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The following is a transcript of the podcast episode:

Rachael Robertson: Hey everybody, welcome to MedPod Today, the podcast series where MedPage Today reporters share deeper insight into the week's biggest healthcare stories. I'm your host, Rachael Robertson.

I'll be kicking off today's episode with my reporting on how an anti-DEI legislator has not been disinvited from speaking at a medical conference. Then Kristina Fiore tells us about a Senate investigation into some private equity companies that own emergency department staffing firms. Last but not least, Jennifer Henderson shares why we still haven't seen the "Best Medical Schools" rankings that were supposed to come out earlier this week.

First, I'm handing the mic to Kristina Fiore, who will take the host seat for my segment.

Kristina Fiore: A bill that would withdraw federal funding from medical schools with diversity, equity, and inclusion, or DEI, programs was introduced last month. It's sponsored by Greg Murphy, a Republican congressman in North Carolina, who's also a urologist. The bill is called the Embracing anti-Discrimination, Unbiased Curricula, and Advancing Truth in Education, or EDUCATE Act. Before Murphy introduced this controversial bill, he had been invited to an American College of Emergency Physicians, or ACEP, conference. Rachael Robertson is here to tell us about the conversation that ensued.

So Rachael, what's the latest on the situation right now?

Robertson: In short, ACEP decided to not disinvite Murphy. So as of now, he is still scheduled to speak at the Leadership & Advocacy Conference next week. ACEP told me that there will be a brief Q&A after Murphy's session. ACEP's President Dr. Aisha Terry went on video last week to explain ACEP's rationale. She said that she had a conversation with Murphy himself, as well as with the ACEP board, and the board came to a consensus to not disinvite Murphy even though ACEP itself does not support the EDUCATE Act. She also said that "ACEP believes in holding our elected officials accountable, while having respectful discourse and fighting for our broad and long mission."

Here's a clip of Dr. Terry:

Aisha Terry, MD: I'd like to emphasize that ACEP is not afraid to defend our policies while having tough conversations on topics about which we might not agree.

Robertson: Terry also met with four ACEP members voicing particularly strong opposition, and I actually spoke with three of them.

Fiore: So what did those members say?

Robertson: Basically, they made it clear that they think letting Murphy speak at the conference is platforming what they called his harmful ideas. They also said that it would make ACEP look bad and distract from the good work being presented at the conference. One of the ACEP members said that "somebody likened it to inviting the CEO of a tobacco company to a high school graduation commencement speech." Another told me that even if letting Murphy come maintains ACEP's relationship to the congressman, it jeopardizes future ACEP membership. Online, the current president of the Emergency Medicine Residents Association called the EDUCATE Act "dangerous and racist legislation" that proved the need for DEI in medical education.

The ACEP members also suggested a few compromises to Terry. They suggested moving the conversation to a smaller room, shortening his time, and inviting other physician legislators to join. Raul Ruiz, a Democratic congressman from California who is an emergency room physician, will actually speak at the conference too. It's worth noting that the three ACEP members also mentioned having empathy for Terry. She's the first Black woman to be the president of ACEP and they said she was receptive to their feedback and, as a whole, she has a strong record of working towards equity.

Fiore: So how has the broader medical community responded to the bill?

Robertson: Again, ACEP itself doesn't support the bill, nor do major medical societies. ACEP says it has an unwavering commitment to a diverse physician workforce. But, of course, as the comments on my story indicate, some physicians think that DEI is anti-meritocracy.

One of the ACEP members told me that's a huge misconception. They pointed out that DEI doesn't give marginalized students an automatic bump on the tests and metrics that all physicians must pass in order to practice. In the video, Terry said she brought that up to Murphy too. She said that she's not aware of any "objective or anecdotal data that the bar has been lowered, that diversity inherently comes at the expense of quality, that DEI initiatives negatively impact the quality of medical education, or that physician diversity impairs health outcomes." In fact, she said, there's "plenty of data to the contrary."

Fiore: Good story. Thanks, Rachael.

Robertson: Thanks so much, Kristina. Now, I'll interview you.

Private equity investment in healthcare has been drawing more scrutiny these days. Now, a Senate committee wants more insights into the business decisions at four emergency department staffing firms, as well as the three private equity companies that own them. Kristina Fiore is here to tell us more.

Kristina, what should we know about this investigation?

Fiore: Sen. Gary Peters, a Democrat from Michigan, is the chair of the Homeland Security and Governmental Affairs Committee. And earlier this month, he sent four letters to emergency department staffing firms: TeamHealth, Envision, USACS [US Acute Care Solutions], and Lifepoint Health, as well as the three private equity firms that own them: Blackstone, KKR, and Apollo Global Management.

