Financial (In)stability of Emergency Medicine Staffing Groups

Tuesday, April 8, 2025

10:10am – 10:30am ET

Location: Trade - Lobby Level

CE: 0.25 CME Credit

Speaker(s)

Leon C. Adelman, MD, MBA, FAAEM (he/him/his)

Co-founder & CEO
Ivy Clinicians
Raleigh, North Carolina

Disclosure(s): No financial relationships to disclose

Session Moderator(s)

David J. Carlberg, MD, FAAEM

Associate Program Director
Georgetown EM
Washington, District of Columbia

Disclosure(s): No financial relationships to disclose

Disclosure(s):

Leon C. Adelman, MD, MBA, FAAEM: No financial relationships to disclose

Approximately one-third of emergency physicians work for large staffing groups with significant debt levels. Most of those companies are owned by non-physicians, including private equity firms. These staffing groups grew rapidly through out-of-network billing, consolidation, and low-interest loans.

However, the legal and regulatory landscape changed in the early 2020s. The No Surprises Act banned out-of-network billing, federal and state regulators began taking action against corporate consolidation, and interest rates rose.

In 2023, two of the six largest emergency medicine employers declared bankruptcy. American Physician Partners ceased operations. Envision lost nearly half of its emergency departments to HCA Healthcare, another for-profit corporate giant. The future of emergency medicine employment structures depends on a combination of physician empowerment, government action, and economics.

Learning Objectives:

To understand the financial strategies used by large emergency medicine staffing firms to grow: out-of-network billing, consolidation, and low-interest debt.
To understand how the legal and economic changes of the early-2020s have threatened those business models.
To learn about strategies that fit with the current economic, legal, and regulatory environment to bring more emergency medicine practices under the ownership of their practicing physicians.