Corporate Control of Emergency Departments: Dangers from the Growing Monster

Abstract

BackgroundCorporate control in emergency departments (EDs) has increased during the past 20 years through hospital consolidation and the growth of ED contract management groups. ObjectivesTo describe the growing corporate influence in the practice of emergency medicine and associated dangers to the public's safety and well-being. DiscussionHospital systems through mergers and acquisitions have created regional monopolies providing them the power to charge high fees, which can lead to economic hardship for patients. Hospitals have also increasingly employed physicians and can exert influence over their practice to further increase profits. ED contract management groups (CMGs) obtain the exclusive contract for emergency services and gain control over the livelihood of emergency physicians, decreasing their autonomy and inserting the business interest into the physician–patient relationship, and this may result in harm to patients. Safety issues identified by emergency physicians may not be articulated for fear of being fired, and protocols may direct physicians to order unneeded testing and encourage unnecessary hospital admissions to make higher profits. Of additional concern, some CMGs are involved in graduate emergency medicine education, exposing physicians in training to corporate influence during their formative years. ConclusionsGiven the potential harm to patients due to corporate influence, there must be serious consideration for legislative or regulatory solutions regarding the increasing corporate control of emergency medicine in the United States.