John didn’t start his career mad.

He trained as an emergency medicine doctor in a tidily run Midwestern emergency room about a decade ago. He loved the place, especially the way its management was so responsive to the doctors’ needs, offering extra staffing when things got busy and paid administrative time for teaching other trainees. Doctors provided most of the care, occasionally overseeing the work of nurse practitioners and physician associates. He signed on to start there full-time shortly after finishing his residency.

A month before his start date, a private equity firm bought the practice. “I can’t even tell you how quickly it changed,” John says. The ratio of doctors to other clinicians flipped, shrinking doctor hours to a minimum as the firm moved to save on salaries.

John — who is being referred to by a pseudonym due to concerns over professional repercussions — quit and found a job at another emergency room in a different state. It too soon sold out to the same private equity firm. Then it […]