The Age Discrimination Act of 1975 (the “Age Act”) proscribes age-based discrimination in programs and activities that receive federal financial assistance. The Age Act generally does not restrict age discrimination in employment practices, as this is the purview of a separate federal law, the Age Discrimination in Employment Act of 1967 (the “ADEA”). On August 18, 2025, a three-judge panel of the Ninth Circuit Court of Appeals held that the ranking of medical residents by medical schools is an “employment practice” to which the Age Act does not apply. The case, Spatz v. Regents of the University of California, clarifies that the decision not to accept a medical student into a residency program does not give rise to a cause of action under the Age Act.

Facts and Procedural History

To become a fully licensed physician, medical school graduates must complete a residency program at a certified institution. Medical students are “matched” to a residency program through the National Resident Matching Program, whereby medical students rank the residency programs they would like to join and medical schools rank the applicants they would like to accept into their residency programs. Under this program, not all medical students are matched with a residency program.

In Spatz, the plaintiff alleged that he was denied admission to the neurological surgery residency program at the University of California San Francisco (UCSF) based on his age. The plaintiff graduated from UCSF’s medical school in 2021. He applied to medical residency programs at UCSF and elsewhere in the 2020 and 2021 match years, but he failed to match with any program both years. UCSF did not rank the plaintiff in either year, and the plaintiff claimed that if UCSF had ranked him in either year, he would have matched with the program. The plaintiff claimed that UCSF’s decision not to rank him constituted age-based discrimination and retaliation.

The plaintiff filed a lawsuit against the Regents of the University of California after he failed to match with UCSF in 2022. The lawsuit asserted a claim for age discrimination in violation of the Age Act, along with five other claims under California’s Fair Employment and Housing Act (the “FEHA”) and a claim for whistleblower retaliation in violation of the California Health & Safety Code. The lawsuit did not include a claim for discrimination under the ADEA. ADEA protections are limited to individuals who are at least 40 years of age, and the plaintiff was under the age of 40 when he failed to match in 2022.

The Age Act proscribes age-based discrimination in any program or activity receiving federal financial assistance. In 1978, the Age Act was amended to include a private cause of action; prior to that, federal agencies were the sole enforcers of the Act. Unlike the ADEA, the Age Act is not limited to individuals who are at least 40 years of age. However, under 42 U.S.C. section 6103(c)(1), the Age Act exempts from its application “any employment practice of any employer, employment agency, or labor organization, or with respect to any labor-management joint apprenticeship training program.” (Emphasis added.)

After the parties engaged in discovery, the defendant moved for summary judgment on all of the plaintiff’s claims. The plaintiff’s opposition only addressed his Age Act claim. The district court granted summary judgment in favor of the defendant on all of the claims, stating that the residency selection process constitutes an “employment practice” to which the Age Act does not apply. The district court also stated that even if the Age Act were applicable to medical residency matching, there was no genuine dispute of material fact as to the merits of the claim. The plaintiff appealed the dismissal of his Age Act claim to the Ninth Circuit Court of Appeals.

The Ninth Circuit’s Decision

On August 18, a three-judge panel of the Ninth Circuit Court of Appeals issued a decision affirming the district court’s order granting summary judgment in favor of the defendant, holding that the ranking of medical residents by medical schools is an “employment practice” under the Age Act. In reaching this conclusion, the Ninth Circuit panel stated that the Age Act “picks up where the ADEA leaves off” and that they should be construed as if they were one law. The panel noted that the Age Act does not define the terms “employer” or “employment practice,” and the panel stated that, consistent with the use of a common-law agency test in construing the term “employee” under the ADEA, it would use the ordinary common-law meaning of “employer” and “employment practice” in construing the Age Act.

The panel stated that, based on the factors used to determine if an individual is an employee in the ADEA context, the ranking of medical residents “is akin to hiring an employee.” The panel explained that residency requires substantial skill, including a degree from a medical school; the hospital provides both the instrumentalities and location of work; residencies have a long duration; medical residents work long hours and are directly responsible for providing patient care; and residents are paid a salary and benefits and they are taxed as employees. The panel stated that virtually every factor used in the ADEA context weighs in favor of finding that the ranking of medical residents is an employment practice akin to hiring an employee.

Based on the determination that the ranking of medical residents is an “employment practice” under the Age Act, the panel concluded that the Age Act does not apply to these rankings. Thus, the panel concluded that the district court properly granted summary judgment in favor of the defendant on the plaintiff’s Age Act claim.

Key Takeaways

Spatz confirms that the Age Act does not apply to the ranking of medical residency applicants by medical schools. Accordingly, if a plaintiff brings an Age Act claim based on alleged age discrimination in medical residency rankings, the defendant is likely to prevail against this claim. While a plaintiff may prevail on an ADEA claim based on alleged age discrimination in residency rankings, only plaintiffs who were at least 40 years of age at the time of the alleged discriminatory action can successfully bring such a claim.

The Ninth Circuit panel’s decision in Spatz is limited to the selection of candidates for medical residency programs. It remains to be seen whether this determination will be extended to other contexts that are similar to medical residency rankings, such as healthcare apprenticeship programs or other clinical training programs. Employers and other organizations that participate in such programs should consult with experienced counsel to understand what this ruling means for them and what steps they should take to prevent and defend against lawsuits brought under the Age Act, the ADEA, and other state and federal anti-discrimination statutes.