A new House Judiciary Committee staff report is taking direct aim at the system that assigns freshly minted doctors to residency programs, arguing the longtime Match operates as a hiring monopoly that worsens the country's physician shortage and keeps trainees stuck with low pay and rough working conditions. The interim report contends the problem is not just about coordinating offers and acceptances, but about a structural choke point that limits how many physicians actually make it into practice.
The interim staff report, released March 27, 2026, says internal documents and transcribed interviews show the National Resident Matching Program, or NRMP, "exercises monopolistic control" over the residency market, limiting residents' ability to move or negotiate, according to the House Judiciary Committee. Investigators single out the Match's "All In" policy and the NRMP's 2020 merger with the American Osteopathic Association as key moves that locked in the program's dominant position.
What the committee found
The report notes that applicants who break Match commitments "can be barred from the matching process for one to three years, or in some cases indefinitely," and highlights how resident salaries remain strikingly similar across many programs. Committee staff say those patterns point to suppressed wages and limited competition, according to the House Judiciary Committee. They argue the result is worse access to care for patients and higher burnout among trainees who feel they have few options once they sign on.
Match numbers and the workforce gap
NRMP data show the 2026 Main Residency Match listed more than 44,000 positions, while roughly 48,000 applicants submitted rank lists, which left several thousand would-be residents unmatched. Nearly 42,000 positions were filled in the initial Match round, according to NRMP. That gap is not just a paperwork headache. The Association of American Medical Colleges projects a shortage of up to 86,000 physicians by 2036, a deficit lawmakers and health systems say must be closed to avoid longer waits and thinner coverage, per the AAMC.
Critics and alternatives
Some physicians and reform advocates argue the Match's rules turn a funding shortfall into a full-blown workforce crisis. Dr. Frances Mei Hardin, an ENT who runs the Rethinking Residency blog, told Spectrum News that trainees often feel stuck when a program's culture is a bad fit, yet they see no realistic path to leave. Hardin and others have floated ideas such as nonbinding early offers, clearer routes for residents to transfer between programs, and direct-hire tracks that would sit alongside the Match to give applicants more leverage.
NRMP pushes back
NRMP leadership strongly disputes the committee's take. The organization told Spectrum News that the "claims ... are unfounded" and warned that dismantling the Match would "deprive future applicants of a proven, transparent, and efficient system." NRMP also stresses that it does not control how many residency slots exist nationwide and says its role is to help fill the positions that funders, including the federal government, make available.
Legal and policy stakes
The Match has enjoyed antitrust immunity since 2004, when a carve-out for Match-related conduct was added as Section 207 of the Pension Funding Equity Act of 2004. That shield has kept the program and its backers out of antitrust court for more than two decades. Now, some lawmakers want it gone. Rep. Victoria Spartz's Restoring Rights of Medical Residents Act (H.R.3018) would repeal Section 207, according to Congress.gov. Legal analysts say ending the immunity would not automatically shut down the Match, but it would expose the NRMP and supporters to standard antitrust scrutiny, which could lead to negotiated changes or full-on litigation, according to analysis from Norton Rose Fulbright.
The Judiciary Committee says it plans to keep the heat on as Congress weighs potential legislation and NRMP continues to defend the Match. For more detailed data and the organization's full response, see NRMP.
