Scott Fitzgerald Leads House Judiciary Committee Hearing On Medical Residency Antitrust Exemption

yesterday

The House Judiciary Committee holds a hearing entitled, "The MATCH Monopoly: Evaluating the Medical Residency Antitrust Exemption."

Transcript

00:00:00At any time, welcome everyone to today's hearing on medical residency antitrust exemption.

00:00:07I will not recognize myself for an opening statement.

00:00:10Before I do that, I want to wave on.

00:00:12We have one member, Mr. Onder, Dr. Onder, who will be waving on to today's hearing.

00:00:23Without objection, Mr. Onder will be permitted to participate in this hearing to question the witnesses

00:00:27if a member yields him time for that purpose.

00:00:42When America's future doctors apply for residency, they enter a closed market controlled by a single accreditation monopoly.

00:00:50The Accreditation Council for Graduate Medical Education, or ACGME,

00:00:55and the centralized hiring system called the match, quote-unquote the match.

00:01:01Together, those two gatekeepers dictate who trains, where they train, and at what wage.

00:01:08Through mountains of red tape, the ACGME alone decides which programs survive and how they operate.

00:01:16And because most opportunities are filled through the match, the allegorythm wields unrivaled power over resident hiring.

00:01:26Twenty-three years ago, residents tried to challenge this setup under America's antitrust laws.

00:01:32They argued that the ACGME and match and the programs operating under them colluded to restrict slots, limit choice, and keep wages low.

00:01:43But before the case could be heard, Congress kowtowed to the hospital lobby and slid an antitrust exemption for graduate medical resident matching programs into the unrelated pension bills.

00:01:55As a result, there's no competition now, and it decides a fate of more than 50,000 residents and fellows each year.

00:02:04Applicants cannot negotiate pay.

00:02:06They must accept whatever slot the logarithm hands them or whatever terms they are given.

00:02:13The command and control model eliminates competition and flattens salaries.

00:02:17Last year, the average first-year resident earned just $66,000.

00:02:22That's roughly $60,000 less than a physician assistant or $100,000 less than a nurse practitioner,

00:02:29despite working long hours and holding more advanced credentials.

00:02:32The match monopoly doesn't just pinch paychecks, it worsens the doctor's shortage.

00:02:38Each cycle, thousands of graduates fail to match with the program.

00:02:42Last year alone, 8,869 applicants, about one in five, were left without a slot.

00:02:49Because every state requires a residency to become a licensed doctor,

00:02:53those unmatched doctors can get a license or board certification.

00:02:56Thus, the match acts as a bottleneck for the training of American physicians

00:03:01precisely when we need more doctors, not fewer.

00:03:07And this oppressive process discourages smart young students from pursuing medical degrees.

00:03:11The squeeze also comes as America's population ages and demands more care.

00:03:16Today, over 77 million people already live in areas with a shortage of primary care doctors.

00:03:23That figure is projected to climb sharply in the years ahead.

00:03:27But as a result of the monopoly, power given to the teaching hospitals,

00:03:32our future doctors, are not choosing primary care.

00:03:37Instead, they're turning to more specialized medicine,

00:03:40hoping to more quickly recoup their investment with the higher salary of specialized practices

00:03:44like orthopedics, cardiology, and anesthesiology.

00:03:48According to Medscape 2024 Physician Compensation Report,

00:03:53the average salary for a primary care physician in the United States is $277,000.

00:03:59By contrast, specialists earn an average of over $394,000.

00:04:05This leaves our communities with fewer family doctors, longer wait times, and a decreased level of care.

00:04:11A second choke point is the ACGME's accreditation monopoly.

00:04:18The ACGME is the sole gatekeeper for the residency program approval in the United States.

00:04:24Without its blessing, programs lose access to billions of dollars in Medicare and Medicaid funding.

00:04:30Doctors must graduate from an ACGME-accredited program to practice medicine.

00:04:36The organization uses that leverage to impose one-size-fits-all rules that crush community hospitals and rural programs.

00:04:44Many small rural residency programs have closed their doors under the weight of the costly mandates.

00:04:50When programs close, residents lose positions and patients lose access to care.

00:04:55Two decades after Congress granted the carve-out for this system,

00:04:58the market is more conclusive and less competitive than ever.

00:05:02Resonant wages are completely stagnant.

00:05:07And America is producing fewer practicing doctors,

00:05:09even as demand for affordable, high-quality care grows at a rapid pace.

00:05:14Today's hearing asks a simple question.

00:05:17Will the next generation of physicians train in a free market or under a government-sanctioned monopoly?

00:05:23Today's witnesses know this system firsthand.

00:05:26Their testimony will help the committee understand the medical residency market

00:05:30and confront the anti-competitive fallout of the ACGME and the match,

00:05:36and their special interest exemption.

00:05:39I want to thank each witness for appearing before us today and look forward to your insights.

00:05:45I'll now recognize the ranking member, Mr. Nadler, for an opening statement.

00:05:49Thank you, Mr. Chairman.

00:05:52Mr. Chairman, it's a little difficult to take seriously

00:05:55a hearing that Republicans bill as an effort to improve health care in this country

00:06:00when their colleagues and other committees are busy gutting Medicaid and other programs,

00:06:05which will have a devastating impact on the health of millions of Americans.

00:06:09Apparently, Republicans think that what really ails our health care system

00:06:12is that low-income Americans, people with disabilities, and children have too much health care.

00:06:18That is the only explanation, because, of course, it couldn't just be a cynical ploy

00:06:23to fund massive tax cuts for billionaires in the backs of the most vulnerable among us.

00:06:29And these same Republicans who claim they want to, quote,

00:06:32make America healthy again have remained silent

00:06:34while the Trump administration systematically dismantles our entire public health infrastructure.

00:06:41Under the leadership of America's number one vaccine skeptic

00:06:44and conspiracy theory promoter, Robert Kennedy, Jr.,

00:06:48the Department of Health and Human Services has fired more than 20,000 experts,

00:06:53eliminated entire agencies, deleted important data sets and public health tracking tools,

00:06:59and cut or threatened to cut billions of dollars in grants for scientific research.

00:07:04At the same time, the administration is waging an ideological war on institutions,

00:07:09such as universities and the National Institutes of Health,

00:07:11that develop the groundbreaking research that underpins most medical advances.

00:07:17The NIH alone has suffered a $1.8 billion cut,

00:07:21and by some estimates as much as $2.7 billion.

00:07:24That will undoubtedly set back research into cancer treatments,

00:07:28infectious disease prevention, and much more by many years.

00:07:32Meanwhile, Republicans cheer as the administration's immigration policies,

00:07:37chase out foreign-born students and researchers,

00:07:39and send a clear message to anyone abroad who might wish to bring their talents and innovation to our country,

00:07:45you are not welcome.

00:07:47Taken collectively, these actions represent the dramatic effort to undermine,

00:07:52destroy, and limit health care research,

00:07:54access to critical health data, and access to care.

00:07:57The impact of these cuts will likely fall most deeply on marginalized communities,

00:08:02but we will all suffer the consequences.

00:08:05That is why today's hearing on the National Residency Matching Program seems beside the point.

00:08:10The health care system is facing an outright assault from the Trump administration,

00:08:15and yet we are being called upon to examine the residency matching program.

00:08:19This is not to say that there are no issues related to the match worth exploring in due course.

00:08:25Any valid criticisms of the program warrant appropriate consideration,

00:08:29whether they concern salary, hours, working conditions, or other matters that call out for refinement.

00:08:35And as part of that revisiting, we could account for collective bargaining,

00:08:39which has led to approximately 20 percent of the resident physician workforce becoming unionized.

00:08:44But we should also recognize that the match provides an effective system

00:08:48for placing more than 40,000 doctors a year across more than 6,500 residency programs

00:08:54and tracks throughout every region of the country that suits the needs of both students and hospitals alike.

00:09:02It's important to remember that the match was created in 1952

00:09:05to solve problems in the placement process that were created by unfettered market competition.

00:09:10Before the match was instituted, residency programs competed with each other

00:09:15to make offers earlier and earlier so as to preempt other programs.

00:09:20This resulted in students receiving limited-time offers as early as the beginning of their junior year of medical school

00:09:25when they had limited exposure to clinical practice before they had done rotations.

00:09:31Attempts to delay the matching process by withholding student information until senior year

00:09:36led to exploding offers with extremely short fuses.

00:09:39This system served no one, and the match was created to address these market breakdowns.

00:09:45Over 70 years later, it is still largely working as intended,

00:09:49avoiding what would otherwise be chaos,

00:09:51even as the needs of candidates and residency programs have evolved.

00:09:55While no system is perfect, many of the Republicans' criticisms

00:09:59simply do not hold up under careful scrutiny.

00:10:02For example, Republicans have taken aim at foreign doctors who enter the match,

00:10:05arguing that they are displacing American students.

00:10:09But statistics show that 99% of all U.S. medical school graduates enter residency or full-time practice in the country within six years of graduation.

00:10:18There is simply little evidence to suggest that foreign medical school graduates are taking slots from U.S. residents.

00:10:26Rather than scapegoating immigrants, Republicans could address a real issue,

00:10:30the need for additional residency slots overall.

00:10:34But that would take an investment in new funding from the federal government,

00:10:37and we have already seen where the Republicans' priorities lie.

00:10:41Finally, if the majority wishes to address flaws in the health care system,

00:10:45they need only look at the important work this subcommittee did under Democratic leadership.

00:10:50We examined issues related to consolidation and market concentration across the health care industry,

00:10:55and we passed several pieces of legislation addressing the rising cost of prescription drugs.

00:11:00Many of these issues had bipartisan support, and there is much we can do together.

00:11:06But instead, Republicans want to distract us from their disastrous health care policies with a hearing on a minor issue.

00:11:13We can do better.

00:11:14I appreciate our witnesses for appearing today.

00:11:17I look forward to hearing from them, and I yield back the balance of my time.

00:11:20The gentleman yields back.

00:11:21Without objection, all other opening statements will be included in the record.

00:11:24We'll now introduce today's witnesses, Dr. James Lynn.

00:11:29Dr. Lynn is a clinical professor of geriatric medicine at the Lake Erie College of Osteopathic Medicine

00:11:35and the president of the LACOM Institute for Successful Living.

00:11:40His practice focuses on geriatrics, internal medicine, and primary care.

00:11:46Mr. Sherman Merrick.

00:11:47Mr. Merrick is the founder and principal attorney at Merrick Health Law,

00:11:50a Chicago-based firm that focuses on representing medical residents in disputes with teaching hospitals

00:11:56through internal appeals, administrative proceedings, direct negotiations, mediation, and litigation.

00:12:03Over the past 25 years, he and his firm have represented more than 1,000 medical residents nationwide.

00:12:10Mr. Thomas Miller.

00:12:12Mr. Miller is a resident fellow in the health policy studies at the American Enterprise Institute,

00:12:17where he focuses on regulatory barriers to choice and competition, market-based alternatives,

00:12:24health care litigation, and the political economy of health care reform.

00:12:29He previously served as a senior health economist with the Joint Economic Committee

00:12:34and as a senior lecturing fellow at Duke University School of Law.

00:12:40Dr. William Feldman.

00:12:41Dr. Feldman is an assistant professor of medicine at Harvard Medical School and Brigham and Women's Hospital.

00:12:49Dr. Feldman's research focuses on drug pricing, FDA regulation, and pharmaceutical policy.

00:12:55We welcome our witnesses and thank them for appearing today.

00:12:58We will begin by swearing you in.

00:13:00Would you please rise and raise your right hand?

00:13:03Do you swear or affirm under penalty of perjury that the testimony you are about to give is true

00:13:12and correct to the best of your knowledge, information, and belief?

00:13:16So help you God.

00:13:18Let the record reflect that the witnesses have answered in the affirmative.

00:13:25You can be seated.

00:13:27Please know that your written testimony will be entered into the record in its entirety.

00:13:31Accordingly, we ask that you summarize your testimony in five minutes.

00:13:38Dr. Lin, you may begin.

00:13:42Thank you, Mr. Chairman and Ranking Member Nadler and members of the committee.

00:13:47Thank you for the opportunity to testify today on a matter of critical national concern,

00:13:52the increasingly detrimental impact of Accreditation Council for Graduate Medical Education,

00:13:57otherwise known as ACGME, Standards on the Sustainability of Medical Residency Fellowship Programs

00:14:03in Rural and Underserved Areas.

00:14:06LECOM Graduate Medical Education, which has trained over 693 residents since 1977,

00:14:13stands as a case study in how a rigid and monopolistic accreditation system

00:14:18is undermining the health infrastructure of America's smaller communities.

00:14:22Despite a proven track record of producing competent, board-certified physicians,

00:14:27417 of whom remain in practice within a 100-mile radius of Erie, Pennsylvania,

00:14:32our programs are being dismantled not due to deficiencies in quality,

00:14:36but due to arbitrary urban-centric inflexible accreditation policies.

00:14:41ACGME is a sole accrediting body for graduate medical education in the U.S.,

00:14:46influencing over $16 to $18 billion in federal and institutional investment.

00:14:50Yet, its governance is dominated by faculty from major academic centers.

00:14:56As a result, accreditation criteria are designed for high-resource university hospitals,

00:15:01not for the realities of rural health systems.

00:15:04Programs have closed due to faculty departure tied to vaccination mandates,

00:15:09a general surgery program in Arnett, Elmira, New York,

00:15:13inflexible geographic limitations on training sites,

00:15:16despite affiliation with top-tier hospitals,

00:15:19LECOM orthopedic program,

00:15:21requirement redundancies that ignores consortium models,

00:15:25punishing programs for sheer training infrastructure,

00:15:28excessive administrative costs,

00:15:30even when programs have no active residence.

00:15:33This rigidity stifles innovation,

00:15:35penalizes lean and effective community models,

00:15:38and directly contributes to the loss of training pathways for future physicians.

