ACEP hosted a large-scale webinar on these questions, and is planning another. It developed and updated its online resources and opened a bulletin board for doctors impacted by the closure to report their circumstances, including a crowdsourcing spreadsheet listing the status at affected hospitals. Its member services include three free counseling sessions with its Wellness & Assistance Program and resources for helping with the formation of independent medical groups—even how to negotiate better agreements and how to read an employment contract.

“We’re talking to legal and financial experts and are waiting to fully see the fallout,” Dr. Kang said. Down the line, ACEP will be looking at how to make sure this kind of situation doesn’t happen again.

“Emergency physicians should never be expected to work without pay, medical malpractice insurance or guaranteed tail coverage,” Ashley Huff, MD, FACEP, FAEMS, an emergency physician in Clarksville, Tenn., said in an August 15 email to ACEP Now. “Many emergency physicians across the American Physician Partners footprint were left to advocate for themselves and their local group of physicians when APP closed.”

Dr. Huff considers herself fortunate since her health care company, Community Health Systems, took over employment contracts for two weeks and paid the doctors for the month of July before inviting them to sign with Team-Health. Given the recent history with APP and Envision, she thinks private equity staffing companies should set aside money or have written agreements specifically for tail coverage in the event that the company fails.

Spurring Introspection

For the field of emergency medicine, these developments are likely to spur some introspection, Dr. Nordlund said. “Certainly, there’s been discussion of reinvigorating the independent, physician owned and operated group, and looking again at the hospital-employed model. As emergency physicians, to a significant degree, we’re invested in responding to problems and delivering care to everyone who needs it, regardless of the ability to pay. We’re open all the time; we take everybody.”

She thinks it’s a mistake to overlook how important that service is to America. “The emergency department truly is an integral part of our health care system.” She also thinks the shockwave from the APP debacle will trigger a lot of attention about the instability of corporate management models and private equity in health care. “Are we going to see, now, more of these collapses? What does that mean to how we deliver care in our nation?”