Can hospitals run ERs without emergency physicians?

It seems like it would be hard to run an emergency room without emergency physicians, right?

According to recent reporting from National Public Radio, that’s the goal of private equity firms who are buying up emergency medicine practice groups. Private equity firms are investment partnerships that buy companies, reorganize them to generate more profit, and then resell them.

Despite private equity efforts, there are some things you can do to improve your safety as a patient.

Medical staff in hospital ERs

Many hospitals operate their emergency rooms (ER) on a contract basis with emergency medicine practice groups. In states such as Texas, the corporate practice of medicine doctrine prevents hospitals from directly employing physicians. Yet, hospitals need to provide 24/7 emergency medical coverage for their ERs.

Hospitals solve this need by entering into contracts with emergency medicine practice groups. In this arrangement, the hospital pays the ER practice group a set or agreed fee. In exchange, the practice groups are responsible for providing 24/7 medical coverage for the hospital’s ER.

Private equity and emergency rooms

There are numerous ER medical staffing companies in the United States. By far, the largest two companies are TeamHealth, and Envision Healthcare, which have contracts with hospitals all over the country. Painter Law Firm has handled lawsuits involving Envision emergency physicians and physician assistants in Texas. They provide ER medical staff coverage at hospitals in the Dallas Fort Worth (DFW) area such as Medical City Plano, and at Memorial Hermann hospitals in the Houston area.

Private equity firms bought both TeamHealth and Envision Healthcare in 2016 and 2018, respectively. Now American Physician Partners, which is half-owned by a private equity firm, is expanding, cutting costs, and trying to compete with the two big players in the ER medical staff business.

Cutting costs in ERs and patient care

The challenge for private equity firms buying emergency medicine practice groups is that the only real cost they can cut is emergency physicians. But emergency physicians are the whole point of ERs, right?

As private equity firms see it, they can make more money by hiring fewer emergency physicians and replacing them with less expensive nurse practitioners (NPs) and physician assistants (PAs). Some states allow NPs and PAs to provide independent medical services—meaning without any supervision. In Texas, state law currently still requires some degree of physician by a doctor. 

The combination of private equity efforts and increasing NP and PA independence has rapidly ushered in changes to ER staffing.

According to a study by the Neiman Institute, the percentage of ER visits where the main clinical care was provided by a non-physician NP or PA increased by a staggering 172% in the 15-year period between 2005 and 2020. With this trend, some researchers expect patients will have a 50-50 chance of being seen by a NP or PA, instead of a physician, on ER visits by 2030.

As a former hospital administrator, I recognize the important contributions that nurse practitioners and physician assistants make to hospitals and healthcare. I’m concerned, though, at how some NPs and PAs are practicing medicine beyond their educational preparation and training.

When receiving care in a hospital emergency room setting, remember that it is your right as a patient to ask questions. The title “Dr.” is no longer a synonym for “physician.” You have the right to ask if you are being seen by a physician or a non-physician provider. You also have the right to request to be seen by a physician.

If you’ve been seriously injured because of poor ER care in Texas, contact a top-rated, experienced Texas medical malpractice attorney for a free strategy session about your potential case.

Article by

Robert Painter

Robert Painter is an award-winning medical malpractice attorney at Painter Law Firm Medical Malpractice Attorneys in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits all over Texas. Contact him for a free consultation and strategy session by calling 281-580-8800 or emailing him right now.