The Private Equity Takeover of America’s Emergency Rooms
Updated
As of 2022, one in four emergency departments in the United States was staffed by a private equity-owned physician group. That figure is likely higher today, given the rapid pace of acquisitions since then. Here is an example. When ER physicians arrived for work at Valley Health in Winchester, VA, on April 2nd, they had no idea their careers were about to be disrupted. By the time the morning ended, the leadership of Emergency Medicine of Blue Ridge (EMBR) had been summoned into an emergency meeting and handed a termination notice. Valley Health explained that it was replacing the 45-physician independent group, with a 25-year history serving six hospitals across Virginia and West Virginia, with a company called SCP Health, an Atlanta-based practice management company owned by Canadian private equity firm Onex. An hour later, the physicians themselves learned of their demise on a hospital-wide Zoom call.
“We were totally blindsided,” remarked ER physician Chris Turnbull, MD, who has lived and worked in Winchester for 24 years. At the top of their field, the group had met or surpassed performance metrics for years. Turnbull told MedPage Today that not being included in any request-for-proposals process was a “kick in the teeth.”
What happened in Winchester is not an isolated event by any means; it is an intentional business model with deadly consequences. Again, since 2022, a private-equity-owned (PE-owned) physician group staffs at least one in four ER departments in the United States, and two corporate staffing giants – Envision and TeamHealth – have strategically moved to control over half of all ER departments in the United States. The takeover is the same. Acquire the contract, cut physician hours, replace existing doctors with lower-cost advanced practice providers and fresh residents, and squeeze profit from one of the most critical points of care in the American healthcare system.
To be clear, the human cost of that profit-driven takeover is well documented. An important study published in September 2025 in the Annals of Internal Medicine examined over one million ER visits across 49 private equity-owned hospitals, and the results are not good. The study revealed that patient death rates in those ERs rose by 13% after being acquired by a PE-owned group compared to similar independent ERs. As deaths rose, emergency department salary expenses dropped by an average of 18% after PE took over. The authors of the study were blunt about the connection, noting that when human labor is cut in staffing-sensitive areas like emergency departments and ICUs, patient harm will surely follow.
Back in Winchester, the percentages played out just as the study data predicted. When EMBR’s contract was terminated, SCP Health offered individual physicians the option to stay, but on terms that were significantly different. SCP stated that it planned to slash physician staffing hours from 90 to 70, while doubling advanced practice provider coverage from 30 to 60 hours. Physicians who stayed would become 1099 contractors, losing health insurance and retirement benefits, and often taking pay cuts. Docs at federally qualified health centers would get a modest raise, but, according to Turnbull, the base rate offered to Winchester Medical Center physicians is arguably below the regional standard.
Valley Health’s CEO attributed the change to Medicaid reimbursements cut under the One Big Beautiful Bill Act (OBBBA). Yes, those cuts are real, but handing its ER department to a private equity-owned staffing firm does not solve a reimbursement problem. Instead, it hands over the keys to an industry with a documented track record of cutting physician staff, replacing experienced doctors with lower-cost providers, and driving up patient mortality, all while pulling profit from the wreckage.
The physicians at EMBR seriously considered fighting back against the takeover. The American Academy of Emergency Medicine (AAEM) sent a letter to the board at Valley Health citing the Annals of Internal Medicine study. At the end of the day, the legal math for the situation was brutal. In Virginia, there is no statute protecting independent physician practice, as in other states such as Oregon. In June 2025, as the first state to do so, Oregon passed a law prohibiting non-clinicians from owning medical practices. With no protection in Virginia, AAEM’s lawyers told the group that a lawsuit would be “a very significant uphill battle.” And the average emergency medicine resident graduates with $250,000 in debt. Thus, fighting and losing means no job. Only 20-25% of the ER physicians at EMBR plan to stay. The majority of them have taken positions elsewhere and put their homes on the market.
EMBR’s vice president, Dr. Ronak Shah, has been meeting with Virginia state senators and members of the House of Delegates to push for legislation that would protect independent physicians. “There isn’t much that we see as a way to preserve the company,” he told MedPage today, “but our demise can still have something good come out of it.” Let’s hope so. The experienced, community-rooted, accountable physicians that patients should depend on at ERs across the country cannot be replaced. From all accounts, the private equity takeover isn’t designed to show up in that way. It shows up for the return.