To assess whether private equity (PE) employment among academic emergency medicine faculty is associated with residents’ board examination performance.
Approach:
Design and population: Cross-sectional study of 267 US emergency medicine residency programs with board examination results available for 2021–2023.
Exposure and outcomes: Programs were classified by whether a physician group at any training site had ever received PE backing. Outcomes were the proportions of graduates who attempted and passed the written qualifying examination (QE) and who passed the oral certification examinati…
Analysis: Weighted regression models compared examination outcomes before and after adjustment for emergency department and program characteristics. A sensitivity analysis used current PE backing.
Key Findings:
Seventy programs (26.2%) employed faculty through PE-backed physician groups, representing 17.1% of graduates after weighting.
PE-backed programs were more often community based and founded after 2015, and less often located at level 1 trauma centers.
Unadjusted QE pass rates were lower in PE-backed programs (81.6% vs 89.6%); unadjusted OCE pass rates did not differ significantly (94.0% vs 95.1%).
After adjustment, PE backing was not significantly associated with QE outcomes (87.1% vs 88.6%; difference, −1.5 percentage points; 95% CI, −5.2 to 2.1) or OCE outcomes (95.3% vs 94.9%; difference, 0.4 percentage points; 95% CI, −1.4 to 2.2).
Results were similar when exposure was defined by current rather than any historical PE backing.
Interpretation:
The authors report that the unadjusted QE difference was no longer significant after adjustment for program characteristics. PE-backed programs differed structurally from other programs, including in age, setting, and trauma-center status.
Limitations:
The observational design limits interpretation of associations.
Board examination outcomes may be an inadequate proxy for educational quality.
Conclusion:
In this national analysis, PE backing was not significantly associated with QE or OCE performance after adjustment for program characteristics.
