The rising toll of private equity in health care
Episode 7, Dec 03, 2025, 02:58 PM
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A newly published study in the Annals of Internal Medicine has added more fuel to the growing alarm over private equity’s expanding role in American health care. Researchers found that hospitals acquired by private equity (PE) companies experience a decrease in staffing and salaries, as well as an increase in emergency department patient deaths and patient transfers to other hospitals.
This isn’t the first time such concerns have surfaced. Previous studies have shown that patients treated in private equity–owned hospitals suffer more hospital-related adverse events including bloodstream and surgical site infections and falls. A 2023 systematic review went further, concluding that private equity ownership was consistently associated with increases in costs for patients and payers with mixed to harmful impacts on quality, noting an association with reduced nurse staffing levels and a shift towards lower nursing skill mix. Researchers concluded: “No consistently beneficial impacts of PE ownership were identified.”
To explore how these findings play out in the trenches, Physicians Taking Back Medicine spoke with two doctors — anesthesiologist Marco Fernandez, M.D. and emergency physician Robert McNamara, M.D. — both of whom have witnessed firsthand the consequences of private equity in health care and are now leading efforts to reverse its influence.
Music Credits
Medical Education by Art Media - stock.adobe.com
Editor's note: Episode timestamps and transcript produced using AI tools.
0:00 – Intro
Announcer tees up new study showing ED mortality rises after private equity hospital acquisitions.
1:22 – Guest Intro: Dr. Marco Fernandez
Anesthesiologist; president, Midwest Anesthesia Partners and Association for Independent Medicine.
1:41 – Hospital Contracts Replaced by PE Firms
Fernandez explains two contracts lost to TeamHealth and NorthStar, no RFP, community backlash, OR shutdowns.
4:32 – Dr. Robert McNamara’s Background
Long-time critic of private equity’s role in emergency medicine; sets context from a 2021 interview.
5:00 – How Private Equity Operates
Investment return expectations, cost-cutting, staffing model changes, profit over patient care.
6:34 – Study Data: Mortality, Staffing Reductions
ED death rates, declines in FTEs, salary cuts in ED/ICU after PE acquisition.
7:21 – Personal Impact on Fernandez & His Family
Private equity staffing squeezes, inadequate nursing support, and his mother’s suffering.
10:32 – Wider Trend: Mortality in PE-Owned Facilities
Research also finds higher death rates in PE-owned nursing homes and hospice.
10:52 – “Penny Wise, Pound Foolish”
Fernandez on leadership short-termism, physician exodus, higher long-term costs, persistent understaffing.
11:57 – Working With Legislators & AGs
Corporate practice of medicine laws, tightening loopholes, educating state leaders.
13:03 – What Corporate Practice of Medicine Means
McNamara explains non-physician control, enforcement failures, and harmful workarounds.
14:23 – Grassroots & Organized Medicine
Joint advocacy efforts, silos among specialties, need for education and alignment.
15:47 – Reimbursement Reality for Anesthesiology
The “30% problem”: Medicare valuation error in the ’90s, lower unit pay, subsidy dependence.
17:26 – How the Miscalculation Happened
Time not accounted for in reimbursement; only anesthesia affected.
18:01 – Subsidies, Locums, Unsustainable Economics
Why most anesthesia groups now require hospital subsidies; Fernandez’s pivot to independent contracting model.
19:39 – Private Equity Pitch: “Efficiency” and Subsidy Cuts
Bait-and-switch promises to administrators; consolidation and extraction incentives.
21:29 – Golden Parachutes & Senior Partners
Deals driven by outgoing partners, quotas, short visit times, erosion of practice control.
22:28 – Strategies to Fight Back
Litigation, protecting physician groups from corporate replacement, expanding advocacy.
23:33 – Going Beyond AMA & Specialty Societies
Coalition-building with large independent orthopedic groups; focusing on state-level strategy.
25:40 – Physician-Led Advocacy & Taking Action
Host discussion on organized medicine vs. grassroots disruption and multi-front tactics.
26:41 – Advocacy as Antidote to Burnout
Meaning, connection, and purpose through engagement.
27:46 – Changing Mindset & “Showing Up”
Networking, persistence, attending meetings, building momentum.