00:15:42The LECOM orthopedic surgical residency program,

00:15:46despite positive outcomes,

00:15:48premier training partnerships,

00:15:49and high board pass rates,

00:15:51the orthopedic surgery program was closed due to inflexibility rules

00:15:54about program mix and rotation supervision.

00:15:58This displaced residents,

00:16:00disrupt their careers,

00:16:01and stripped Erie County of essential orthopedic care.

00:16:05The LECOM internal medicine residency program,

00:16:07This is a long-standing program that was closed following an unresolved hotline complaint,

00:16:13despite an internal and legal review finding of no merit.

00:16:17Its closure cascaded into a termination of our gastroenterology and pulmonary fellowship,

00:16:22eliminating critical pipeline for specialty care.

00:16:27Since 2020,

00:16:28the number of withdrawn or closed programs has increased dramatically,

00:16:31many in rural areas.

00:16:33The ACGME one-size-fits-all model disproportionately harms smaller institutions

00:16:38and federally qualified health centers.

00:16:40Programs have been denied probationary periods or closed outright,

00:16:44sometimes via Zoom meetings,

00:16:45with no room for remediation.

00:16:48Critical specialties like psychiatry, cardiology, obstetrics,

00:16:51and surgery are being lost in precisely the regions that need them most.

00:16:57The loss of residency program directly reduced patient access today and in the future.

00:17:03Without local training opportunities,

00:17:05DOs, candidates,

00:17:06faces increasing exclusion from competitive specialties

00:17:09due to documented disparities in the match.

00:17:12Moreover, rural systems and urban underserved

00:17:17are left with workforce shortages,

00:17:19longer wait times,

00:17:20and higher recruitment costs.

00:17:22Even federal efforts are thwarted.

00:17:24Despite winning a rural residency planning grant from HRSA,

00:17:28our psychiatry program was denied rural track status

00:17:31by ACGME due to a rigid and outdated definition of rural

00:17:36in direct conflict with other federal agencies like CMS and USDA.

00:17:41Some proposed solutions.

00:17:43Number one,

00:17:44revise accreditation criteria,

00:17:46modernize standard to allow flexibility in rural

00:17:48and consortium-based models.

00:17:51Number two,

00:17:51diversity review committees,

00:17:53ensure rural osteopathic educator

00:17:55have a voice in shaping specialty standard.

00:17:57Number three,

00:17:58create an alternative accreditor,

00:18:01promote innovative training track models

00:18:04specifically designed for rural and urban underserved areas.

00:18:08Streamline administrative burden,

00:18:10shift focus from bureaucratic checklist

00:18:12to actual outcomes in training and patient care.

00:18:15Protect federal investments,

00:18:17align ACGME definition with federal and rural health policies

00:18:20to avoid undermining HRSA support initiative.

00:18:22The current ACGME model well-intentioned

00:18:26has created systemic barriers

00:18:27that disproportionately harm rural communities,

00:18:30limit innovations,

00:18:31and suppress diversity in physician pipeline.

00:18:34We urge Congress and CMS to take action,

00:18:36whether through oversight reform

00:18:38or the creation of an alternative accreditation pathway

00:18:41to ensure rural America is not left behind.

00:18:44We can no longer allow bureaucratic rigidity

00:18:46to dictate where and how the next generation of doctors are trained.

00:18:49The health of millions in rural and urban underserved region

00:18:52depends on a more inclusive and responsive system.

00:18:56Thank you, Dr. Lin.

00:18:58Mr. Merrick, you're now recognized for five minutes.

00:19:07Here we go.

00:19:10Good morning, Chairman Fitzgerald,

00:19:12Ranking Member Nadler,

00:19:13and members of the subcommittee.

00:19:15Thank you for the opportunity to testify today.

00:19:18My name is Sherman Merrick,

00:19:20and I support repeal of the 2004 Match Antitrust Exemption.

00:19:24It was engineered to stop a lawsuit I filed in 2002

00:19:28on behalf of medical residents.

00:19:31I have since represented more than 1,000 residents

00:19:34in disputes with their hospitals.

00:19:36I witness daily the harm caused by the exemption

00:19:39to residents, to patients, to taxpayers,

00:19:43to rural hospitals,

00:19:45and to the medically underserved public nationwide.

00:19:49In my view, formed now over decades,

00:19:52the exemption protects market distortions,

00:19:55undermines free market principles,

00:19:57limits personal freedom and choice,

00:20:00prevents normal employment negotiations,

00:20:04shields wage suppression,

00:20:05and contributes to the nationwide physician shortage.

00:20:09The Match is, and always has been,

00:20:12operated by hospitals for hospitals.

00:20:16It assigns each resident to a single program

00:20:19for the duration of residency.

00:20:21The system, including an unspoken ban on transfers,

00:20:26traps the resident there in that position

00:20:28for three to five years.

00:20:30Residents are not free to leave,

00:20:32even in cases of unsafe working conditions,

00:20:36inadequate pay,

00:20:38incompatible supervisors,

00:20:40or a family or medical emergency,

00:20:43or simply changes in personal preference.

00:20:46Anyone who leaves or is terminated

00:20:49is blacklisted and denied a position anywhere.

00:20:53There are very few second chances.

00:20:56There is no freedom

00:20:57and no flexibility in the system.

00:20:59Residents who leave their program

00:21:02generally lose their entire career in medicine.

00:21:05Their entire career in medicine.

00:21:09Correspondingly,

00:21:10taxpayers generally lose their entire investment

00:21:13in that resident.

00:21:15Medicare pays hospitals $150,000 to $180,000 annually

00:21:19for each one.

00:21:21And the public loses someone

00:21:23who would otherwise help reduce the physician shortage.

00:21:26That was not a sustainable system 20 years ago

00:21:30and is even less sustainable now.

00:21:33These were the anti-competitive restraints

00:21:37we challenged in the 2002 Jung case.

00:21:40We won the opening rounds

00:21:42and the judge ruled our claims viable

00:21:44under the Sherman Act.

00:21:46Faced with the loss of lucrative cheap labor,

00:21:49the hospitals turned to Congress.

00:21:51In 2004,

00:21:53they were quietly given an exemption

00:21:55at the expense of residents.

00:21:58It happened without notice,

00:22:00without hearings,

00:22:02without public debate,

00:22:04without transparency,

00:22:05and without meaningful consideration

00:22:07of the harm that would result.

00:22:10The exemption has now perpetuated the match's harm

00:22:13for another 20 years.

00:22:15That harm caused from lack of competition

00:22:19includes artificially suppressed wages for residents,

00:22:23long work hours dangerous to patients,

00:22:27wasted taxpayer funds,

00:22:29disadvantaged recruiting for rural programs,

00:22:33and a worsening nationwide physician shortage.

00:22:36The Jung case did not stand alone in its conclusions.

00:22:40Independent experts and studies

00:22:42have corroborated our conclusions.

00:22:44Repealing the 2004 exemption

00:22:48would not dismantle the match

00:22:50or decide its legal merits.

00:22:53It would simply restore the authority of courts

00:22:55to examine those merits fully and fairly.

00:23:00The hospitals may present their justifications in court

00:23:03and attempt to prove them.

00:23:05Or they may simply reform on their own

00:23:08when faced with standard antitrust liability.

00:23:11In my view, this is a watershed opportunity

00:23:14for Congress to reaffirm core American values

00:23:19of free competition, individual opportunity,

00:23:24fiscal responsibility, and legal accountability.

00:23:28Based on my experience in the Jung litigation

00:23:30and my daily experience with the ongoing harm

00:23:35of the match exemption,

00:23:36I strongly support repeal for the benefit of residents,

00:23:41patients, taxpayers, rural hospitals,

00:23:45and the general public.

00:23:47I look forward to any questions you may have.

00:23:49Thank you, Mr. Merrick.

00:23:50Mr. Miller, you may begin.

00:23:51Thank you, Chairman Fitzgerald,

00:23:55Ranking Member Nadler,

00:23:57and members of the subcommittee

00:23:58for the opportunity to testify today

00:24:00on the medical residency antitrust exemption

00:24:04and more generally

00:24:05on competition policy considerations

00:24:07involving physician licensing.

00:24:09One version or another

00:24:11of the so-called match mechanism

00:24:12for assigning graduating medical students

00:24:14to resident physician programs

00:24:16has been around for over 70 years.

00:24:18Today's hearing considers whether to thaw

00:24:21what was essentially frozen

00:24:23in competition law terms over 20 years ago

00:24:26by virtue of an unusual legislative exemption

00:24:29from antitrust liability for the program

00:24:31amid ongoing litigation

00:24:33with no debate and little explanation.

00:24:36Such exemptions are rarely granted.

00:24:39They are disfavored and construed narrowly by the courts.

00:24:42They usually reflect the efforts of power and privilege

00:24:45to gain or preserve special commercial advantages.

00:24:48Most limited antitrust exemptions

00:24:50also presume other regulatory mechanisms

00:24:53to monitor and police anti-competitive aspects

00:24:56of the activities otherwise protected.

00:24:59Early discovery and initial rulings

00:25:01in that older class action litigation

00:25:03concerning the match program

00:25:04provided evidence of serious problems.

00:25:07Absent the sweeping statutory exemption,

00:25:10further litigation under rule of reason analysis

00:25:13would have helped assess the net competitive effects

00:25:16of the match program at that time

00:25:18or even later as its practices evolved

00:25:20and then assessed the likelihood

00:25:23of less restrictive alternatives.

00:25:25At a minimum, this subcommittee

00:25:26in the current Congress

00:25:27should seriously consider ways to limit,

00:25:29if not repeal, the current antitrust exemption

00:25:32and it certainly should review it extensively

00:25:35for the first time in over 20 years.

00:25:37My written testimony recognizes

00:25:39that the likely competition problems

00:25:41come not from the mathematical elegance

00:25:44and ingenuity of the match algorithm per se.

00:25:47They derive rather from the program's related assembly

00:25:50of mutually reinforcing levers of market power

00:25:53that attach one-sided conditions to it.

00:25:56The match program may do an excellent job

00:25:59in solving the wrong problem.

00:26:01How to fix selection timing problems

00:26:03in a resident market monopsony

00:26:06that the program only strengthens.

00:26:08The matching process delivers efficient sorting

00:26:12of bounded preferences, finality,

00:26:15and fewer unfilled positions

00:26:16when it operates as described.

00:26:19There's some question about that.

00:26:20The main drawbacks tied to older legal objections

00:26:23appear to be the vastly unequal bargaining power,

00:26:27the wage suppression and compression,

00:26:29and onerous working conditions for residents

00:26:31that the program's interrelated rules

00:26:33and practices sustain.

00:26:34Reduced labor market competition

00:26:37reduces the quality, availability,

00:26:40and value of health care services.

00:26:42I suggest an initial set of incremental changes,

00:26:45far from original on my part,

00:26:47that could improve competition

00:26:49within a reform match program

00:26:51rather than displace it completely.

00:26:53They might be added as conditions

00:26:54to retain the current antitrust exemption,

00:26:57inserted within a newly granted more narrow one,

00:27:00or adopted to minimize new legal liabilities.

00:27:03However, a singular focus on antitrust law

00:27:06will not solve all the problems

00:27:07of physician labor markets,

00:27:09let alone the larger issues of cost, quality,

00:27:12and access throughout our overall health care system.

00:27:14Policymakers should consider

00:27:16a broader inventory of tools and levers

00:27:18that can shape not just the initial supply

00:27:20of new physicians,

00:27:21but also facilitate how all health care providers

00:27:24can deliver more accessible, effective,

00:27:26and affordable care.

00:27:28Most policy interventions aimed

00:27:30at rebalancing competitive forces

00:27:31within physician labor markets

00:27:33face resistance not only

00:27:35from the powerful interest groups

00:27:36benefiting from the longstanding status quo,

00:27:39they also can trigger fears of disruption

00:27:41and timing mismatches

00:27:43in any transition toward alternative mechanisms.

00:27:46A different set of policy conflicts

00:27:48may arise from federalism concerns.

00:27:50States have traditionally been viewed

00:27:51as the natural constitutional stewards

00:27:53of physician licensing

00:27:55as part of their traditional police powers.

00:27:57But neither types of concerns

00:27:59are irreconcilable roadblocks

00:28:01to reasonable reforms

00:28:02that are calibrated and phased in carefully.

00:28:05Although some states have led on this front,

00:28:08not enough of them have done so

00:28:09as rapidly and thoroughly

00:28:11as they might and should.

00:28:13Hence arguments for an increased

00:28:14federal government role

00:28:15and at least providing stronger incentives to do so.

00:28:19The MATCH program's nationwide competition

00:28:21for resident positions

00:28:22was only an early sign

00:28:24of eroding geographical boundaries

00:28:26for health care labor markets.

00:28:28The issue is not whether Congress

00:28:29and the federal government

00:28:30have the power to be more assertive,

00:28:32but whether they decide to do so

00:28:34absent more effective state-level actions.

00:28:37The potential policy reforms

00:28:38and tools are available

00:28:40if the necessary political will

00:28:41to promote and adopt them develops.

00:28:44In the meantime,

00:28:45we should expect the more immediate resort

00:28:47of recent years

00:28:48to leaving such matters

00:28:49to litigation, regulation,

00:28:51and other administrative actions.

00:28:52Not coincidentally,

00:28:54this subcommittee's area of jurisdiction.

00:28:58Thank you, Mr. Miller.

00:28:59Dr. Feldman, you may now begin.

00:29:01Chair Fitzgerald,

00:29:02Ranking Member Nadler,

00:29:03members of the committee,

00:29:04I'm honored to talk with you all today

00:29:07about medical training

00:29:08in the United States

00:29:09and more broadly about ways

00:29:10of strengthening our health care system

00:29:12to improve outcomes for patients.

00:29:15The MATCH,

00:29:16the subject of our hearing today,

00:29:18is the mechanism

00:29:19by which residency applicants

00:29:21are paired with hospitals

00:29:22for their training

00:29:22after medical school.

00:29:24For the past two decades,

00:29:26this mechanism

00:29:26has been protected

00:29:28by an exemption

00:29:28from antitrust violations.

