“One of the nation’s biggest employers of emergency physicians is liquidating, in one of the more unruly sagas American medicine has experienced since the first wave of the pandemic,” Maureen Tkacik writes over at The American Prospect. “The collapsing entity is American Physician Partners, a private equity-owned operator of about 135 hospital emergency rooms and hospital-owned ‘freestanding’ ERs in 18 states, which was co-founded by a sitting Republican congressman. Until two weeks ago, the company was by all appearances relatively indistinguishable from the other deeply indebted, private equity-backed mega-practices that staff ERs with round-the-clock physicians and ‘midlevels’ (physician assistants and nurse practitioners). Now it’s shutting down, effective Monday. APP’s largest competitors have been drowning in debt for years. KKR-owned Envision Healthcare filed for bankruptcy protection in May with $7.7 billion in debt; Blackstone-owned TeamHealth has been mired for months in negotiations with creditors to restructure part of its $5 billion debt load. For years, the financial urgency had fostered an environment of institutionalized short-staffing throughout the ER business. The only ‘tell’ that there was anything different about APP, according to one of its longtime physicians, was its refusal to staff an extra doctor at a busy ER in affluent Fort Wayne, Indiana, where well-insured patients were regularly abandoning the hospital in the face of intolerable wait times. ‘I knew they were generating enough billing to be more generous with staffing,’ says the doctor, who has worked for four different private equity-owned emergency medicine groups and asked for anonymity to discuss the industry. ‘So why are you seemingly so desperate for money? They were behaving like someone who has a gambling debt.’ And so the physician was less than shocked when, in early July, he received an email announcing that the company was being acquired by SCP Health, another emergency medicine mega-practice owned by the Canadian private equity firm Onex, which previously owned Envision. Private equity financed well over a thousand physician practice buyouts during the nine years between 2012 and 2021, including the half dozen or so buyouts that had created APP. Another day, another merger. But the plot thickened on July 17, when the physician, and 2,500 other doctors and midlevels on APP’s payroll, received an email from the company’s top three remaining executives — notably not including the CEO or chief financial officer, who had resigned a few months and a few days earlier, respectively — informing them that the deal with SCP was off.” Maureen Tkacik, “Shock treatment in the emergency room,” The American Prospect.