I’m an ER doctor. The people calling the shots have never saved a life

It’s 3 a.m. Your child is struggling to breathe. You rush her to the nearest emergency room. The waiting room is packed. And there is only one emergency physician responsible for a room full of sick and frightened patients. You might assume the hospital couldn’t find another doctor to work that night. But what if someone decided another doctor costs too much?Most patients assume the doctors working in an emergency room work for the hospital whose name is on the building. Often, they don’t. Hospitals frequently contract with outside companies to staff emergency departments with emergency physicians. Increasingly, those companies are owned by private-equity firms, whose business model depends on generating returns for investors, creating an environment where clinical staffing is an expense line item to be managed, rather than a critical safeguard for patients.I have seen the difference firsthand. Earlier in my career, I worked as a doctor in an emergency department staffed by a private-equity-backed company. Today, I practice as part of an independent, physician-owned democratic group, meaning the physicians working the shifts also own and govern the practice. We have budgets and financial pressures, too. But when our emergency department is overwhelmed, we call in a backup physician, even when it costs more.You cannot schedule an emergency. You don’t know when three heart attacks will arrive within minutes of one another.In emergency medicine, minutes matter. Cutting physician hours may save money. But in a crowded emergency department, it can mean one doctor caring for too many patients at once, less time with each person, longer waits, and worse outcomes.In 2023, 37-year-old Jennifer Knight arrived at a Steward Health Care hospital in Massachusetts with chest pain and trouble breathing. Steward was built with an infusion of private-equity capital and became known for aggressive cost-cutting. According to investigators, the emergency department was overwhelmed, with too few nurses to handle the surge of patients. A nurse sent Knight back to the registration line without evaluating her or checking her vital signs. Twenty minutes later, Knight collapsed and died.At Ascension St. John Hospital in Detroit, the emergency department was staffed by TeamHealth, a company backed by private equity giant Blackstone. In 2024, emergency physicians there became so concerned about staffing and patient safety that they unionized and walked off the job for 24 hours.Their concerns reached the U.S. Senate, where physicians told congressional investigators that doctors had sometimes been responsible for more than 20 beds at once and that patients routinely faced 16-hour waits. They described treating a patient in cardiac arrest on the waiting room floor, while another patient with appendicitis reportedly waited six hours, and a patient with a pulmonary embolism waited four.What the physicians wanted was pretty basic: enough doctors to safely care for patients.Members of Congress are beginning to tackle this issue head-on. Sen. Elizabeth Warren (D-MA), Sen. Ron Wyden (D-OR), and Sen. Jeff Merkley (D-OR), along with U.S. Reps. Val Hoyle (D-OR), Alexandria Ocasio-Cortez (D-NY) and Suhas Subramanyam (D-VA), recently introduced the Stop Corporate Takeovers of Physicians Act. It would prohibit outside investors from influencing medical decisions and require clinicians, not corporations, to control staffing, employment, billing, and contracts. The American Academy of Emergency Medicine, which I lead, has signed on in support of this bill after working for several years to help bring the legislation forward.Most patients don’t know who employs their emergency physicians or who decides how many doctors will be working that night. They have no idea who is calling the shots.In an emergency, you don’t get to shop around. You get in your car and go. And you trust that we will be there.Patients deserve to know who controls their emergency departments. Hospitals should be transparent about who staffs their emergency departments and who ultimately owns those companies.I’M A DOCTOR, AND I’M SICK OF WATCHING MY PATIENTS GO BANKRUPT JUST TO STAY ALIVEDecisions about how many physicians are needed to safely care for patients should be made by medical professionals whose first responsibility is to the person lying on the stretcher, not private equity investors whose first responsibility is generating a financial return.Because when you bring someone you love through the doors of an emergency room, you should never have to wonder whether saving money mattered more than saving them.Vicki Norton, MD, FAAEM, is president of the American Academy of Emergency Medicine, a practicing emergency physician in Florida, and a partner in an independent, physician-owned emergency medicine group.