00:29:30In March of this year,

00:29:31the subcommittee sent letters

00:29:32to several stakeholders

00:29:33requesting information

00:29:35they consider

00:29:35as they consider potential removal

00:29:38of this longstanding exemption.

00:29:40The two central arguments

00:29:41of those letters

00:29:42are that the residency match

00:29:44has created a bottleneck

00:29:45resulting in physician shortages

00:29:47in that it has depressed

00:29:48resident salaries.

00:29:50The goals of this subcommittee

00:29:52as expressed in those letters

00:29:53of increasing physician workforce

00:29:55and ensuring adequate compensation

00:29:57for residents

00:29:58are laudable

00:29:59and ought to be pursued.

00:30:01And the MATCH certainly

00:30:02has its downsides,

00:30:03but in my view,

00:30:04eliminating the MATCH

00:30:05would not necessarily accomplish

00:30:07the goals set forth

00:30:08by this committee.

00:30:09Let's start with physician shortages,

00:30:11which are expected to increase

00:30:13from 37,000 in 2021

00:30:15to over 80,000 in 2036.

00:30:19The problem is not

00:30:20that a large number

00:30:21of residency spots

00:30:22go unfilled each year.

00:30:23In fact, in 2024,

00:30:2599.6% of the more

00:30:27than 40,000 advertised positions

00:30:29were filled.

00:30:31Instead, the problem

00:30:32is that more residency spots

00:30:33are needed.

00:30:34This in turn

00:30:35would require additional funding

00:30:36for Medicare and Medicaid

00:30:37and the hospitals themselves.

00:30:39But the MATCH per se

00:30:40is not the bottleneck

00:30:42in the physician shortage.

00:30:45Beyond creating

00:30:46and funding more positions,

00:30:48lawmakers should also identify

00:30:49new ways

00:30:50of bringing international

00:30:51medical graduates

00:30:52into our workforce,

00:30:53as many states are now doing.

00:30:55Numerous sectors

00:30:56in the U.S. economy,

00:30:57from tech

00:30:58to financial services,

00:31:00benefit from the infusion

00:31:01of highly skilled workers

00:31:02who train abroad.

00:31:03Why should medicine

00:31:04be different?

00:31:06On the question

00:31:07of residency wages,

00:31:08I can tell you firsthand

00:31:10that living on a

00:31:12residency salary

00:31:13while trying to pay off

00:31:14student loans

00:31:14and start a family

00:31:15was challenging.

00:31:17But it's not clear

00:31:18that eliminating the MATCH

00:31:20would yield higher salaries

00:31:22across the board

00:31:22without disruption.

00:31:24There are certainly

00:31:25other ways

00:31:25of improving wages.

00:31:27Resident unionization,

00:31:29as Chair Nadler mentioned,

00:31:31has accelerated

00:31:32in recent years

00:31:32with 20% of all residents

00:31:33now unionized,

00:31:34including at my own institution.

00:31:37Through collective bargaining,

00:31:39residents have successfully

00:31:39negotiated wage increases,

00:31:41housing allowances,

00:31:42increased educational time,

00:31:44and numerous other benefits

00:31:45that help improve

00:31:46their quality of life

00:31:47and educational experience.

00:31:49Residency programs

00:31:51can and should

00:31:52offer more,

00:31:54and Congress

00:31:55could facilitate this

00:31:56in any number of ways

00:31:57beyond actions

00:31:59to eliminate the MATCH,

00:32:00from increasing CMS funding

00:32:01of residency programs

00:32:02and supporting the right

00:32:03to unionize

00:32:04to setting minimum salary floors

00:32:06and implementing

00:32:07more generous

00:32:07loan forgiveness programs.

00:32:09I want to close

00:32:11by noting

00:32:12that some of the biggest

00:32:13threats to medical education

00:32:14and indeed

00:32:15to the very practice

00:32:16of medicine

00:32:17in the United States

00:32:18come not

00:32:19from the residency match,

00:32:21but from efforts

00:32:22by the current administration

00:32:23to undermine

00:32:24the very fabric

00:32:26of scientific discovery.

00:32:28Foundational research

00:32:29funded by the NIH

00:32:31and NSF

00:32:32form the core

00:32:33of what medical students

00:32:35and residents learn

00:32:36during their training.

00:32:37Future groundbreaking cures

00:32:40that residents

00:32:41of today

00:32:41will prescribe

00:32:42to patients of tomorrow

00:32:44depend on a robust NIH

00:32:46and NSF for discovery,

00:32:47a well-staffed FDA

00:32:49for evaluation,

00:32:50and strong public players,

00:32:52including Medicare

00:32:53and Medicaid,

00:32:54for access.

00:32:56Yet the current administration

00:32:57seems bent

00:32:58on gutting

00:32:58these institutions.

00:33:00The administration's

00:33:01budget blueprint

00:33:02proposes cuts

00:33:02of 37%

00:33:04to the NIH

00:33:05and more than 50%

00:33:06to the NSF.

00:33:08Over 700 NIH grants

00:33:10accounting for

00:33:11close to $2 billion

00:33:12in funding

00:33:13have been terminated

00:33:14this year,

00:33:15and more than half

00:33:16of these canceled grants

00:33:17are for medical schools

00:33:18and hospitals,

00:33:20a large number of which,

00:33:21by the way,

00:33:21are for clinical trials

00:33:23that are investigating

00:33:26diseases like cancer,

00:33:28psychiatric illness,

00:33:29HIV, and COVID.

00:33:31At the FDA,

00:33:31more than 3,500 layoffs

00:33:33have already begun

00:33:34slowing review times

00:33:36of new drugs.

00:33:38An entire office

00:33:39tasked with developing

00:33:40product-specific guidance

00:33:41and facilitating entry

00:33:43of low-cost generic drugs

00:33:44to keep prices down

00:33:45for patients

00:33:46was terminated.

00:33:48Proposed cuts to Medicaid,

00:33:49according to the CBO,

00:33:51will leave 8 million

00:33:52beneficiaries uninsured,

00:33:53and these cuts

00:33:54will have disproportionate

00:33:55effects on hospitals

00:33:56that already struggle

00:33:56to cover the costs

00:33:57of uncompensated care.

00:33:59This committee has begun

00:34:00asking hard questions

00:34:01about medical training

00:34:01in the United States,

00:34:03which is good.

00:34:03Mr. Chairman,

00:34:03can I have regular order,

00:34:04please?

00:34:05Yeah.

00:34:06Mr. Feldman,

00:34:06can you wrap up

00:34:07your comments, please?

00:34:08Yep.

00:34:09I would encourage you

00:34:10all to widen

00:34:11the scope of assessment

00:34:12and consider an array

00:34:13of tools for addressing

00:34:13physician shortages,

00:34:15residency well-being,

00:34:16and larger threats

00:34:16to science

00:34:17in our health care system.

00:34:18Thank you, Dr. Feldman.

00:34:19We will now proceed

00:34:19under the five-minute rule

00:34:20with questions.

00:34:21I'll recognize the gentleman

00:34:22from California,

00:34:23Mr. Eisen,

00:34:23for five minutes.

00:34:25Thank you, Mr. Chairman.

00:34:27Dr. Feldman,

00:34:28I love it.

00:34:28that you just had to go

00:34:30for a minute and 25 seconds

00:34:33on a rant against Trump

00:34:34for 100 days

00:34:35as though what we're hearing

00:34:37about today

00:34:38had anything to do with it

00:34:39or that any real difference

00:34:41has occurred in 100 days

00:34:43to the root causes

00:34:45of not having enough physicians

00:34:47or that this didn't happen

00:34:49during the previous four years.

00:34:51The least you could have done,

00:34:52of course,

00:34:52is talk about his first four years

00:34:54to give him at least a chance

00:34:55to have had some impact,

00:34:57but you chose not to.

00:34:58I heard you say money, money, money.

00:35:02I think I'll go to Mr. Merrick.

00:35:06You spend a fortune

00:35:08to become a doctor.

00:35:10Then your system

00:35:11puts you into slave wages

00:35:13while the federal government

00:35:15is subsidizing the hospitals

00:35:17so they effectively have you

00:35:18for less than free.

00:35:20Is that a fair assessment

00:35:21of how we create residents?

00:35:23The federal government

00:35:25already pays more

00:35:26than you receive.

00:35:26Isn't that true

00:35:27if you're a resident?

00:35:32Yes, I agree with that.

00:35:33The government pays an average

00:35:34between $150,000 and $180,000

00:35:37a year per resident

00:35:38and they convey about $65,000

00:35:40to each resident.

00:35:41Okay, so we've all heard

00:35:43about the rough hours

00:35:45that doctors go through

00:35:47and sort of part of this test,

00:35:50sort of like Navy SEALs

00:35:52and Rangers, you know,

00:35:53you've got to stay up

00:35:54for a couple of days

00:35:54to prove you could

00:35:55in the future.

00:35:57I'm okay with that.

00:35:58I understand the stressing.

00:36:00What I don't understand

00:36:01is how we can have

00:36:02a projected shortage

00:36:04under a monopoly

00:36:06that was supposed to allocate

00:36:08and guarantee sufficiency

00:36:10and then Dr. Feldman comes in

00:36:14and tells us the problem is

00:36:15that paying more to the hospital

00:36:17than they actually spend

00:36:19while getting a doctor for free

00:36:21who they bill out

00:36:23is somehow the fault

00:36:25of an administration

00:36:26that's been here

00:36:27for 100 days.

00:36:28Mr. Miller,

00:36:29am I misunderstanding

00:36:31what I'm hearing?

00:36:32No, but let me add

00:36:34something else to this.

00:36:34I mean, it's worse.

00:36:35I was working on this

00:36:36about 10 years ago.

00:36:37There's no correlation

00:36:38between the federal funding

00:36:41and the supply of physicians.

00:36:43Now, we could change the rules

00:36:45and make it more targeted

00:36:46to incentivize the expansion

00:36:49of certain types of physicians

00:36:51or other areas,

00:36:52but the money goes in.

00:36:53It goes to certain favored parties

00:36:56over a period of time.

00:36:57It's not allocated

00:36:58on a need basis,

00:36:59so it's just more sloshing

00:37:02around the funding,

00:37:03which is unrelated

00:37:04to what we say

00:37:04we're trying to accomplish.

00:37:06Dr. Lin, Dr. Feldman

00:37:09seemed to think

00:37:10that unions were the answer

00:37:11while maintaining

00:37:12an antitrust exemption.

00:37:15Do you see that as the answer,

00:37:17or do you see

00:37:18that a free market,

00:37:19or at least a partial free market,

00:37:21being restored

00:37:22could help with this problem?

00:37:25I would say the latter,

00:37:27Congressman.

00:37:28I think a union

00:37:30is not an answer

00:37:32for rural community,

00:37:34especially small community hospitals.

00:37:36If you look at the current

00:37:37financial situation,

00:37:40we have hospitals closing,

00:37:42nursing homes closing

00:37:43because of the financial stress,

00:37:45and if you increase

00:37:46the wages artificially like that

00:37:49with union,

00:37:51I think that would be detrimental,

00:37:53and that would be a hindrance

00:37:54to our future.

00:37:55Now, Dr. Lin,

00:37:56I also serve over the years

00:37:58on the Immigration Subcommittee,

00:37:59so one thing I understand

00:38:01is that we have

00:38:02a minuscule allocation

00:38:03to rural of foreigners

00:38:06able to get visas.

00:38:08Is that something

00:38:09that you would also seek

00:38:11to try to increase

00:38:13that number

00:38:13since obviously

00:38:14there are more

00:38:15foreign-born doctors,

00:38:16some of whom

00:38:17have been U.S. educated,

00:38:19who are looking

00:38:19for those opportunities

00:38:22when they leave

00:38:22than we allocate slots?

00:38:24It's a quite small number,

00:38:25correct?

00:38:26That's correct.

00:38:28Okay.

00:38:29Mr. Merrick,

00:38:30your case was dismissed

00:38:32because Hillary Clinton

00:38:34and the late Senator Ted Kennedy

00:38:37got together

00:38:38and slipped it in there,

00:38:39and that's where we are.

00:38:41What, if any,

00:38:43improvement have you seen

00:38:44as a result

00:38:45of this antitrust exemption

00:38:47in any part

00:38:48of the process?

00:38:50Well, shortly after

00:38:51we filed the case,

00:38:53I believe that the hospital

00:38:54saw the long,

00:38:56dangerous work hours

00:38:57as their Achilles heel,

00:38:58and so they supposedly

00:39:02voluntarily adopted

00:39:0380-hour work.

00:39:06Okay.

00:39:06Well, Mr. Miller,

00:39:08let me,

00:39:08so I'll take that

00:39:09as some good,

00:39:10only 80 hours.

00:39:12Mr. Miller,

00:39:13my remaining time,

00:39:16antitrust exemption

00:39:17for the organization

00:39:18that does this work

00:39:20versus the effective antitrust

00:39:23that goes to the hospital.

00:39:24Should we make it clear

00:39:25that the selection process

00:39:27enjoys an antitrust,

00:39:28but all other aspects

00:39:30of the process

00:39:30should never have enjoyed

00:39:32antitrust exemption?

00:39:34Yeah, it was a very

00:39:35sweeping exemption

00:39:36because basically

00:39:37it also prevented

00:39:39any evidence

00:39:40related to this

00:39:41to be used

00:39:41in collateral actions,

00:39:43so certainly it should be

00:39:44set as narrowly

00:39:46as possible

00:39:46at a minimum.

00:39:49Thank you, Mr. Chairman.

00:39:49I yield back.

00:39:50Gentleman yields back.

00:39:51Now I recognize

00:39:51the ranking member

00:39:52for five minutes.

00:39:53Thank you, Mr. Chairman.

00:39:54Dr. Feldman,

00:39:55since you've been

00:39:56attacked by several

00:39:57of their witnesses,

00:39:58is there anything

00:39:59you'd like to say

00:39:59in response?

