Key Takeaways
- • A cross-sectional study published in JAMA Network Open (Nov. 2, 2026) found that private equity (PE) backing of emergency medicine (EM) physician hiring was associated with lower resident board qualifying examination (QE) sit-and-pass rates, with PE-backed programs at 81.6% versus 89.6% for non-PE programs unadjusted (difference -8.0 percentage points).
- • After adjusting for program characteristics such as program age and community-hospital setting, the QE gap narrowed to -1.5 percentage points (95% CI, -5.2 to 2.1) and was no longer statistically significant.
- • No significant difference emerged in oral certification exam (OCE) pass rates, at 94.0% for PE-backed versus 95.1% for non-PE programs unadjusted and 95.3% versus 94.9% after adjustment.
- • Of 267 U.S. EM residency programs analyzed (2021-2023 data), 70 (26.2%) had faculty hired with PE involvement, representing a weighted 17.1% of graduating residents.
- • The authors attribute any residual differences more to individual program characteristics than to PE ownership itself, and the observational design limits causal conclusions.
Summary
A cross-sectional study published in JAMA Network Open on November 2, 2026, examined whether private equity backing of emergency medicine physician hiring is linked to resident performance on board examinations, according to 2 Minute Medicine's summary of the research. The study, led by Shearer E, Palacios S, Burke RC, Singh Y, Ryan AM and Burke LG, drew on data from all U.S. EM residency programs with available board results between 2021 and 2023.
Of 267 programs included, 70 (26.2%) had physician groups hired with PE involvement. Those programs were more often based in community hospitals and more often formed after 2015. The authors estimated that 17.1% of residents graduated from PE-backed programs. The primary outcome was the percentage of graduating residents who sat for and passed the written qualifying examination (QE); the secondary outcome was the percentage who sat for and passed the oral certification exam (OCE).
On an unadjusted basis, PE-backed programs had lower QE sit-and-pass rates than non-PE programs, at 81.6% versus 89.6% (difference -8.0 percentage points; 95% CI, -11.6 to -4.4). OCE pass rates showed no significant difference (94.0% versus 95.1%; difference -1.1 pp). After adjusting for program characteristics, the QE difference shrank to -1.5 pp (87.1% versus 88.6%; 95% CI, -5.2 to 2.1) and was not statistically significant. Redefining PE exposure as current rather than ever-backed produced consistent results, with a QE difference of -3.1 pp that was also not significant.
The study's authors concluded that, although PE-backed programs showed lower QE rates before adjustment, the findings became statistically insignificant once program characteristics were accounted for. The 2 Minute Medicine summary notes the study's limitations: its observational design and its use of board examination outcomes as a proxy for education quality. The summary characterizes the findings as suggesting that differences may reflect individual program characteristics that impair educational quality rather than PE ownership alone.
Of 267 programs included, 70 (26.2%) had physician groups hired with PE involvement. Those programs were more often based in community hospitals and more often formed after 2015. The authors estimated that 17.1% of residents graduated from PE-backed programs. The primary outcome was the percentage of graduating residents who sat for and passed the written qualifying examination (QE); the secondary outcome was the percentage who sat for and passed the oral certification exam (OCE).
On an unadjusted basis, PE-backed programs had lower QE sit-and-pass rates than non-PE programs, at 81.6% versus 89.6% (difference -8.0 percentage points; 95% CI, -11.6 to -4.4). OCE pass rates showed no significant difference (94.0% versus 95.1%; difference -1.1 pp). After adjusting for program characteristics, the QE difference shrank to -1.5 pp (87.1% versus 88.6%; 95% CI, -5.2 to 2.1) and was not statistically significant. Redefining PE exposure as current rather than ever-backed produced consistent results, with a QE difference of -3.1 pp that was also not significant.
The study's authors concluded that, although PE-backed programs showed lower QE rates before adjustment, the findings became statistically insignificant once program characteristics were accounted for. The 2 Minute Medicine summary notes the study's limitations: its observational design and its use of board examination outcomes as a proxy for education quality. The summary characterizes the findings as suggesting that differences may reflect individual program characteristics that impair educational quality rather than PE ownership alone.
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