Emergency Physician Employer Market Share and Concentration by Ownership Type - 04/08/25

Doi : 10.1016/j.annemergmed.2025.06.610

Angela G. Cai, MD, MBA ^a,^⁎ , Zachary J. Jarou, MD, MBA ^b, Alexander T. Janke, MD, MHS, MSc ^c, Cameron J. Gettel, MD, MHS ^d, Craig Rothenberg, MPH ^d, Leon C. Adelman, MD, MBA ^e, Matthew Simpson, BS ^f, Jonathan Fisher, MD, MPH ^g, Arjun K. Venkatesh, MD, MBA, MHS ^d
^a Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
^b Department of Emergency Medicine, Henry Ford Providence Southfield Hospital/Michigan State University, Southfield, MI
^c Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI
^d Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
^e Department of Emergency Medicine, Novant Health Rowan Medical Center, Salisbury, NC
^f EnsoData, Madison, WI
^g Department of Emergency Medicine, Burnett School of Medicine, Texas Christian University, Fort Worth, TX

^∗Corresponding Author.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Monday 04 August 2025
Cet article a été publié dans un numéro de la revue, cliquez ici pour y accéder

Abstract

Study objective

With rapid consolidation and corporatization of the emergency physician workforce over recent years, little is known about the current state of the emergency physician market. We characterized employer group market share by ownership structure and market concentration by ownership across geographies.

Methods

We selected hospitals from the Centers for Medicare and Medicaid Services (CMS) Hospital General Information Dataset (2021). Ivy Clinicians (2024) defined ownership category (majority ownership by health system, private equity, or clinician partnerships [single-site, regional, national]). National Emergency Department Inventories 2021, the most recent data set available, served as a proxy for 2024 emergency department (ED) visit volumes. The primary outcome was market share defined as the percentage of national ED annual visits staffed by employers within each ownership category. Secondary outcomes measured market concentration.

Results

Our sample included 3,998 hospital-based EDs, accounting for 109.7 million ED visits in 2021. Per 2024 ownership data, health system groups staffed 33.0% of ED visits followed by private equity 24.7%, regional partnership 20.8%, national partnership 13.4%, and single-site partnership 8.1%. The top 3 private equity groups staffed 93.5% of the private equity visits. In contrast, the top 31 regional partnerships, 51 single-site partnerships, and 63 health system groups comprised 50% market share within their respective categories. Three national partnerships staff all visits in this category. Of the 306 hospital referral regions, 258 (84%) were highly concentrated.

Conclusion

Groups with majority physician ownership staffed less than half of ED visits. The emergency medicine market is highly concentrated regionally, as well as within the private equity and national partnership ownership categories.

Le texte complet de cet article est disponible en PDF.

Keywords : Consolidation, Corporate practice of medicine, Physician ownership, Staffing group, Workforce

Plan

Introduction

Background

Importance

Goals of This Investigation

Methods

Study Design

Selection of Participants

Characteristics of the Study Participants

Main Results

Limitations

Discussion

	Please see page XX for the Editor’s Capsule Summary of this article.
	Supervising editors : Diane Kuhn, MD, PhD, and David L. Schriger, MD, MPH. Specific detailed information about possible conflict of interest for individual editors is available at editors .
	Author contributions: All authors conceived the study and designed the study. ZJJ and ATJ provided statistical advice on study design and analyzed the data. AGC drafted the manuscript and all authors contributed substantially to its revision. AGC takes responsibility for the paper as whole.
	Data sharing statement: Data dictionary and analytic code are available upon request from the date of article publication by emailing jarouzac@msu.edu . Data sets can be obtained from the original sources as described in the manuscript.
	Authorship : All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
	Fundingandsupport: By Annals ' policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). AGC's time was supported by a grant from the Emergency Medicine Foundation. The authors have no other funding or support to disclose.
	Disclaimer: The opinions and views expressed in this article are solely the authors' and not necessarily those of any organization, employer, or group they are associated with.