Growth of for‐profit involvement in emergency medicine graduate medical education and association between for‐profit affiliation and resident salary

BACKGROUND: Following projections of an emergency medicine (EM) physician oversupply, the growth of EM residency programs affiliated with for‐profit hospitals has been subject to increased attention and speculation. However, essentially no literature exists regarding these programs. Resident pay is one area where these programs could differ from nonprofit‐affiliated programs, as investor obligations could make for‐profit corporations more likely to reduce resident salaries to increase profit margins. Here, we aim to quantify the growth of EM for‐profit affiliated residency programs from 2001–2021 and determine if PGY1 salaries differ between these program types. METHODS: Medicare and ACGME accreditation data were used to determine the profit status of hospitals affiliated with EM residency programs. ACGME new accreditation data from 2001–2021 were used to quantify the growth of both for‐profit and nonprofit affiliated programs over this period. We searched program websites and called programs to determine 2021–2022 PGY1 salary. Multiple regression was used to model the relationship between profit status and salary using program characteristic covariates to control for confounding variables. RESULTS: The number of EM programs increased from 117 to 276 from 2001–2021 while the number of for‐profit affiliated EM residency programs increased from 1 to 29 during this period. Most (85.7%, [24/29]) for‐profit affiliated programs were accredited from 2016–2021. Mean for‐profit affiliated program salary ($55,658, n = 24) was $3840 lower than mean nonprofit affiliated program salary ($59,498, n = 203). For‐profit affiliation was a significant predictor of lower 2021–2022 PGY1 salary after controlling for other program characteristics using multiple regression ( ß = −1919.88, P = 0.010). CONCLUSIONS: We found a substantial growth of newly ACGME accredited for‐profit affiliated EM residency programs from 2016–2021. We also found for‐profit affiliated programs pay lower PGY1 salaries than nonprofit–affiliated programs after controlling for potential confounding variables, which suggests more oversight over the salary determination process could be necessary to prevent resident underpayment.