Peters asked for more information on business operations, staffing decisions, patient care, and safety at these companies. And his letters followed interviews with more than 40 emergency physicians who raised serious concerns about patient care while working for these organizations. And since this is the Homeland Security Committee, there were questions about how well they could care for patients during a major emergency, like a mass shooting, a terrorist attack, or a future pandemic.

Robertson: What are some of the concerns raised in these letters?

Fiore: So in the letter to TeamHealth, and its owner Blackstone, Peters asked about working conditions at Ascension St. John Hospital in Detroit. Doctors there complained that they've sometimes been responsible for more than 20 beds at a time, and that patients routinely faced 16-hour wait times. Doctors who work for TeamHealth at that hospital have actually formed a union and they announced their intention to strike on April 18. So we'll be standing by to report on that.

A TeamHealth spokesperson told us that, in 2023, the median door-to-doctor time was actually 25 minutes and went down to 17 minutes this year. And he said that physician staffing levels are "higher than published medians for comparable emergency rooms across the country."

Letters to Envision and USACS also focused on physician staffing levels and patient safety. Now the interesting thing about Envision is that it went bankrupt last year, and KKR is actually no longer its owner. But Peters noted in the letter that the bankruptcy and the restructuring raise questions about the impact on patient care.

Robertson: How big of an impact do these companies have on emergency care?

Fiore: Well, the letters say that these companies run hundreds of emergency departments across the country. So TeamHealth operates about 600 emergency departments, Envision operates some 440 EDs, and USACS runs about 300 EDs. So that's a substantial portion of the EDs that could be running into patient care issues if physician staffing levels just aren't up to par. It'll be interesting to see what comes from the investigation. Peters asked the companies to respond to his questions by April 17 and to hold meetings with him by May 3. So I guess we'll have another update after that.

Robertson: Looking forward to it. Thank you, Kristina.

Fiore: Thanks, Rachael.

Robertson: Last year, a number of top institutions publicly announced that they would no longer participate in -- or even give data to -- the U.S. News & World Reports "Best Medical Schools" rankings. The rankings were released, but there was a significant delay. But this year, the rankings were delayed yet again. Jennifer Henderson is here to tell us about it.

Jennifer, what happened with the rankings this year? When were they expected?

Jennifer Henderson: This year's rankings were set to be released on April 9, which MedPage Today previously reported. But the afternoon prior to the release, U.S. News revealed in a blog post that the rankings were once again being held back. The blog post detailed how U.S. News received questions from some grad schools during the regular pre-publication process. Some of these queries were about whether and to what extent affiliated institutions were considered in bibliometrics data.

Robertson: Okay, so we were supposed to get the rankings earlier this week. But now we have no idea when those are coming through. Is this similar to the delays that happened last year?

Henderson: It's a little different, but there are some similarities. Prior to last year's rankings, a number of top schools publicly withdrew from the rankings. Harvard Medical School led the way in doing so, and a number of other institutions were quick to follow. They cited reasons ranging from overall concern with medical school rankings to issues with specific metrics used in the rankings.

Before the release of last year's rankings, U.S. News removed a preview of the year's top-ranked medical schools from its site. They said at the time that it was "dealing with an unprecedented number of inquiries" during its embargo period for the 2023-2024 "Best Graduate Schools" rankings. That included requests from schools to update data submitted after the collection period. Ultimately, when last year's final rankings were rolled out, there were measurable changes from the preview. However, the addition still included a number of schools that had publicly withdrawn from the rankings due in part to data that U.S. News had sourced itself.

Robertson: Hmm, what did U.S. News say regarding when this year's rankings will be released?

Henderson: As of now, U.S. News has not provided an updated timetable for the release. Rather, it noted that the delay would continue until it could appropriately address questions from some of the schools. Though there was not a public preview of this year's rankings, medical schools were provided their rankings under embargo about 1 week prior to the scheduled release, a spokesperson for U.S. News previously confirmed. We'll be checking in for updates.

Robertson: Awesome. Thank you, Jennifer.

Henderson: Thanks, Rachael.

Robertson: And that is it for today. If you liked what you heard, leave us a review wherever you listen to podcasts (, ). And please hit subscribe if you haven't already. We will see you again soon.

This episode was hosted and produced by me, Rachael Robertson, with sound engineering by Greg Laub. Our guests were MedPage Today reporters Rachael Robertson, Kristina Fiore, and Jennifer Henderson. Links to their stories are in the show notes.

MedPod Today is a production of MedPage Today. For more information about the show, check out medpagetoday.com/podcasts.

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