Competition and cost in graduate medical education. Should we train unsalaried residents and fellows?

In 1985, a total of 6,080 applicants to the National Resident Matching Program (Match) were unable to match with residency positions. The majority of unmatched applicants were graduates of foreign medical schools. In addition, many US and foreign medical graduate applicants did not find positions in their preferred choice of specialties. As a result, teaching hospitals are increasingly receiving offers from would-be residents who are willing to work without financial support to gain the experience and credentials required for medical licensure. Teaching hospitals that consider accepting unsalaried house staff must begin to develop policies and guidelines that ensure fair and equitable treatment of all residents and fellows and that standards of quality are not compromised.