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Relationship between wages and presence of a match in medical fellowships.

To the Editor: There is ongoing litigation about whether the National Resident Matching Program (NRMP) restrains competition for residents and suppresses wages. 1 Although the legal issues have been discussed in detail, 2,3 the basic economic question is whether a market organized by a match results in lower wages than if there were no match. We compared similar markets for postgraduate medical fellowships that operate with and without a match. Methods. Some subspecialties of internal medicine use the Medical Specialties Matching Program (MSMP), while others use no centralized match. We purchased from the American Medical Association the Graduate Medical Education Directory, 2002-2003 data set of fellowship wages by program, 4 and compared all internal medicine subspecialty fellowships in the United States requiring 3 years of prior residency. Of the 1249 directory entries representing 14 subspecialties in 209 hospitals, 1178 include wages. Sports medicine was excluded because there are only 2 internal medicine programs in that subspecialty, bringing the final number of directory entries including wages to 1176. Results. The mean compensation of the 4 subspecialties that use a centralized match is $41963 ($41357 weighted by number of first-year fellows), while it is $41 171 ($41 248, similarly weighted) for the other subspecialties that do not use the MSMP (Mann-Whitney U test, P=.28) (TABLE). Furthermore, the median, minimum, and maximum wage, and the SD of the distribution of wages of subspecialties that use the MSMP, are all marginally greater than those that do not use this match (Mann-Whitney U test, PϾ.05 for each). To test the hypothesis that, within hospitals, wages for sub-specialties that use the match are different than wages for sub-specialties that do not, we computed the average wage within each hospital for subspecialties that use and do not use the MSMP. The Wilcoxon matched-pairs signed-ranks test for 169 hospitals was nonsignificant (P=.96). Comment. Internal medicine subspecialties that use the MSMP do not offer different salaries than those that do not. Thus, a match is not the feature of these markets that determines wages. The market for fellowships is not the same as the market for residencies: there are similarities and differences. Although both the MSMP and the NRMP use the same Roth-Peranson matching algorithm, 5,6 stipends for residents are presently funded largely by Medicare, while fellowships are mostly funded by the National Institutes of Health. In each case, additional funds would need to be found if wages were …