Lower resident board pass rates in private-equity backed emergency physician groups

1. In this cross-sectional study, private equity (PE) backing of emergency medicine (EM) physician hiring was associated with lower rates of residents sitting for and passing resident board qualifying examinations (QEs), although findings were no longer statistically significant after accounting for individual program characteristics.

2. No significant difference was seen between PE-backed and non-PE-backed physician groups in oral certification exam (OCE) performance.

Evidence Rating Level: 3 (Average)

Study Rundown: Ownership of hospitals and physician groups by private, for-profit entities is associated with worse educational outcomes, but little information is available regarding the effects of PE-backed physician staffing on graduate medical education. This study aimed to assess whether employment of academic EM faculty by PE is linked to resident board examination performance. Around 26% of residency programs in a nationwide sample had faculty hired by PE groups, which made up 17.1% of total graduated residents. In programs where PE was involved in physician hiring, fewer residents sat for and passed resident board QEs compared with programs without PE involvement, although there was no significant difference in OCE performance. However, after adjusting for program characteristics such as program age, PE employment was not significantly associated with QE or OCE performance. The generalizability of this study was limited by the observational design and its use of board examination outcomes as a stand-in for quality of education. Nevertheless, this study suggested that PE-backed EM residency programs are associated with poorer outcomes, although differences may be more associated with characteristics of individual programs that impair educational quality.

Click to read this study in JAMA (Journal of the American Medical Association)

Relevant Reading: Quantifying For-Profit Outcomes in GME: A Multispecialty Analysis of Board Certifying Examination Pass Rates in For-Profit Affiliated Residency Programs

In-Depth [cross-sectional study]: This cross-sectional study aimed to assess the effect of PE hiring on resident board examination performance across EM programs in the United States. Data were obtained from all US EM residency programs with available board examination results between 2021 and 2023. The primary outcome was the percentage of graduating residents who sat for and passed the written QE during the study period, whereas the secondary outcome was the percentage of residents who sat for and passed the OCE. A total of 267 residency programs were included in this sample, 70 (26.2%) of which had physician groups hired with PE involvement. A weighted total of 17.1% of residents graduated from PE-backed programs. Programs backed by PE were more often based in community hospitals and more often formed after 2015. Programs backed by PE had lower unadjusted rates of graduating residents sitting for and passing the QE than programs without PE backing (81.6% vs. 89.6%; difference, -8.0 [95% CI, -11.6 to -4.4] percentage points [pp]), while no significant difference was seen for unadjusted OCE pass rates (94.0% vs 95.1%; difference, -1.1 [95% CI, -2.7 to 0.6] pp). After adjusting for program characteristics, no significant association was found between PE backing and performance in QEs (87.1% vs 88.6%; difference, -1.5 [95% CI, -5.2 to 2.1] pp) or (95.3% vs 94.9%; difference, 0.4 [95% CI, -1.4 to 2.2] pp). Redefining PE exposure as current PE backing rather than ever backing by PE showed consistent results (QE: 85.7% vs 88.8%; difference, -3.1 [95% CI, -6.7 to 0.6] pp; OCE: 95.7% vs 94.9%; difference, 0.8 [95% CI, -1.0 to 2.7] pp). Overall, this study suggested that although PE-backed EM programs had lower rates of QE sitting and passing rates, these findings became statistically insignificant after adjusting for program characteristics.

Citation: Shearer E, Palacios S, Burke RC, Singh Y, Ryan AM, Burke LG. Private Equity-Backed Faculty Employment and Emergency Medicine Board Examination Performance. JAMA Netw Open. 2026 Nov 2;9(11):e2643023. doi: 10.1001/jamanetworkopen.2026.43023. PMID: 43007677.

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