Unperceived Territory: The Impact of Private Equity on Graduate Medical Education

Private equity (PE) involvement in healthcare has risen steeply, with a growing investment in healthcare from $5 billion to over $100 billion from 2000 to 2018. The impact of graduate medical education (GME) with PE ownership is unknown. We aimed to characterize the national burden of medical training program closures associated with PE-owned institutions and quantify the scale of trainee displacement across the United States.

The Private Equity Hospital Tracker created by the Private Equity Stakeholder Project was utilized to review all PE owned hospitals in the United States. These hospitals were then cross-referenced with the Accreditation Council for Graduate Medical Education (ACGME) records to account for currently functioning residency programs. The Federation of State Medical Boards list of closed residency programs was reviewed to assess for PE ownership. A wide internet search was utilized to review news articles, and hospital websites to assess the number of displaced trainees from hospital closures. Predictive scenario modeling was utilized to estimate physician work force loss.

National GME programs.

Trainees in GME programs.

Of the 6120 hospitals in the US, currently there are 460 (7.5%) hospitals which are owned by a PE firm. Of those, 169 institutions were acute care and critical access hospitals. Sixteen (9.4%) of these institutions were found to have active GME programs. Review of the FSMB Closed Program Registry identified 52 residency or fellowship program closures, of which 19 (36.5%) occurred at hospitals owned or financially managed by PE firms. These accredited programs which were closed due to multitude of reasons, have displaced many trainees from various residency programs. Records on displaced trainees from these closures are unavailable and unknown. Based on available trainee complement data, an estimated 1756 residents and fellows were displaced across these programs. Predictive scenario modeling demonstrates physician work force loss of 0.02-0.21 physicians per 100,000 population.

The impact of PE ownership on GME is unknown. Based on our review, there is a need for increased scrutiny and accountability of PE firms impact on GME with the rising predominance of PE owned hospitals and bankruptcies. Further studies are required to assess impact of trainees in PE owned institutions and closures.