Emergency Physician Employer Market Share and Concentration by Ownership Type

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.

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.

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.

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.