00:40:01The one thing

00:40:02I would like to say

00:40:03is that my comment

00:40:04about more funding

00:40:06is about funding

00:40:07more positions.

00:40:07If we're concerned

00:40:08about a residency

00:40:09shortage,

00:40:11if we're concerned

00:40:12about a physician shortage,

00:40:13we need more positions,

00:40:14and the way to do that

00:40:15is by more funding.

00:40:18Dr. Feldman,

00:40:18in an April executive order,

00:40:20the Trump administration

00:40:21once again took aim

00:40:22at institutions

00:40:23of higher education.

00:40:24This time,

00:40:25it was focused

00:40:25on the administration's

00:40:27crusade against DEI.

00:40:29Can you explain

00:40:30whether there is

00:40:30a value in accounting

00:40:31for diversity

00:40:32in the provision

00:40:34of medical care?

00:40:34I do think there's

00:40:38value in accounting

00:40:39for diversity

00:40:39in the selection

00:40:41of medical students

00:40:43and residents.

00:40:44I think that having

00:40:45classes with

00:40:47a diverse set

00:40:48of interests

00:40:49and backgrounds

00:40:49can help strengthen

00:40:50the medical care

00:40:53that doctors provide

00:40:55and can strengthen

00:40:56residency classes.

00:40:59Dr. Feldman,

00:41:00you've seen the match

00:41:00from both the applicant

00:41:01and program sides.

00:41:03What was the experience

00:41:04that you and your peers

00:41:05had with the match

00:41:06as applicants?

00:41:07And what concerns you

00:41:08about the prospect

00:41:09of eliminating the match?

00:41:13The experience

00:41:14with the match

00:41:15is that you apply

00:41:16to a bunch of programs,

00:41:18you interview,

00:41:19you rank the programs

00:41:22that you like the best

00:41:23and you place

00:41:23into the one

00:41:24that also ranks you.

00:41:29It is,

00:41:31the match

00:41:32is not without

00:41:33its downsides,

00:41:35as I've said,

00:41:36but I would worry

00:41:37that eliminating the match

00:41:38would create

00:41:39a kind of free-for-all

00:41:41that would make it

00:41:42harder for applicants.

00:41:45This idea that you mentioned

00:41:47about exploding offers

00:41:48and being pushed

00:41:51to commit early

00:41:53to one program

00:41:55without actually looking

00:41:56at all of the programs

00:41:57I think would ultimately

00:41:58be problematic

00:41:59for residents,

00:42:02for applicants.

00:42:04Drawing upon your experience,

00:42:06Dr. Feldman,

00:42:07with the FDA

00:42:07and the pharmaceutical industry,

00:42:10what anti-competitive practices

00:42:11have you encountered

00:42:12that impact most

00:42:14the public's health

00:42:15and well-being?

00:42:15I see lots

00:42:19of anti-competitive practices

00:42:21in the pharmaceutical industry.

00:42:23I'll give you one example

00:42:24that's very close

00:42:26to research

00:42:27that I've conducted

00:42:29with our team

00:42:30at Harvard Medical School.

00:42:32We see brand-name

00:42:34pharmaceutical companies

00:42:36obtaining patents

00:42:37that limit

00:42:38generic competition,

00:42:39that limit the entrance

00:42:40of low-cost generics

00:42:41onto the market.

00:42:43More competition

00:42:44is the way

00:42:45that we bring down

00:42:46drug prices.

00:42:46How can the patent

00:42:47limit the generic?

00:42:49Well, the companies

00:42:51list the patents

00:42:51with the FDA

00:42:52in what's called

00:42:52the Orange Book

00:42:53and the generic entrance

00:42:55can't come onto the market

00:42:56until those patents expire

00:42:57or they challenge them

00:42:58in court.

00:42:59And so we see

00:43:01anti-competitive practices

00:43:02all of the time

00:43:03from pharmaceutical companies.

00:43:05We see anti-competitive practices

00:43:06from PBMs

00:43:07throughout the

00:43:08pharmaceutical supply chain.

00:43:10and I would love

00:43:11for this subcommittee

00:43:13to be focused

00:43:14on those issues.

00:43:16Research funding

00:43:17is being cut

00:43:17for a variety of reasons,

00:43:19including administration

00:43:20concerns about

00:43:21a range of issues

00:43:22unrelated to the research itself.

00:43:24Against this

00:43:24undiscriminating approach

00:43:25to cost-cutting,

00:43:27for context,

00:43:27please explain

00:43:28the process

00:43:28by which these grants

00:43:29are made in the first place,

00:43:30Dr. Feldman.

00:43:32The process

00:43:32by which NIH grants

00:43:33are made?

00:43:34No.

00:43:35Well, we spend

00:43:37many, many hours

00:43:37writing grant applications.

00:43:38We submit them

00:43:39to the NIH.

00:43:40They go to

00:43:41study sections

00:43:42for evaluation,

00:43:43peer review,

00:43:44and the grants

00:43:46that have a certain score

00:43:47end up getting funded.

00:43:49It's an arduous process.

00:43:51It makes for good science

00:43:53because you get

00:43:54the best applications

00:43:55that are being selected.

00:43:57And I worry a lot

00:43:58about actions

00:43:59that are being taken now

00:43:59to cut funding

00:44:02from the NIH.

00:44:03As a researcher

00:44:04who receives NIH funding,

00:44:06what are your concerns

00:44:07about how freezing

00:44:07or terminating grants

00:44:08will affect

00:44:09the research enterprise

00:44:10and on researcher choices?

00:44:13I have already seen

00:44:16the chilling effect

00:44:17that these cuts have had.

00:44:19I've had conversations

00:44:19with colleagues

00:44:20who are in academia

00:44:22and have thought

00:44:23about going into industry

00:44:25because of uncertainties

00:44:26around getting NIH funding.

00:44:28The NIH funds

00:44:29some of the riskiest research,

00:44:31also the highest reward research,

00:44:33in our country.

00:44:33And I think these cuts

00:44:35are going to be devastating

00:44:37if they persist

00:44:37for breakthrough therapies.

00:44:40And finally,

00:44:42the administration

00:44:42has been doing everything

00:44:45it can

00:44:46to deport

00:44:46foreign students

00:44:48and researchers.

00:44:51To what extent

00:44:52do you think

00:44:53what I just said

00:44:53is accurate

00:44:54and how will this affect

00:44:55medical care?

00:44:57I'll comment

00:45:00on the latter question.

00:45:02I think that

00:45:03deporting

00:45:04international students,

00:45:06that making it hard

00:45:07for international students

00:45:08to learn

00:45:09in the United States

00:45:10and practice

00:45:10in the United States

00:45:11will only contribute

00:45:12to the physician shortage.

00:45:14I yield back.

00:45:15Gentleman yields back.

00:45:16Now recognize

00:45:16the gentleman

00:45:17from Virginia

00:45:17for five minutes.

00:45:19Dr. Lin,

00:45:20the ACGME

00:45:21leverages

00:45:22its accreditation monopoly

00:45:24to impose DEI hiring requirements

00:45:26on medical residency programs.

00:45:29According to ACGME

00:45:30program requirement IC,

00:45:32programs must hire

00:45:33a diverse

00:45:33and inclusive workforce.

00:45:36And we heard

00:45:36Dr. Feldman

00:45:37try and justify that.

00:45:38But race-based hiring requirements

00:45:40are against federal law.

00:45:42And the Supreme Court

00:45:43was clear

00:45:43in Students for Fair Admission

00:45:45versus Harvard

00:45:45that educational institutions

00:45:47cannot base

00:45:48admission on race either.

00:45:50American health care

00:45:51patients suffer

00:45:52when residency programs

00:45:54focus on gender

00:45:55or skin color

00:45:56instead of a resident's competency.

00:45:59Do you think

00:45:59the ACGME

00:46:00should be in the business

00:46:01of forcing programs

00:46:02to hire residents

00:46:03based on race or gender

00:46:04instead of merit?

00:46:08Congressman,

00:46:09I would tell you

00:46:10that, of course,

00:46:12personally,

00:46:12I would think

00:46:14that they should not

00:46:15impose their will

00:46:16on individual programs.

00:46:18Some good news,

00:46:19as of May 9th,

00:46:20the ACGME

00:46:22has suspended

00:46:23their common standard

00:46:25for DEI practices.

00:46:28And I remain to be seen

00:46:29how they're going to

00:46:30change their standard.

00:46:31So we just got the email

00:46:33last week.

00:46:35That's good news.

00:46:37Mr. Miller,

00:46:38the medical residency market

00:46:39is stagnant

00:46:40with low wages

00:46:41for residents

00:46:42and worse outcomes

00:46:43for patients.

00:46:43It also functions

00:46:44as a bottleneck

00:46:45that contributes

00:46:45to America's doctor shortage.

00:46:47would removing

00:46:49the medical residency

00:46:50antitrust exemption

00:46:51make the market

00:46:51more competitive?

00:46:55I think we need

00:46:56to parse a couple

00:46:57of different parts

00:46:58to this.

00:47:01The supply line

00:47:02is a little more complex

00:47:04than just removing

00:47:04the antitrust exemption.

00:47:06I think it could create

00:47:08some opportunities,

00:47:09but primarily

00:47:10in terms of improving

00:47:11the overall

00:47:11working conditions

00:47:12and the quality

00:47:13of the health care

00:47:15workforce we produce.

00:47:16There are a broader

00:47:18set of tools

00:47:19than that alone.

00:47:20There's some ambiguity

00:47:21over exactly

00:47:22what's driving

00:47:23the production line.

00:47:25I'd suggest

00:47:26we need a bigger basket

00:47:27than simply

00:47:28this tool alone.

00:47:29It'll help,

00:47:30but I would not

00:47:31exaggerate its effects.

00:47:34As you know,

00:47:35to receive a physician's

00:47:36license,

00:47:37doctors are required

00:47:38to participate

00:47:38in an ACGME

00:47:40accredited residency.

00:47:42Traditionally,

00:47:43state licensing requirements

00:47:44that facilitate

00:47:45anti-competitive conduct

00:47:46are shielded

00:47:47from antitrust law

00:47:48under the state action

00:47:49immunity doctrine.

00:47:50What issues do you see

00:47:51with state medical

00:47:52licensing boards

00:47:53rubber stamping

00:47:55monopolistic conduct

00:47:56like that of the ACGME?

00:47:57Okay.

00:47:58You're opening up

00:47:59a different basket.

00:48:00Yep.

00:48:00That's okay.

00:48:02Certainly,

00:48:04many state actions,

00:48:08that can be,

00:48:08there's real state action

00:48:09and then there's kind of

00:48:10periphery state action.

00:48:12Certainly encourage

00:48:13an anti-competitive atmosphere

00:48:15in state physician markets.

00:48:19In general,

00:48:21they are being carved back,

00:48:24but not as much

00:48:25as they should.

00:48:26We've eroded

00:48:26some of the excesses

00:48:28of the state action doctrine

00:48:29in terms of having

00:48:30a clear articulation

00:48:31of state policy

00:48:32and closer supervision.

00:48:34That's a process

00:48:35in which we're moving

00:48:37slower than we should

00:48:38on that front.

00:48:40States certainly could

00:48:41do a better job

00:48:42in this regard

00:48:43and there are,

00:48:44as I've suggested,

00:48:45other federal levers

00:48:46to give them

00:48:48some encouragement

00:48:48to do so.

00:48:50But any individual state

00:48:52should be responsible

00:48:53for its medical markets

00:48:54and the results

00:48:55it produces

00:48:56and I think the process

00:48:58is fairly disappointing

00:48:59thus far.

00:49:00Some states have led the way,

00:49:01but it's a handful,

00:49:03whether it's licensing

00:49:04of foreign physicians,

00:49:06alternative ways

00:49:06to expand the workforce.

00:49:08We've got to go

00:49:08a lot further

00:49:09on that front end

00:49:10reciprocity.

00:49:11We had to have

00:49:12the extremes

00:49:12of the COVID situation

00:49:14to begin to find out

00:49:15how we could loosen things up

00:49:16when we're really desperate.

00:49:17We should do that

00:49:18more often

00:49:18as a general rule

00:49:19and we've got a long way

00:49:20to go in order

00:49:21to expand the overall

00:49:22supply of health care,

00:49:24not just kind of

00:49:25the newly minted physicians.

00:49:28Staying with the ACGME,

00:49:29medical residency programs

00:49:31can only receive

00:49:31federal funding

00:49:32through Medicare

00:49:33and Medicaid

00:49:33if they're accredited

00:49:34by the ACGME.

00:49:35As a result,

00:49:37the ACGME

00:49:37essentially controls

00:49:38the on and off switch

00:49:39for billions of dollars

00:49:40in federal funding.

00:49:42With that power,

00:49:42the ACGME has set

00:49:43accreditation requirements

00:49:45that are not consistent

00:49:46with the federal government's priorities

00:49:47like radical DEI hiring requirements

00:49:49and wasteful administrative burdens.

00:49:51How would creating

00:49:52an alternative certification process

00:49:54for Medicare and Medicaid funding

00:49:55loosen the ACGME's power

00:49:57over the medical residency market?

00:49:59There's always room

00:50:01for competition

00:50:01even in government franchises

00:50:04and certainly there are ways

00:50:05to think of other forms

00:50:07of certification

00:50:08independently driven

00:50:10through the private sector

00:50:11which could be recognized

00:50:12as alternative sources

00:50:13of that supply.

00:50:14That would require

00:50:15the federal government

00:50:16to step forward though

00:50:17and take more control

00:50:18of that situation

00:50:19or states also

00:50:20in their own determination

00:50:21of accreditation

00:50:22deciding they need

00:50:23additional sources.

00:50:24When you have a shortage

00:50:26of supply

00:50:26and you only have one supplier

00:50:28it suggests time

00:50:29to either find

00:50:30some alternatives

00:50:31or say to the person

00:50:32let's make some adjustments.

00:50:34Thank you Mr. Chairman

00:50:35I yield back.

