There are some freestanding emergency departments that have been privately owned and have flipped that on its head a little bit. There are advantages and disadvantages to that. It’s important to investigate the autonomy that they offer us as physicians to own our own space and control those factors that are otherwise outside of our control. But in my opinion, the core of improving [our situation] is greater autonomy, greater control over our schedules, and greater control over our lives.

Dr. Dark: We published a piece in ACEP Now about the role of private equity in health care in September, and according to Ivy Clinicians, about 25 percent of emergency physicians work at private-equity owned firms. Do you think that private equity needs to get out of the business of emergency medicine?¹

Dr. Haddock: It’s a difficult question because there are some well-run hospitals that may have some degree of private equity involvement, and there are some poorly run small democratic groups that aren’t necessarily treated well by their hospital and able to offer what they want. However, broadly speaking, private equity is not holding the interests of patients or the interests of physicians at the top of mind.

The business model of private equity is to briefly invest in something, extract as much profit as you can during that brief investment, and then get out. That’s not a model that’s patient focused or physician focused. It’s only about extracting dollars. I don’t think that model is well suited for health care. Health care should be about putting patients first and putting the caretakers of patients second. That’s not what private equity is doing. Honestly, it’s not what most insurance companies are doing either. That’s why we’re seeing burnout. That’s why we’re seeing patients who are so dissatisfied with the health care system.

Click to watch Dr. Haddock’s interview on YouTube.

Dr. Dark: On a related note, a lot of emergency physicians seem to be growing frustrated with so-called contract management groups [CMGs], which are larger organizations that are trying to run the business practice of emergency medicine across multiple hospitals, sometimes multiple states. Do you agree with these frustrations and, if so, what do you think ACEP can do about that?

Dr. Haddock: I think that there is a lot of frustration with a variety of physician employers. That’s why ACEP is working to increase transparency in this space and restore physician autonomy. The reason why people are frustrated with employers is because they’re not being given the autonomy they need. They don’t feel compensated. They don’t feel like schedules are fair. They don’t feel like they have control over the resources they need. What’s driving the dissatisfaction with physician employers is the lack of autonomy.