Two states, one question: Who controls emergency medicine?
As private equity investment continues to reshape healthcare, states are increasingly looking for ways to preserve physician autonomy and ensure clinical decisions remain in the hands of doctors rather than corporate entities.
A good illustration of the issue can be found in recent developments in Oregon and Virginia.
What happened in Oregon
Earlier this year, Pacific Northwest nonprofit Catholic health system PeaceHealth announced plans to replace Eugene Emergency Physicians, an independent physician group that had staffed the region's emergency departments for more than three decades, with a national staffing company.
Following significant pushback from emergency physicians, lawmakers and organized medicine — along with a lawsuit from Eugene Emergency Physicians saying the action was against state law — PeaceHealth agreed to extend its relationship with the local physician group while discussions continue.
What happened in Virginia
Valley Health Winchester Medical Center, one of six sites employing EMBR emergency physicians.
Winchester-based Valley Health announced in April that it would terminate its long-standing contract with Emergency Medicine of Blue Ridge (EMBR), an independent physician-owned emergency medicine group that staffs six emergency departments across Virginia and West Virginia. Valley selected SCP Health, a national emergency medicine management company backed by private equity ownership, to assume responsibility for emergency physician staffing beginning this fall.
The dispute has become a focal point in Virginia's own debate over physician autonomy, due process in emergency medicine contracting and the growing role of private-equity-backed staffing companies in emergency medicine. VACEP and ACEP made a joint statement on the matter.
Why Oregon matters
Oregon's Senate Bill 951, signed into law in 2025 and before the PeaceHealth announcements, is one of the most aggressive state efforts yet to reinforce the corporate practice of medicine (CPOM) doctrine and limit the ability of non-physician entities to influence clinical care. The reforms combine restrictions on non-compete agreements with broader changes aimed at strengthening physician control over medical decision-making. The law:
Puts restrictions on relationships between physician practices and management services organizations (MSOs), the entities often used by private equity firms and corporate investors to provide administrative support while avoiding direct ownership of medical practices.
Limits the ability of management companies to control physician hiring and firing decisions, influence compensation models tied to clinical care, restrict ownership and governance arrangements that could give non-physicians undue control over medical practices, and increase transparency around ownership structures.
Largely prohibits non-compete agreements for physicians and other healthcare professionals
In other words, Oregon is one of a growing number of states seeking to improve physician mobility and reduce barriers to patient access.
While many states have some form of corporate practice of medicine doctrine, Oregon attempts to address the management-company and ownership structures that physician advocates argue have allowed corporate interests to exert influence despite existing legal restrictions.
Where Virginia stands
While Oregon is drawing national attention, Virginia emergency physicians are already ahead of the curve on one key issue: Non-competes.
This year, legislation supported by VACEP largely prohibited non-compete agreements for healthcare professionals. The General Assembly passed and Gov. Abigail Spanberger signed House Bill 627/Senate Bill 128, which prohibit employers from entering into, enforcing, or threatening to enforce non-compete agreements against most healthcare professionals, including emergency physicians.
For physicians, nurses and many other clinicians, that means employers generally can no longer prevent them from taking a job with another healthcare organization after leaving employment.
As to the Valley Heath issue: Unlike Oregon, there is no Virginia law in place that would prevent the health system from terminating its contract and selecting a private-equity backed emergency medicine provider.
Why emergency physicians should care
Many states, including Virginia, have long had corporate practice of medicine principles intended to prevent non-physicians from directing patient care.
The challenge is that sophisticated corporate structures, management services organizations and private-equity-backed arrangements often allow companies to operate around those restrictions while remaining compliant with state law.
Oregon's experience may provide a roadmap for other states seeking to strengthen physician autonomy, but it is also likely to serve as a real-world test of how effective those reforms can be. Can these laws can keep pace with increasingly complex ownership and management structures?
VACEP is following these developments closely and remains engaged with physician leaders across the country, including colleagues at Oregon ACEP and national ACEP, to better understand what is working, what challenges remain, and what lessons may be applicable in Virginia.
Bottom line
While different because of the underlying state laws, the Oregon and Virginia situations have become real-world tests of larger national debates surrounding corporate practice of medicine, private equity in healthcare and physician independence.
Oregon is testing whether new laws can limit corporate influence in healthcare. Virginia will help reveal whether existing protections are strong enough.
In both cases, the underlying question is the same: Who should control emergency medicine — physicians or corporations?