00:50:36Gentleman yields back

00:50:37now recognize

00:50:38the gentleman from Georgia

00:50:39for five minutes.

00:50:40Thank you Mr. Chairman.

00:50:42The medical match

00:50:43is not perfect

00:50:44but let's be honest

00:50:45about why we are having

00:50:46this hearing today.

00:50:48For House Republicans

00:50:49this is a hearing

00:50:51this hearing is an outgrowth

00:50:53of MAGA Republican

00:50:55ongoing attacks

00:50:57on science and research.

00:50:59President Trump

00:51:00and the Republican

00:51:01controlled Congress

00:51:02have made massive cuts

00:51:04to medical research programs

00:51:06at universities

00:51:07and at the federal level

00:51:09including research

00:51:10into things like

00:51:11women's health

00:51:12racial disparities

00:51:14and chronic diseases.

00:51:16I'm proud that

00:51:17the Centers for Disease Control

00:51:19and Prevention

00:51:21is headquartered

00:51:22in my hometown of Atlanta

00:51:23but the Trump administration

00:51:26already cut 2,400 jobs

00:51:28from the CDC last month

00:51:30and ended programs

00:51:32on lead poisoning

00:51:33smoking cessation

00:51:35and reproductive health.

00:51:37Now that does not make

00:51:39America healthy again

00:51:41does it Dr. Lin?

00:51:42Yes or no?

00:51:48Congressman.

00:51:49Okay so yes or no?

00:51:50I'm running out of time

00:51:52so I'm going to move on

00:51:54you don't want to answer

00:51:54that question.

00:51:56President Trump's

00:51:56latest budget calls

00:51:58for cutting CDC's funding

00:51:59by half

00:52:01and eliminating

00:52:02its chronic disease center

00:52:04entirely

00:52:05wiping out programs

00:52:07aimed at preventing

00:52:08cancer

00:52:08heart disease

00:52:10diabetes

00:52:10epilepsy

00:52:11and Alzheimer's disease

00:52:14that doesn't make

00:52:14America healthy again

00:52:16does it

00:52:16Mr. Marek?

00:52:18Yes or no?

00:52:19I don't have an answer

00:52:21for that.

00:52:21Okay well

00:52:22it's clear

00:52:23it's abundantly clear

00:52:25to most Americans

00:52:28exempting of course

00:52:30MAGA Republicans

00:52:31I guess would not

00:52:32understand.

00:52:35Now House Republicans

00:52:36are trying to jam

00:52:37through a spending bill

00:52:38that would make

00:52:39massive cuts

00:52:41to research

00:52:42as well as

00:52:42massive cuts

00:52:43to Medicaid

00:52:44ripping away

00:52:458 million Americans

00:52:47health care

00:52:47so that they can fund

00:52:48tax breaks

00:52:49for their billionaire

00:52:50buddies.

00:52:52Mr. Miller

00:52:52that does not

00:52:53make America

00:52:54healthy again

00:52:54does it?

00:52:55A lot of things

00:52:56don't make America

00:52:57healthy

00:52:57we can talk about them

00:52:59if you wish

00:52:59to have a wider range

00:53:00of hearing

00:53:00but by time

00:53:01Dr. Feldman

00:53:04international medical

00:53:05graduates

00:53:06represent a substantial

00:53:08chunk of physicians

00:53:10practicing in the United States

00:53:12you said 23%

00:53:13in your testimony

00:53:14but the Trump administration

00:53:16and House Republicans

00:53:18are trying to make it harder

00:53:19for non-citizens

00:53:21to come work

00:53:22in the United States

00:53:23how would it impact

00:53:25care in this country

00:53:26if we lost

00:53:27those international

00:53:28medical graduates?

00:53:29I think it would be

00:53:31devastating

00:53:32international medical

00:53:34graduates often serve

00:53:35in rural communities

00:53:36in primary care roles

00:53:37and they help solve

00:53:39the physician shortage

00:53:40that we're here

00:53:40to talk about today

00:53:41Yeah, that would not

00:53:42make America

00:53:43healthy again

00:53:44would it?

00:53:44It would not

00:53:45Dr. Feldman

00:53:46the Trump administration

00:53:48and Republicans

00:53:48are trying to slash

00:53:50spending

00:53:51to federal health care

00:53:52could you say more

00:53:54about why programs

00:53:55would be impacted

00:53:56if Congress

00:53:57increased funding

00:53:58for residency programs

00:54:00through the centers

00:54:01for Medicare

00:54:02and Medicaid services

00:54:04rather than trying

00:54:05to cut funding

00:54:07for those programs?

00:54:11I think that we need

00:54:12to increase funding

00:54:13because we have

00:54:15a physician shortage

00:54:15and the way to solve

00:54:16the physician shortage

00:54:17in part

00:54:18is through more positions

00:54:20the only way to have

00:54:21more positions

00:54:21is more funding

00:54:22That's common sense

00:54:23and Mr. Miller

00:54:24you're shaking your head

00:54:25no, I don't understand

00:54:27but back to Dr. Feldman

00:54:29Republicans are floating

00:54:31ideas

00:54:32are floating an idea

00:54:33that would require

00:54:34doctors to work

00:54:36even longer

00:54:37to achieve

00:54:38public interest

00:54:39loan forgiveness

00:54:40because it would not

00:54:41count the years

00:54:42of their residency

00:54:43toward the 10 year

00:54:45requirement

00:54:46Can you speak

00:54:47as to how this

00:54:49would impact

00:54:50the availability

00:54:51of care

00:54:52particularly in rural

00:54:53or underserved areas?

00:54:55If you ask

00:54:56the wrong question

00:54:57you'll get

00:54:57the wrong answer

00:54:58I'm asking Dr. Feldman

00:54:59I'll tell you

00:55:02as somebody

00:55:03who is doing

00:55:05public service

00:55:06loan forgiveness

00:55:06and who started

00:55:08paying down

00:55:09my student loans

00:55:10during residency

00:55:11there's no reason

00:55:13to push that out

00:55:15and I think

00:55:16it's a very good program

00:55:17and it's a way

00:55:18to get physicians

00:55:19into the workforce

00:55:21and I think

00:55:22it would be a bad idea

00:55:23Yeah, if Republicans

00:55:24were serious

00:55:25about making health care

00:55:28more affordable

00:55:29and more accessible

00:55:31to the American people

00:55:34there are so many things

00:55:36that we could have

00:55:37hearings about

00:55:38other than this match

00:55:41Gentleman's time

00:55:42has expired

00:55:42And I yield back

00:55:44the remainder of it

00:55:45Gentleman yields back

00:55:46Gentlewoman from Wyoming

00:55:48is recognized

00:55:49Mr. Miller

00:55:49you seemed as though

00:55:50you had something to say

00:55:51Well

00:55:53there's one view

00:55:55of the world

00:55:56which says simply

00:55:57pour more resources in

00:55:59and everything

00:56:00will work wonderfully

00:56:01Problems with our

00:56:02health care system

00:56:03are what we're getting

00:56:04out of it

00:56:05as well as what

00:56:05we're putting into it

00:56:07and so a singular focus

00:56:08on just

00:56:09adding more dollars

00:56:10for more inputs

00:56:11says nothing about

00:56:13the quality of the care

00:56:15its efficiency

00:56:16its alternative delivery

00:56:17we need to make

00:56:18lots of changes

00:56:19in a lot of things

00:56:20in order to get

00:56:21a better health care system

00:56:22It is not

00:56:23should not be solely

00:56:25focused on

00:56:25let's just have

00:56:26a lot more physicians

00:56:27and everything

00:56:28will be great

00:56:29We've tried that approach

00:56:30before

00:56:31it doesn't produce

00:56:32the results

00:56:32Now there are barriers

00:56:33to production

00:56:34of physicians

00:56:35which we can talk about

00:56:36but it isn't solved

00:56:38simply by increasing

00:56:39federal funding

00:56:40Okay, I appreciate

00:56:41that comment

00:56:42Several of you

00:56:43have testified

00:56:44that the match system

00:56:45harms rural hospitals

00:56:47I'm from Wyoming

00:56:48which is a very rural state

00:56:51dealing with many challenges

00:56:53in its ability

00:56:54to provide health care services

00:56:56and with barriers

00:56:57related to financing

00:56:58transportation and access

00:57:00Dr. Lynn

00:57:02is it difficult

00:57:02for rural hospitals

00:57:03to meet ACGME's

00:57:05accreditation requirements?

00:57:08It is challenging

00:57:10Congresswoman

00:57:11What are those challenges?