29:08 – Closing Reflections & Call to Action
Partnership, unity, and showing up as vehicles to reclaim medicine.
29:11 – Outro
Host sign-off and thank you.
This isn’t the first time such concerns have surfaced. Previous studies have shown that patients treated in private equity–owned hospitals suffer more hospital-related adverse events including bloodstream and surgical site infections and falls. A 2023 systematic review went further, concluding that private equity ownership was consistently associated with increases in costs for patients and payers with mixed to harmful impacts on quality, noting an association with reduced nurse staffing levels and a shift towards lower nursing skill mix. Researchers concluded: “No consistently beneficial impacts of PE ownership were identified.”
To explore how these findings play out in the trenches, Physicians Taking Back Medicine spoke with two doctors — anesthesiologist Marco Fernandez, M.D. and emergency physician Robert McNamara, M.D. — both of whom have witnessed firsthand the consequences of private equity in health care and are now leading efforts to reverse its influence.
Music Credits
Medical Education by Art Media - stock.adobe.com
Editor's note: Episode timestamps and transcript produced using AI tools.
0:00 – Intro
Announcer tees up new study showing ED mortality rises after private equity hospital acquisitions.
1:22 – Guest Intro: Dr. Marco Fernandez
Anesthesiologist; president, Midwest Anesthesia Partners and Association for Independent Medicine.
1:41 – Hospital Contracts Replaced by PE Firms
Fernandez explains two contracts lost to TeamHealth and NorthStar, no RFP, community backlash, OR shutdowns.
4:32 – Dr. Robert McNamara’s Background
Long-time critic of private equity’s role in emergency medicine; sets context from a 2021 interview.
5:00 – How Private Equity Operates
Investment return expectations, cost-cutting, staffing model changes, profit over patient care.
6:34 – Study Data: Mortality, Staffing Reductions
ED death rates, declines in FTEs, salary cuts in ED/ICU after PE acquisition.
7:21 – Personal Impact on Fernandez & His Family
Private equity staffing squeezes, inadequate nursing support, and his mother’s suffering.
10:32 – Wider Trend: Mortality in PE-Owned Facilities
Research also finds higher death rates in PE-owned nursing homes and hospice.
10:52 – “Penny Wise, Pound Foolish”
Fernandez on leadership short-termism, physician exodus, higher long-term costs, persistent understaffing.
11:57 – Working With Legislators & AGs
Corporate practice of medicine laws, tightening loopholes, educating state leaders.
13:03 – What Corporate Practice of Medicine Means
McNamara explains non-physician control, enforcement failures, and harmful workarounds.
14:23 – Grassroots & Organized Medicine
Joint advocacy efforts, silos among specialties, need for education and alignment.
15:47 – Reimbursement Reality for Anesthesiology
The “30% problem”: Medicare valuation error in the ’90s, lower unit pay, subsidy dependence.
17:26 – How the Miscalculation Happened
Time not accounted for in reimbursement; only anesthesia affected.
18:01 – Subsidies, Locums, Unsustainable Economics
Why most anesthesia groups now require hospital subsidies; Fernandez’s pivot to independent contracting model.
19:39 – Private Equity Pitch: “Efficiency” and Subsidy Cuts
Bait-and-switch promises to administrators; consolidation and extraction incentives.
21:29 – Golden Parachutes & Senior Partners
Deals driven by outgoing partners, quotas, short visit times, erosion of practice control.
22:28 – Strategies to Fight Back
Litigation, protecting physician groups from corporate replacement, expanding advocacy.
23:33 – Going Beyond AMA & Specialty Societies
Coalition-building with large independent orthopedic groups; focusing on state-level strategy.
25:40 – Physician-Led Advocacy & Taking Action
Host discussion on organized medicine vs. grassroots disruption and multi-front tactics.
26:41 – Advocacy as Antidote to Burnout
Meaning, connection, and purpose through engagement.
27:46 – Changing Mindset & “Showing Up”
Networking, persistence, attending meetings, building momentum.
29:08 – Closing Reflections & Call to Action
Partnership, unity, and showing up as vehicles to reclaim medicine.
29:11 – Outro
Host sign-off and thank you.