on their lists, the doctors were required to sign a contract with the institution, regardless of the terms.
Now, the program-a Washington-based not-for-profit that matches about 24,000 students with residency programs every March- has liberalized that strict policy, approving guidelines last week requiring full disclosure of all contract terms before medical students rank their preferences in the first step toward their long-term commitment.
"This is an extremely important change," said Lauren Oshman, national president of the 40,000-member American Medical Student Association in Reston, Va. "Once you've listed preferred residency programs, you are legally bound to attend that residency. You can now see the contract you'll be expected to sign."
Ingrid Philibert, director of field activities for the Accreditation Council for Graduate Medical Education in Chicago, said she expects the new policy to add another level of administrative burdens to some residency programs, especially larger ones at teaching hospitals. "Any good idea, when you make it a requirement, has a certain amount of added burden, obligation and pain associated with it," she said. "But I'm not sure most (programs) have really thought this through. It's pretty early yet."
Oshman credits the lobbying effort by her group with helping to persuade the NRMP to change its long-standing policy. While contract terms are standard and salaries always are fairly low for residents, it's vital for students to know exactly what they're getting into, Oshman said.
The NRMP's new policy will go into effect for applicants taking part in the March 2005 match. For the last two matches, the association has asked residency programs to voluntarily provide a detailed sample contract to would-be residents.
Robert Beran, executive director of the NRMP, said the group's board of directors has been working on this change in policy for about three years-before the intense lobbying efforts by student groups like the AMSA.
"It's a significant change," Beran said. "There's a big difference between providing some kind of a sample contract and providing the actual contract that a student will have to sign on July 1."
The typical medical school graduate ranks about 10 or 11 residency programs in order of preference sometime in February after a round of face-to-face interviews with program directors or staff, Beran said. If they are assigned to any of the programs on their list on "Match Day"-always the third Thursday in March-students must sign a contract with that institution.
"This will allow a student to see the actual contract for residency programs before they finalize the rank-order list," Beran said, adding that about 80% of U.S. medical school graduates are matched to one of their top three choices.
A survey earlier this year by the NRMP indicated that about 90% of residency programs would be willing to provide students with actual contracts this year, he said. Many of those programs already include specific contract language on their Web sites, he said.
Beran said the liberalization of the group's policies predates an antitrust lawsuit filed against the NRMP and other groups last year in Washington, charging that the annual match thwarts competition and keeps wages low-most residents earn about $40,000 a year and often work 80 hours or more a week. Teaching hospitals across the nation have asked Congress to intervene and pass a law to block the lawsuit, now pending in federal court.