00:57:14Some of the challenges

00:57:15are some of the standards

00:57:16that they put in place

00:57:17that for example

00:57:19distance radius

00:57:21obviously if you look

00:57:23at rural America

00:57:24there are 1300

00:57:25critical access hospital

00:57:27and by critical access hospital

00:57:29by definition

00:57:31there are less than 25 beds

00:57:33so given that

00:57:34if you're training

00:57:35a physician

00:57:36obviously scope

00:57:37and volume

00:57:37becomes a problem

00:57:38so when you're trying

00:57:40to train a rural program

00:57:41for residents

00:57:42you have to send them

00:57:43to distance away

00:57:45for training

00:57:46and one of the barriers

00:57:47to that is that

00:57:49for example

00:57:49our orthopedic program

00:57:51got shut down

00:57:51because we have to send

00:57:53our residents

00:57:53to Cincinnati Children's Hospital

00:57:55and we have a consortium model

00:57:57that we have partnership

00:57:58with them

00:57:59and that was not

00:58:00acceptable to them

00:58:01so that creates

00:58:02a barrier

00:58:02where we're trying

00:58:03to increase quality

00:58:04and scope and volume

00:58:06for our residents

00:58:06and they thought

00:58:08that was a negative

00:58:10we got cited

00:58:11and that was one

00:58:12of the reasons

00:58:12why they closed

00:58:13down our program

00:58:14so do you have

00:58:15some ideas

00:58:16of how to fix

00:58:16those kind of

00:58:17accreditation problems

00:58:18yeah absolutely

00:58:19if you look at

00:58:21prior to 2015

00:58:23the merger

00:58:24of the ACGME

00:58:25and the AOA

00:58:26there was an alternative

00:58:28accreditation body

00:58:29which is from the AOA

00:58:30and if you look at

00:58:31prior to the merger

00:58:33we have

00:58:35most of

00:58:36osteopathic institutions

00:58:38have a consortium model

00:58:39where we

00:58:40have a network

00:58:42of small community hospitals

00:58:44and or community hospitals

00:58:46and we sort of

00:58:47leverage each other's strength

00:58:49and we put in

00:58:49the consortium model

00:58:50that we

00:58:51have a network

00:58:53of training sites

00:58:54that we can send

00:58:55our residents

00:58:55and collaborate

00:58:56and that

00:58:57model has worked out

00:58:59for many many years

00:59:00Mill Creek Community Hospital

00:59:02which now is called

00:59:03why was it changed

00:59:04it changed because

00:59:06of the merger

00:59:08of the merger

00:59:09that's correct

00:59:10specifically the issue

00:59:11that this committee

00:59:12addressed antitrust

00:59:13is focusing on

00:59:15correct

00:59:15in my opinion

00:59:17yes

00:59:17okay

00:59:18Mr. Miller

00:59:19there is persistent

00:59:21and growing shortage

00:59:22of medical professionals

00:59:23in this country

00:59:24and again

00:59:25representing a state

00:59:26like Wyoming

00:59:27we seem to be

00:59:28hit harder

00:59:28than many others

00:59:29do you think

00:59:30placing qualifications

00:59:31on job positions

00:59:32that are not based

00:59:33on merits

00:59:34such as the DEI

00:59:36requirements

00:59:37exacerbates the challenges

00:59:38our nation is facing

00:59:40in terms of providing

00:59:41care for our citizens

00:59:42well the

00:59:44it sounds like

00:59:46a euphemism

00:59:47you know

00:59:47the goal is

00:59:49to have everything

00:59:49based upon

00:59:50competition

00:59:50quality and merit

00:59:51the rest of the

00:59:53distinctions are

00:59:54ancillary

00:59:55and can be

00:59:55distracting from that

00:59:56I don't want to

00:59:57overstate

00:59:58the magnitude

00:59:59of DEI

00:59:59and this is going

01:00:00to fight its way

01:00:00out through the courts

01:00:01we've got rulings

01:00:02they're going to be

01:00:03interpreted

01:00:04and some games

01:00:05are going to be played

01:00:06in the educational

01:00:06system in general

01:00:07not just for physicians

01:00:08but the more we can

01:00:10focus on

01:00:11what physicians

01:00:12are doing

01:00:13at the point of care

01:00:15and what they're

01:00:15producing

01:00:15that's what we want

01:00:17to measure

01:00:17as opposed to

01:00:18any other

01:00:19ancillary considerations

01:00:20but I think

01:00:21that's going to

01:00:22work itself out

01:00:22through further litigation

01:00:23probably more so

01:00:24than

01:00:25random interventions

01:00:27changes

01:00:27okay

01:00:27Mr. Mary

01:00:29very quickly

01:00:29this hearing

01:00:30focuses on the

01:00:31antitrust exemption

01:00:32granted by Congress

01:00:34but you were hired

01:00:35in the 1990s

01:00:36as part of a lawsuit

01:00:37against the match

01:00:38system

01:00:38the National Resident

01:00:40Matching Program

01:00:41also known as

01:00:42MATCH

01:00:42was founded in 1952

01:00:44the ACGME

01:00:46was established

01:00:47in 1981

01:00:48how far back

01:00:49does the harm

01:00:50for your clients

01:00:50and other medical

01:00:51students go

01:00:52I think the harm

01:00:54goes all the way

01:00:54back to 1952

01:00:56frankly

01:00:56from the beginning

01:00:58just created

01:00:59the program itself

01:01:00people got their

01:01:01positions by

01:01:02telegrams

01:01:03back in 1952

01:01:04the problems

01:01:05then have no

01:01:06relevance to today

01:01:07in my view

01:01:08okay

01:01:08thank you

01:01:09I yield back

01:01:10gentlewoman yields

01:01:11back

01:01:11gentleman from

01:01:12Illinois is now

01:01:13recognized for five

01:01:14minutes

01:01:14thank you

01:01:15Chairman Fitzgerald

01:01:16and members

01:01:18the witnesses

01:01:19that are here today

01:01:20we're here today

01:01:22because we're

01:01:23talking about

01:01:24the possibility

01:01:25of an antitrust

01:01:27exemption

01:01:27for the medical

01:01:28residency

01:01:30match program

01:01:30as a strong

01:01:31proponent of

01:01:32enforcing

01:01:33antitrust laws

01:01:34I approach

01:01:35any exemption

01:01:36with skepticism

01:01:37it seems to me

01:01:38that the exemption

01:01:39for the match

01:01:40has pros

01:01:42and cons

01:01:43in some ways

01:01:43it does limit

01:01:45choice for candidates

01:01:45who are bound

01:01:46to the program

01:01:47they match with

01:01:48and cannot negotiate

01:01:49employment terms

01:01:50or benefits

01:01:51since they are

01:01:52matched

01:01:52so there are

01:01:54legitimate questions

01:01:55about how the system

01:01:56works and how

01:01:57it can be improved

01:01:59but it's also true

01:02:00that repealing

01:02:01the antitrust

01:02:03exemption

01:02:04outright

01:02:04may have

01:02:06unintended

01:02:07consequences

01:02:07that worsen

01:02:08outcomes for

01:02:10medical residents

01:02:11Dr. Feldman

01:02:12in your opinion

01:02:13could repealing

01:02:15the exemption

01:02:17actually end up

01:02:19benefiting the most

01:02:20well-resourced

01:02:21hospitals

01:02:22medical schools

01:02:24and residency

01:02:24programs

01:02:25I think it could

01:02:28because

01:02:28what

01:02:29what I think

01:02:31I would worry

01:02:32about

01:02:33is

01:02:33a sort of

01:02:34insiderism

01:02:35where

01:02:36outside of the match

01:02:37you would have

01:02:38well-resourced applicants

01:02:39with well-resourced

01:02:40mentors

01:02:41who are connecting

01:02:42with well-resourced

01:02:43institutions

01:02:44and some of the

01:02:45fairness that

01:02:46the match

01:02:46engenders

01:02:47would be lost

01:02:49I think

01:02:49thank you

01:02:50clearly this is

01:02:51a nuanced

01:02:53issue

01:02:53and congress

01:02:54should be taking

01:02:56a nuanced

01:02:57approach to it

01:02:58as well

01:02:58our

01:02:59one relevant

01:03:00factor here

01:03:01is that

01:03:01most medical

01:03:02residencies

01:03:03are at least

01:03:04partially funded

01:03:05by federal dollars

01:03:07so

01:03:07if we want to fix

01:03:08some of the issues

01:03:09created by the match

01:03:11like compensation

01:03:12and shortages

01:03:13of internal

01:03:15medicine residents

01:03:16congress

01:03:16can act

01:03:17to solve them

01:03:18Dr. Feldman

01:03:19would you agree

01:03:20that federal

01:03:21funding

01:03:21can be used

01:03:22to address

01:03:23these issues

01:03:24I would agree

01:03:25thank you

01:03:26I also want

01:03:28to join

01:03:28my colleagues

01:03:29here

01:03:30in pointing out

01:03:31how absurd

01:03:32it is

01:03:32that Republicans

01:03:33are portraying

01:03:33themselves

01:03:34as champions

01:03:35of physicians

01:03:37patients

01:03:37and health care

01:03:39more broadly

01:03:40when their policies

01:03:41are actively

01:03:42destroying access

01:03:43to affordable

01:03:44health care

01:03:44my colleagues

01:03:45have addressed

01:03:46that

01:03:46and they've

01:03:47also brought

01:03:47up

01:03:48the devastating

01:03:49cuts

01:03:50to the NIH

01:03:51and the FDA

01:03:52which will

01:03:54jeopardize

01:03:55the research

01:03:56that residents

01:03:56and physicians

01:03:58rely on

01:03:59to treat

01:03:59their patients

01:04:00but there are

01:04:00also significant

01:04:02anti-trust issues

01:04:03in health care

01:04:04that are driving

01:04:05up costs

01:04:06for patients

01:04:07if Republicans

01:04:08cared about

01:04:09solving the root

01:04:10causes

01:04:10of those problems

01:04:12we would be

01:04:13talking about

01:04:14hospital mergers

01:04:15price gouging

01:04:16or consolidation

01:04:17in the

01:04:18pharmaceutical

01:04:19industry

01:04:20Dr. Feldman

01:04:21let me ask you

01:04:22about the last

01:04:23issue

01:04:24since your

01:04:26research has

01:04:27focused on it

01:04:28how is

01:04:29how is

01:04:30vertical integration

01:04:31in the

01:04:32pharmaceutical

01:04:33industry

01:04:34driving up

01:04:35the cost

01:04:35for consumers

01:04:36at the center

01:04:38of the

01:04:39of vertical

01:04:40integration

01:04:40in the

01:04:41pharmaceutical

01:04:41industry

01:04:42are PBMs

01:04:43pharmacy benefit

01:04:43managers

01:04:44and PBMs

01:04:46distort the

01:04:47incentives

01:04:48for lower

01:04:49cost drugs

01:04:50PBMs

01:04:52are after

01:04:53large

01:04:55confidential

01:04:55discounts

01:04:56which

01:04:56can keep

01:04:58list prices

01:04:58high

01:04:59and patients

01:05:00don't see

01:05:00the benefits

01:05:01of those

01:05:01discounts

01:05:02in fact

01:05:03their out-of-pocket

01:05:03costs are tied

01:05:04more to

01:05:05list prices

01:05:06and so

01:05:06PBMs

01:05:07have been

01:05:08in part

01:05:09responsible

01:05:09for driving

01:05:10some of the

01:05:11high out-of-pocket

01:05:12costs

01:05:12that we see

01:05:13in vertical

01:05:14integration

01:05:15when PBMs

01:05:16and pharmacies

01:05:17and payers

01:05:18are all

01:05:18owned by

01:05:19the same

01:05:19company

01:05:20can lead

01:05:22to reduced

01:05:22choices

01:05:23at the

01:05:23pharmacy

01:05:24and bad

01:05:25outcomes

01:05:25for patients

01:05:26thank you

01:05:27this

01:05:28exchange

01:05:29illustrates

01:05:30why we

01:05:31need a

01:05:31serious

01:05:32principled

01:05:33approach

01:05:33to antitrust

01:05:34enforcement

01:05:35and why

01:05:36we need

01:05:37antitrust

01:05:38enforcers

01:05:38at the

01:05:39FTC

01:05:40and the

01:05:41DOJ

01:05:41who are

01:05:42willing

01:05:43to fight

01:05:43for workers

01:05:44for consumers

01:05:45and patients

01:05:46instead of

01:05:47bending the

01:05:47knee

01:05:48to billionaires

01:05:49and corporate

01:05:50interests

01:05:51thank you

01:05:52and I yield

01:05:53back

01:05:53the gentleman

01:05:54yields back

01:05:55I'm not going

01:05:55to recognize

01:05:56myself for

01:05:56five minutes

01:05:57and yield

01:05:57my time

01:05:58to the

01:05:59gentleman

01:05:59from Missouri

01:06:00for five minutes

01:06:02who waved

01:06:03onto the

01:06:03committee

01:06:03thank you

01:06:05Mr.

01:06:05Chairman

01:06:06and thanks

01:06:06for all

01:06:06the witnesses

01:06:07here today

01:06:08Dr.

01:06:10Lin

01:06:10in your

01:06:10testimony

01:06:11you

01:06:11touched

01:06:12a little

01:06:12bit

01:06:13on some

01:06:13of the

01:06:14residency

01:06:15closures

01:06:16that

01:06:16were those

01:06:18ones

01:06:18at your

01:06:19institution

01:06:19specifically

01:06:20or around

01:06:21the country

01:06:22or

01:06:22so in

01:06:23my written

01:06:23testimony

01:06:24my oral

01:06:24testimony

01:06:25it's a

01:06:25combination

01:06:25of

01:06:26our

01:06:27LECOM

01:06:28system

01:06:30hospitals

01:06:31okay

01:06:32and

01:06:33you know

01:06:34I was

01:06:34reading

01:06:35in your

01:06:35early

01:06:36in your

01:06:36written

01:06:36testimony

01:06:37that there

01:06:38was a

01:06:38general

01:06:39surgery

01:06:40program

01:06:40let's see

01:06:41the termination

01:06:42oh is of

01:06:42the director

01:06:43due to

01:06:44non-compliance

01:06:45with COVID-19

01:06:46vaccination

01:06:47yeah so

01:06:48that was

01:06:48in our

01:06:49Almira

01:06:50campus

01:06:50in our

01:06:51regional

01:06:51campus

01:06:52my

01:06:53understanding

01:06:54of that

01:06:54case

01:06:55is that

01:06:55it was

01:06:56the height

01:06:56of COVID

01:06:56and the

01:06:58program

01:06:58director

01:06:59didn't want

01:07:00to get

01:07:01a vaccination

01:07:01and because

01:07:02of that

01:07:03there was a

01:07:03mandate

01:07:03from ACGME

01:07:04that required

01:07:06the program

01:07:06directors

01:07:06to have

01:07:07vaccinations

01:07:08so the

01:07:09program

01:07:10director

01:07:10resigned

01:07:11from the

01:07:12position

01:07:12and because

01:07:13of that

01:07:13there was

01:07:14no program

01:07:14director

01:07:15and they

01:07:15shut down

01:07:15the program

01:07:16oh and

01:07:16that was

01:07:17my question

01:07:17the program

01:07:18did end up

01:07:19getting shut

01:07:19down

01:07:19yes

01:07:20okay

01:07:20and how

01:07:22many do

01:07:22you have an

01:07:23estimate

01:07:23of about

01:07:23how many

01:07:24residency

01:07:25programs

01:07:25have been

01:07:26shut down

01:07:27over the

01:07:27years

01:07:27because

01:07:28of ACGME

01:07:29so I

01:07:30just have

01:07:31general

01:07:31statistics

01:07:32where

01:07:33after the

01:07:34merger

01:07:35of the

01:07:35ACGME

01:07:36and AOA

01:07:36there is

01:07:37approximately

01:07:38670 some

01:07:39programs

01:07:40that have

01:07:40closed

01:07:41and more

01:07:42recently

01:07:43it's an

01:07:44ongoing

01:07:44process

01:07:45where

01:07:46you know

01:07:46there are

01:07:46new programs

01:07:47they're trying

01:07:47to get

01:07:48started

01:07:48and then

01:07:49there are

01:07:49programs

01:07:50getting shut

01:07:51down

01:07:51but if

01:07:51you look

01:07:51at it

01:07:52disproportionately

01:07:53it's always

01:07:54the smaller

01:07:54community

01:07:55program

01:07:56that is

01:07:56not as

01:07:57resourced

01:07:57as a

01:07:58tertiary care

01:07:58center

01:07:59or a

01:08:00university

01:08:00based

01:08:01center

01:08:01that

01:08:02can't

01:08:02meet

01:08:02the

01:08:02standards

01:08:03that are

01:08:03getting

01:08:03shut

01:08:04down

01:08:04right

01:08:05yeah

01:08:05that's

01:08:05what it

01:08:05seems

01:08:06to me

01:08:06that it's

01:08:07a matter

01:08:07of

01:08:07resources

01:08:09you're

01:08:09not

01:08:09going

01:08:10to see

01:08:10a

01:08:10program

01:08:10at

01:08:11Harvard

01:08:11Medical

01:08:12School

01:08:12getting

01:08:12shut

01:08:13down

01:08:13but

01:08:13in

01:08:14rural

01:08:15America

01:08:16where we

01:08:16have

01:08:17the

01:08:17most

01:08:17acute

01:08:18shortage

01:08:18of

01:08:19primary

01:08:19care

01:08:19doctors

01:08:20and

01:08:20of

01:08:20specialists

01:08:21you know

01:08:22with fewer

01:08:23resources

01:08:24that's where

01:08:24they get

01:08:24shut

01:08:25down

01:08:25correct

01:08:25and

01:08:26I

01:08:26would

01:08:27say

01:08:27that

01:08:28you know

01:08:28Dr.

