Background: Following projections of an emergency medicine (EM) physician oversupply, the growth of EM residency programs affiliated with for-profit hospitals has been subject to increased attention and speculation. However, essentially no literature exists regarding these programs. Resident pay is one area where these programs could differ from nonprofit-affiliated programs, as investor obligations could make for-profit corporations more likely to reduce resident salaries to increase profit margins. Here, we aim to quantify the growth of EM for-profit affiliated residency programs from 2001-2021 and determine if PGY1 salaries differ between these program types.
Methods: Medicare and ACGME accreditation data were used to determine the profit status of hospitals affiliated with EM residency programs. ACGME new accreditation data from 2001-2021 were used to quantify the growth of both for-profit and nonprofit affiliated programs over this period. We searched program websites and called programs to determine 2021-2022 PGY1 salary. Multiple regression was used to model the relationship between profit status and salary using program characteristic covariates to control for confounding variables.
Results: The number of EM programs increased from 117 to 276 from 2001-2021 while the number of for-profit affiliated EM residency programs increased from 1 to 29 during this period. Most (85.7%, [24/29]) for-profit affiliated programs were accredited from 2016-2021. Mean for-profit affiliated program salary ($55,658, n = 24) was $3840 lower than mean nonprofit affiliated program salary ($59,498, n = 203). For-profit affiliation was a significant predictor of lower 2021-2022 PGY1 salary after controlling for other program characteristics using multiple regression ( ß = -1919.88, P = 0.010).
Conclusions: We found a substantial growth of newly ACGME accredited for-profit affiliated EM residency programs from 2016-2021. We also found for-profit affiliated programs pay lower PGY1 salaries than nonprofit-affiliated programs after controlling for potential confounding variables, which suggests more oversight over the salary determination process could be necessary to prevent resident underpayment.
Keywords: EM physician oversupply; EM residency growth; HCA Hospitals; for‐profit hospitals; graduate medical education; resident salary.
© 2022 The Authors. AEM Education and Training published by Wiley Periodicals LLC on behalf of Society for Academic Emergency Medicine.