One of the biggest, most dangerous medical scams in the United States is the residency system.

It operates entirely in the open, with government protection (more on that in a moment), and is rarely questioned even by its critics. Like this article in Slate about long medical resident hours, which result in overly fatigued residents making important decisions, versus "night float" positions, which result in inexperienced residents with little information about patients making important decisions:

Night float felt worse to me than working when I was exhausted, but is it really worse for patient care? The data are mixed. A study published in 2004 in the New England Journal of Medicine showed that interns working in an intensive-care unit made 36 percent more serious medical errors during a traditional schedule as compared with a schedule that eliminated extended work shifts and reduced the number of hours worked per week from 80 to 63. On the other hand, a study in the Journal of the American Medical Association appeared to indict the cross-coverage hospitals have been relying on to conform with the work limits. It showed that increasing cross-coverage in a large urban hospital caused delays in tests and an increased number of complications that could have been prevented, like drug reactions and infections. Work limits have other troubling consequences as well, including interruption of resident learning, fracturing of traditional hospital teams, and the creation of a kind of shift-work clock-watching mentality among young doctors.

The author, goes on to advocate for better hand-off systems, which is all well and good. In the rest of capitalist society, though, when your business can’t field enough employees to cover the work needed, you hire more employees.

That’s the first part of the scam: US medical schools are nowhere near large enough to accommodate the demand for physicians. So there aren’t enough residents to fill the need.

Great for medical residents, right? Given their scarcity, they can demand higher pay, better working conditions and reforms that make it less likely for them to make mistakes.

Except for the second part of the scam: the medical resident "matching" system is the most tightly controlled and effective monopoly / business trust in the country. All residents join a single hiring pool months in advance where they rank their preferences; later the hospitals rank them, and the pool allocates residents based on those "preferences."

Pay is uniformly abysmal everywhere and the hours are so bad they are literally unsafe for others. The new, "safer" system is to have a single resident bouncing between dozens of different specialties with little or no medical history easily available.

That’s easy to cure: sue! Our antitrust laws are so tough that even two non-dominant grocery stores can’t merge.

Great! And residents tried it in 2002, just to have Congress and the President arbitrarily declare it not a monopoly.

So there you have it: the guild of medical schools won’t admit enough students to meet the market, and Congress won’t let residents exercise the same legal rights available to everyone else. The result is no surprise: a residency system so brutal it’s literally unsafe.