01:08:29Philman

01:08:29and my

01:08:30job

01:08:30are probably

01:08:31very

01:08:32different

01:08:32his

01:08:33environment

01:08:33my

01:08:33environment

01:08:34is

01:08:34very

01:08:34different

01:08:35I

01:08:35work

01:08:35in a

01:08:36critical

01:08:36access

01:08:36hospital

01:08:37with 25

01:08:38beds

01:08:39in

01:08:39Corrie

01:08:39Pennsylvania

01:08:40where the

01:08:41population

01:08:41is probably

01:08:42less than

01:08:436,000

01:08:43in that

01:08:44town

01:08:44but there's

01:08:45absolutely

01:08:45no

01:08:45resources

01:08:46so from

01:08:47that

01:08:47perspective

01:08:47you know

01:08:48I'm not

01:08:51saying

01:08:51ACGME

01:08:52is bad

01:08:52I'm saying

01:08:53that there

01:08:54needs to be

01:08:54an alternative

01:08:55way to

01:08:55focus on

01:08:56a different

01:08:57venue

01:08:57so we can

01:08:58create

01:08:58different types

01:09:00of physicians

01:09:00nor I'm

01:09:01sure are you

01:09:02saying that

01:09:02every

01:09:03residency

01:09:04program in

01:09:05the country

01:09:05is good

01:09:06that there

01:09:07isn't

01:09:08there has

01:09:08to be

01:09:09a standard

01:09:09but it

01:09:11seems to

01:09:11me

01:09:11that at

01:09:12a time

01:09:12when

01:09:13over

01:09:148,800

01:09:15medical school

01:09:16graduates

01:09:16per year

01:09:17go unmatched

01:09:18that it's

01:09:19a tragedy

01:09:20that a

01:09:21bureaucratic

01:09:21organization

01:09:22with a

01:09:22monopoly

01:09:23is shutting

01:09:23down

01:09:23programs

01:09:25correct

01:09:26and I

01:09:29believe

01:09:29there was

01:09:31a question

01:09:32earlier

01:09:32in this

01:09:33about

01:09:33DEI

01:09:35and

01:09:35maybe

01:09:36ACGME

01:09:37backing

01:09:38away

01:09:39from

01:09:39DEI

01:09:40requirements

01:09:41did

01:09:42one of

01:09:43the witnesses

01:09:43address

01:09:44that

01:09:44yes

01:09:45that was

01:09:46me

01:09:46we did

01:09:47receive

01:09:47an email

01:09:48notifying

01:09:49all the

01:09:50programs

01:09:50that

01:09:51as of

01:09:51May 9th

01:09:52they were

01:09:52suspending

01:09:53the DEI

01:09:53requirements

01:09:54that used

01:09:55to be

01:09:55an

01:09:55institutional

01:09:56and

01:09:56common

01:09:57program

01:09:58requirement

01:09:59for

01:09:59every

01:10:00sponsored

01:10:01institution

01:10:01as well

01:10:02as programs

01:10:03did many

01:10:04of those

01:10:04programs

01:10:04have

01:10:05DEI

01:10:05officers

01:10:06or someone

01:10:07employed

01:10:08to monitor

01:10:09these mandates

01:10:10well yes

01:10:11because using

01:10:12the standards

01:10:13if you want

01:10:14to maintain

01:10:14the program

01:10:16the individual

01:10:17program

01:10:18institution

01:10:18would have

01:10:19to expand

01:10:19resources

01:10:20to meet

01:10:21that requirement

01:10:21my concern

01:10:23there of course

01:10:24is that

01:10:24even if the

01:10:25requirement

01:10:26goes away

01:10:27all of these

01:10:27institutions

01:10:28have hired

01:10:28people

01:10:29to do

01:10:29something

01:10:30those people

01:10:31are going

01:10:31to

01:10:31unless they

01:10:32relieve them

01:10:33of their

01:10:33jobs

01:10:34these

01:10:36same

01:10:37people

01:10:37embedded

01:10:38in the

01:10:38system

01:10:39driven by

01:10:40ACGME

01:10:40requirements

01:10:41over the

01:10:41years

01:10:41will continue

01:10:42to engage

01:10:44in pernicious

01:10:44discrimination

01:10:45based on race

01:10:47in violation

01:10:48of I think

01:10:48both moral

01:10:49principle

01:10:49and federal

01:10:50law

01:10:50but that's

01:10:51something I

01:10:52think ACGME

01:10:53has given

01:10:53us over the

01:10:54years

01:10:54well thank you

01:10:56for your

01:10:56testimony

01:10:56I yield

01:10:57back

01:10:57gentleman

01:10:58yields back

01:10:59who now

01:10:59recognize

01:11:00the ranking

01:11:00member of

01:11:01the full

01:11:01committee

01:11:01for five

01:11:03minutes

01:11:03thank you

01:11:04very much

01:11:04Mr. Chairman

01:11:05Dr. Feldman

01:11:06President Trump

01:11:09and Secretary

01:11:11Kennedy want

01:11:12to cut

01:11:1318 billion

01:11:14dollars

01:11:14from NIH

01:11:15they want

01:11:16to cut

01:11:17three and a

01:11:17half billion

01:11:18dollars

01:11:18from CDC

01:11:19the Centers

01:11:21for Disease

01:11:21Control

01:11:21and they want

01:11:22to cut

01:11:224.7

01:11:23billion dollars

01:11:24from the

01:11:24National Science

01:11:25Foundation

01:11:26these

01:11:27unprecedented

01:11:28proposed

01:11:30reductions

01:11:30in America's

01:11:32health care

01:11:34research

01:11:34spending

01:11:35would come

01:11:37at a time

01:11:37when we have

01:11:38overwhelming

01:11:38needs in

01:11:39the American

01:11:40public

01:11:41for medical

01:11:43and scientific

01:11:43breakthroughs

01:11:44and also

01:11:45they come

01:11:45at a time

01:11:46when we have

01:11:46the opportunity

01:11:47to make

01:11:47big breakthroughs

01:11:50in scientific

01:11:51research

01:11:52related to

01:11:54everything

01:11:54from

01:11:55multiple

01:11:57sclerosis

01:11:58to

01:11:59cystic

01:11:59fibrosis

01:12:00to

01:12:01breast

01:12:01cancer

01:12:02to

01:12:02malignant

01:12:03narcissistic

01:12:05personality

01:12:05disorder

01:12:06you name

01:12:06it

01:12:06what would

01:12:08be the

01:12:08direct

01:12:09effects

01:12:09of such

01:12:11drastic

01:12:12budget

01:12:12reductions

01:12:13on health

01:12:14care

01:12:14delivery

01:12:15and on

01:12:17the progress

01:12:18of

01:12:18health care

01:12:19research

01:12:20I think

01:12:22the effects

01:12:22would be

01:12:23dramatic

01:12:24when you

01:12:24look at

01:12:25FDA

01:12:26approved

01:12:26drugs

01:12:27nearly

01:12:27every

01:12:28single

01:12:28drug

01:12:29that gets

01:12:29approved

01:12:29by the

01:12:29FDA

01:12:30is traced

01:12:31back

01:12:31to some

01:12:32funding

01:12:32through

01:12:33the

01:12:33NIH

01:12:34NIH

01:12:35funding

01:12:35has

01:12:36contributed

01:12:37to

01:12:37cures

01:12:38for

01:12:38hepatitis

01:12:38C

01:12:39to

01:12:39treatments

01:12:40for

01:12:40HIV

01:12:40to

01:12:41COVID-19

01:12:41vaccines

01:12:42cutting

01:12:45NIH

01:12:46funding

01:12:46will

01:12:47absolutely

01:12:48reduce

01:12:50the number

01:12:50of

01:12:51breakthrough

01:12:51therapies

01:12:52of

01:12:53game

01:12:54changing

01:12:54therapies

01:12:55that

01:12:55patients

01:12:55would

01:12:55see

01:12:56in the

01:12:56future

01:12:56I think

01:12:57it's

01:12:57a bad

01:12:57idea

01:12:57so it

01:12:59sounds

01:12:59like

01:13:00we

01:13:00would

01:13:00be

01:13:01essentially

01:13:01destroying

01:13:03the

01:13:05wellspring

01:13:06for

01:13:07research

01:13:08across

01:13:09the board

01:13:09I think

01:13:11that's

01:13:11right

01:13:11and what

01:13:12you have

01:13:12to

01:13:12remember

01:13:13is that

01:13:14the NIH

01:13:14is funding

01:13:15the highest

01:13:17risk

01:13:18highest reward

01:13:18research

01:13:19that

01:13:19pharmaceutical

01:13:20companies

01:13:20then

01:13:21take

01:13:22to

01:13:23market

01:13:23so

01:13:24it's

01:13:24hard

01:13:24to

01:13:25know

01:13:25what's

01:13:25going

01:13:25to

01:13:25work

01:13:25and

01:13:25what

01:13:26doesn't

01:13:26and

01:13:26that's

01:13:27why

01:13:27you

01:13:27need

01:13:27broad

01:13:28funding

01:13:28and

01:13:29NIH

01:13:29has

01:13:29been

01:13:30incredibly

01:13:30successful

01:13:32in

01:13:33funding

01:13:34new

01:13:35cares

01:13:35so

01:13:36what

01:13:36are

01:13:36some

01:13:37of

01:13:37the

01:13:37next

01:13:38generation

01:13:38breakthroughs

01:13:39that

01:13:40might

01:13:40be

01:13:40lost

01:13:41if

01:13:41Robert F.

01:13:43Kennedy

01:13:43Jr.

01:13:44and Donald

01:13:44Trump

01:13:44have

01:13:44their

01:13:45way

01:13:45in

01:13:46dismantling

01:13:46so much

01:13:47scientific

01:13:48health

01:13:48research

01:13:49I think

01:13:49what's

01:13:50hard

01:13:50about

01:13:50this

01:13:51is

01:13:51that

01:13:51we

01:13:51can't

01:13:52know

01:13:52until

01:13:52we

01:13:52actually

01:13:53do

01:13:53the

01:13:53research

01:13:53until

01:13:54the

01:13:55funding

01:13:55comes

01:13:56but

01:13:56you

01:13:57mentioned

01:13:57some

01:13:58key

01:13:58disease

01:13:59areas

01:13:59that

01:14:00are

01:14:00vital

01:14:00for

01:14:01public

01:14:01health

01:14:01cancer

01:14:02we've

01:14:03had

01:14:03breakthroughs

01:14:04in

01:14:04cancer

01:14:04therapy

01:14:05over

01:14:05the

01:14:05last

01:14:0510

01:14:0620

01:14:0630

01:14:06years

01:14:07checkpoint

01:14:07inhibitors

01:14:08that

01:14:08treat

01:14:09a

01:14:09variety

01:14:09of

01:14:09different

01:14:10malignancies

01:14:10Alzheimer's

01:14:12dementia

01:14:12there

01:14:14are

01:14:14numerous

01:14:15untreated

01:14:16diseases

01:14:18in

01:14:18my area

01:14:19pulmonology

01:14:20COPD

01:14:22asthma

01:14:22these are

01:14:23diseases

01:14:23that

01:14:23have had

01:14:25some

01:14:25recent

01:14:26breakthroughs

01:14:26but I

01:14:27would love

01:14:27to see

01:14:27more

01:14:28therapies

01:14:28available

01:14:28for

01:14:29patients

01:14:30my

01:14:31guest

01:14:32to the

01:14:32joint

01:14:32session

01:14:33of

01:14:33congress

01:14:34Dr.

01:14:35Lauren

01:14:35McGee

01:14:36a

01:14:36constituent

01:14:36of mine

01:14:37was the

01:14:37chief

01:14:38biologist

01:14:38on a

01:14:39pediatric

01:14:39cancer

01:14:40unit

01:14:40at

01:14:41NIH

01:14:41and she

01:14:42got

01:14:42sacked

01:14:42on

01:14:43February

01:14:4314th

01:14:44because she

01:14:44made the

01:14:45mistake

01:14:45of being

01:14:45on

01:14:45probation

01:14:46not because

01:14:47she'd

01:14:47done

01:14:47anything

01:14:47wrong

01:14:48but because

01:14:48she'd

01:14:48been

01:14:48promoted

01:14:49after

01:14:50serial

01:14:51superior

01:14:52evaluations

01:14:53by the

01:14:54people

01:14:54reviewing

01:14:54her

01:14:55then we

01:14:55heard

01:14:56President

01:14:58Trump

01:14:58at the

01:14:59State

01:14:59Union

01:14:59saying

01:15:00that

01:15:00attacking

01:15:01childhood

01:15:02cancer

01:15:02was one

01:15:03of his

01:15:03key

01:15:03priorities

01:15:03do we

01:15:04have

01:15:04any

01:15:04chance

01:15:05of

01:15:05making

01:15:05progress

01:15:06on

01:15:07childhood

01:15:07cancer

01:15:07if we're

01:15:08dismantling

01:15:08the

01:15:09basic

01:15:09research

01:15:10that's

01:15:10going

01:15:10on at

01:15:11NIH

01:15:11about

01:15:12it

01:15:12the

01:15:13way

01:15:13to

01:15:14make

01:15:14progress

01:15:14on

01:15:15childhood

01:15:15cancer

01:15:15other

01:15:16diseases

01:15:16of

01:15:17childhood

01:15:17is

01:15:18through

01:15:18funding

01:15:19the

01:15:19research

01:15:20enterprise

01:15:20that

01:15:20finds

01:15:21new

01:15:23cures

01:15:24the

01:15:27administration

01:15:27is also

01:15:28proposing

01:15:28a massive

01:15:29cut to

01:15:29Medicaid

01:15:29which

01:15:31the

01:15:31CBO

01:15:31estimates

01:15:32would result

01:15:32in 8.5

01:15:33million

01:15:33people

01:15:34losing

01:15:34health

01:15:34care

01:15:35access

01:15:35over the

01:15:35next

01:15:35decade

01:15:36what

01:15:37population

01:15:38groups

01:15:38in what

01:15:39parts of

01:15:39the

01:15:39country

01:15:40are

01:15:40most

01:15:40affected

01:15:41by

01:15:41these

01:15:42Medicaid

01:15:42cuts

01:15:42these

01:15:43cuts

01:15:44will

01:15:44affect

01:15:44the

01:15:44most

01:15:45disadvantaged

01:15:45members

01:15:46of

01:15:46society

01:15:47in

01:15:48rural

01:15:50communities

01:15:50urban

01:15:51communities

01:15:51and cities

01:15:52I think

01:15:53it will

01:15:54be

01:15:54lead to

01:15:56very bad

01:15:56health

01:15:57outcomes

01:15:57my time

01:15:58is up

01:15:59but thank

01:15:59you Mr.

01:15:59Chairman

01:15:59we're now

01:16:01going to

01:16:02recognize

01:16:02the

01:16:02gentleman

01:16:03from

01:16:03California

01:16:04for five

01:16:04minutes

01:16:05thank you

01:16:06Mr.

