At least 27% of U.S. emergency departments are staffed by private equity-backed companies, according to a Sept. 18 report from the Private Equity Stakeholder Project.
The three largest ED staffing companies by volume, TeamHealth, US Acute Care Solutions and SCP Health, are all private equity-owned.
PESP tied the consolidation to two recurring complaints from physicians and lawmakers: understaffing linked to cost-cutting and surprise billing linked to out-of-network contracting.
A Michigan emergency physician, Emily Li, MD, told MedPage in 2021 that after TeamHealth took over her hospital’s ED staffing, the group grew more focused on patient satisfaction scores and “left without being seen” metrics than on physician staffing levels, and used physician assistants for screenings to improve those numbers while patients waited hours to see a doctor. American Physician Partners, a PE-backed staffing company that shut down in 2023, told lenders it planned to cut physician headcount as a cost-saving measure, according to PESP.
In 2025, Vicky Norton, MD, then-president-elect of the American Academy of Emergency Medicine, told MedPage PE firms “understaff facilities, cut pay and benefits” while charging patients multiples more, with profits flowing to shareholders rather than physicians.
Before the No Surprises Act took effect in 2020, researchers Eileen Appelbaum, PhD, and Rosemary Batt, PhD, said surprise billing functioned as a deliberate strategy for some PE-backed ED operators. The New York Times later identified TeamHealth and Envision, both PE-backed at the time, as the primary funders behind Doctor Patient Unity, a dark-money group that spent more than $57 million opposing the legislation, according to ProPublica.
Since the law’s independent dispute resolution process took effect, PE-backed staffing companies have consistently filed the most payment disputes. TeamHealth accounted for 30% of all disputes in the first half of 2023 and SCP Health another 20%, per federal IDR data cited by PESP. PESP also found that at least a third of certified IDR entities are themselves private equity-backed, and that two arbiters share investors with providers that bring disputes to them.
Sen. Gary Peters, D-Mich., raised concerns in an April 2024 letter about ED staffing levels and patient safety at PE-backed facilities, writing that leveraged debt and pressure for fast returns “exacerbate” issues not unique to private equity ownership.
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