01:16:07Chairman

01:16:07first of

01:16:07all I

01:16:07want to

01:16:08welcome

01:16:08the

01:16:08witnesses

01:16:09here

01:16:09today

01:16:09my wife

01:16:11is a

01:16:11medical

01:16:11doc

01:16:12and

01:16:12this

01:16:14subject

01:16:14brings

01:16:14back

01:16:15a lot

01:16:15of

01:16:15memories

01:16:16some

01:16:17kind

01:16:17of

01:16:17nightmarish

01:16:18residents

01:16:19as an

01:16:19OB

01:16:20resident

01:16:21putting in

01:16:21all those

01:16:22hours

01:16:2290 hours

01:16:24a week

01:16:24pay was

01:16:26challenging

01:16:26but we

01:16:27all knew

01:16:27it was

01:16:27part of

01:16:29the education

01:16:29process

01:16:30to become

01:16:31a good

01:16:31medical

01:16:32doctor

01:16:32a good

01:16:33specialist

01:16:34in the

01:16:34area

01:16:35of

01:16:35practice

01:16:35I've

01:16:40spoken to

01:16:40her

01:16:41about

01:16:41this

01:16:41issue

01:16:41and

01:16:42she

01:16:42concurs

01:16:43with me

01:16:43a lot

01:16:44of

01:16:44nightmares

01:16:44a lot

01:16:45of

01:16:45challenges

01:16:45and a

01:16:46tight

01:16:46budget

01:16:46it worked

01:16:48out

01:16:49so my

01:16:49question

01:16:50would be

01:16:50Dr.

01:16:51Feldman

01:16:52I'm going

01:16:52to ask

01:16:52you

01:16:52if it

01:16:53ain't

01:16:53broke

01:16:53why

01:16:54fix it

01:16:54what

01:16:54is wrong

01:16:55right now

01:16:56with the

01:16:56match

01:16:56system

01:16:58or the

01:16:58program

01:16:59I think

01:17:01the

01:17:01downsides

01:17:02have been

01:17:03spelled

01:17:04out

01:17:04by

01:17:04other

01:17:05witnesses

01:17:05and

01:17:06to an

01:17:07extent

01:17:07in my

01:17:08testimony

01:17:08I mean

01:17:10the current

01:17:11system

01:17:12does not

01:17:12allow

01:17:13individuals

01:17:13to

01:17:14negotiate

01:17:15salaries

01:17:16or benefits

01:17:16directly

01:17:17with

01:17:17institutions

01:17:18so let

01:17:18me ask

01:17:19you

01:17:19so it's

01:17:19an issue

01:17:20of money

01:17:21so to

01:17:21speak

01:17:22like

01:17:22everything

01:17:22else

01:17:23how much

01:17:23can you

01:17:24pay

01:17:24and

01:17:25we're

01:17:26looking at

01:17:27possible

01:17:27Medicaid

01:17:27cuts

01:17:28where

01:17:28do

01:17:28most

01:17:29of

01:17:29the

01:17:29match

01:17:30where

01:17:30is

01:17:30that

01:17:31funded

01:17:31you

01:17:32got

01:17:32medical

01:17:32schools

01:17:33that

01:17:33are

01:17:33growing

01:17:33you

01:17:33got

01:17:33you

01:17:34know

01:17:34we

01:17:35have

01:17:35a

01:17:35doctor

01:17:35shortage

01:17:36and

01:17:36you

01:17:36have

01:17:36people

01:17:37like

01:17:37Kaiser

01:17:38permanent

01:17:38back home

01:17:39in

01:17:40California

01:17:40they have

01:17:41a doctor

01:17:41shortage

01:17:42they started

01:17:43their own

01:17:43medical

01:17:44school

01:17:44they're

01:17:44moving

01:17:45on their

01:17:45own

01:17:45to try

01:17:46to

01:17:46alleviate

01:17:46the

01:17:46challenges

01:17:47they

01:17:47have

01:17:47so

01:17:47we

01:17:48want

01:17:48to

01:17:48have

01:17:48more

01:17:49docs

01:17:49expand

01:17:51the

01:17:51match

01:17:51what

01:17:51does

01:17:51it

01:17:52take

01:17:52more

01:17:52money

01:17:52I

01:17:54think

01:17:54we

01:17:54need

01:17:55more

01:17:55residency

01:17:56positions

01:17:56and

01:17:57as

01:17:57you

01:17:57said

01:17:57the

01:17:57funding

01:17:58for

01:17:58residency

01:17:58positions

01:17:59comes

01:17:59largely

01:17:59from

01:18:00Medicare

01:18:00and

01:18:00Medicaid

01:18:01so

01:18:01I

01:18:02think

01:18:02cuts

01:18:02to

01:18:03Medicaid

01:18:03are

01:18:04counterproductive

01:18:05it's

01:18:05also

01:18:05worth

01:18:06noting

01:18:06that

01:18:07hospitals

01:18:08that

01:18:08serve

01:18:09disadvantaged

01:18:09patient

01:18:10populations

01:18:10including

01:18:11patients

01:18:11with

01:18:11Medicaid

01:18:12will

01:18:12be

01:18:12hurt

01:18:13by

01:18:13these

01:18:14cuts

01:18:14to

01:18:14Medicaid

01:18:15inner

01:18:15city

01:18:15rural

01:18:16areas

01:18:16farms

01:18:17Midwest

01:18:19is that

01:18:20what you're

01:18:20talking

01:18:21about

01:18:21all

01:18:21of

01:18:22what

01:18:22you just

01:18:22mentioned

01:18:23because I

01:18:24know

01:18:24that

01:18:24my

01:18:25my

01:18:25spouse

01:18:26usually

01:18:26gets

01:18:27very

01:18:28interesting

01:18:28offers

01:18:29to go

01:18:29work

01:18:30as an

01:18:30OB

01:18:30in

01:18:31the

01:18:31middle

01:18:31of

01:18:32somewhere

01:18:33in this

01:18:34country

01:18:34and

01:18:35they're

01:18:37not

01:18:37very

01:18:37lucrative

01:18:38if it

01:18:39wasn't

01:18:39for the

01:18:40fact

01:18:40that we

01:18:40had

01:18:40you know

01:18:41family

01:18:42established

01:18:43in

01:18:43Southern

01:18:43California

01:18:43we may

01:18:44have

01:18:44taken

01:18:44some

01:18:44of

01:18:45them

01:18:45but

01:18:45yeah

01:18:46there's

01:18:46not

01:18:46much

01:18:47money

01:18:47to be

01:18:48made

01:18:48as a

01:18:48doc

01:18:48in

01:18:48the

01:18:49middle

01:18:49of

01:18:49nowhere

01:18:49I

01:18:51would

01:18:51love

01:18:52to see

01:18:52more

01:18:53incentives

01:18:53for

01:18:53primary

01:18:54care

01:18:54doctors

01:18:55in

01:18:55these

01:18:56underserved

01:18:57communities

01:18:57including

01:18:58rural

01:18:58communities

01:18:58give me

01:18:59an example

01:18:59of

01:18:59incentive

01:19:02higher

01:19:03pay

01:19:03loan

01:19:03forgiveness

01:19:04what are we

01:19:04talking about

01:19:05I think

01:19:06you know

01:19:06we could

01:19:06debate

01:19:07what incentives

01:19:07would work

01:19:08best

01:19:08loan forgiveness

01:19:09I think

01:19:09is a good

01:19:10example

01:19:10of a way

01:19:11in which

01:19:11the system

01:19:13might be able

01:19:13to entice

01:19:14physicians

01:19:14into areas

01:19:15that they

01:19:16might otherwise

01:19:16not be

01:19:17considering

01:19:17well you

01:19:18know

01:19:18I

01:19:18remember

01:19:19again

01:19:19speaking

01:19:20to my

01:19:20spouse

01:19:21and her

01:19:21colleagues

01:19:22the new

01:19:22brand

01:19:24spanking

01:19:24new

01:19:24docs

01:19:25that are

01:19:25hitting

01:19:25the market

01:19:26half a

01:19:27million dollars

01:19:28in debt

01:19:29something like

01:19:30that

01:19:31an unbelievable

01:19:32amount of

01:19:33money

01:19:33so how

01:19:35does a

01:19:36doc like

01:19:36that coming

01:19:37out of

01:19:37medical

01:19:38school

01:19:38residency

01:19:39balance

01:19:41their

01:19:41checkbook

01:19:42those numbers

01:19:45are right

01:19:45I can tell

01:19:46you coming

01:19:46out of

01:19:46residency

01:19:47I had

01:19:48over

01:19:48$300,000

01:19:49in medical

01:19:50school debt

01:19:51that's just

01:19:52the cost

01:19:52of going

01:19:52to medical

01:19:53school

01:19:53now

01:19:53there are

01:19:55programs

01:19:55in place

01:19:55we're looking

01:19:56at

01:19:56we need

01:19:58more money

01:19:58and I think

01:19:59the testimony

01:19:59that we need

01:20:01to pay

01:20:01residents

01:20:02a whole lot

01:20:03more

01:20:03is probably

01:20:04correct

01:20:04I wish

01:20:04it would

01:20:05have been

01:20:05there

01:20:0540 years

01:20:06ago

01:20:06when my

01:20:06wife

01:20:06was

01:20:07going

01:20:07to

01:20:07residency

01:20:07we

01:20:08appreciated

01:20:09your

01:20:09efforts

01:20:09but today

01:20:10here we

01:20:11are

01:20:11and you're

01:20:12looking at

01:20:13some public

01:20:13policies

01:20:14by the

01:20:14administration

01:20:15to cut

01:20:16Medicaid

01:20:17possibly

01:20:18Medicare

01:20:18when we're

01:20:20trying to

01:20:20expand

01:20:21the field

01:20:22of doctors

01:20:23available

01:20:24to take

01:20:25care of

01:20:25Americans

01:20:25it seems

01:20:26to me

01:20:26it's

01:20:26contradictory

01:20:27here

01:20:27what am

01:20:28I missing

01:20:28I don't

01:20:29think you're

01:20:30missing

01:20:30anything

01:20:30I agree

01:20:31so we

01:20:32all got

01:20:32to get

01:20:32on the

01:20:33same

01:20:33page

01:20:33need

01:20:34more

01:20:34docs

01:20:35need

01:20:35more

01:20:35residents

01:20:36need

01:20:36a better

01:20:36matching

01:20:37program

01:20:37need

01:20:37more

01:20:38money

01:20:38but it

01:20:39seems like

01:20:39the public

01:20:40policy is

01:20:41going the

01:20:41other way

01:20:41I agree

01:20:45I think

01:20:45if the

01:20:46focus is

01:20:46on solving

01:20:47the goals

01:20:48set out

01:20:49by this

01:20:49subcommittee

01:20:50of addressing

01:20:51physician

01:20:51shortages

01:20:52and

01:20:52improving

01:20:54resident

01:20:55salaries

01:20:55there are

01:20:56numerous

01:20:57countless

01:20:58ways

01:20:58to do

01:20:59that

01:20:59that I

01:21:00think

01:21:00are worth

01:21:01discussing

01:21:01thank you

01:21:02very much

01:21:03and I

01:21:03thank the

01:21:03witnesses

01:21:04all for

01:21:04their time

01:21:05and interest

01:21:06in this

01:21:06issue

01:21:06Mr. Chairman

01:21:07I yield

01:21:08gentlemen

01:21:08yields

01:21:09back

01:21:09recognize

01:21:10Mr. Nadler

01:21:11for some

01:21:11unanimous

01:21:12consent

01:21:12request

01:21:13thank you

01:21:13Mr. Chairman

01:21:14I ask

01:21:14unanimous

01:21:15consent

01:21:15to submit

01:21:15for the

01:21:16record

01:21:16this

01:21:17statement

01:21:18from the

01:21:19Association

01:21:20of American

01:21:21Colleges

01:21:21dated May

01:21:2214th

01:21:232024

01:21:24without

01:21:24objection

01:21:25and I

01:21:26ask

01:21:26unanimous

01:21:27consent

01:21:28to enter

01:21:28into the

01:21:29record

01:21:29an article

01:21:29titled

01:21:30more

01:21:30Medicare

01:21:30supported

01:21:31GME

01:21:31slots

01:21:32needed to

01:21:33curb

01:21:33doctor

01:21:33shortages

01:21:34from the

01:21:35AMA

01:21:35journal

01:21:36dated

01:21:36October

01:21:374th

01:21:382024

01:21:39without

01:21:40objection

01:21:40thank you

01:21:41Mr. Chairman

01:21:41I ask

01:21:42unanimous

01:21:42consent

01:21:43to enter

01:21:43the record

01:21:43the following

01:21:44statements

01:21:44a statement

01:21:45from Dr.

01:21:45John Ward

01:21:46a double

01:21:46board

01:21:46certified

01:21:47dermatologist

01:21:48practicing

01:21:48in Florida

01:21:49statement

01:21:50from Dr.

01:21:50Caleb

01:21:50Atkins

01:21:51current

01:21:51resident

01:21:52practicing

01:21:52family

01:21:53medicine

01:21:53in rural

01:21:54New York

01:21:54statement

01:21:55from National

01:21:55Board of

01:21:56Physicians

01:21:56and Surgeons

01:21:57calling for

01:21:58antitrust

01:21:58scrutiny

01:21:59of the

01:21:59medical

01:22:00residency

01:22:01market

01:22:01and a

01:22:02statement

01:22:02from Dr.

01:22:02Jeffrey

01:22:03Singer

01:22:03Senior Fellow

01:22:05at the

01:22:05Cato

01:22:05Institute

01:22:06no

01:22:08objection

01:22:08at this

01:22:10time

01:22:10that

01:22:11would

01:22:12conclude

01:22:13today's

01:22:14hearing

01:22:14we thank

01:22:15our

01:22:15witnesses

01:22:15for appearing

01:22:16before the

01:22:17committee

01:22:17today

01:22:18without

01:22:18objection

01:22:18all

01:22:19members

01:22:19will

01:22:19have

01:22:19five

01:22:20legislative

01:22:20days

01:22:21to

01:22:21submit

01:22:21additional

01:22:22written

01:22:22questions

01:22:22for the

01:22:23witnesses

01:22:23or additional

01:22:24materials

01:22:25for the

01:22:25record

01:22:25without

01:22:26objection

01:22:26the

01:22:27hearing

01:22:27is

01:22:27adjourned

01:22:28to

Scott Fitzgerald Leads House Judiciary Committee Hearing On Medical Residency Antitrust Exemption

Category

Transcript

Recommended