August 15, 2023: At the risk of sounding cliché: there has never been a time like this in emergency medicine. I’ve been an ER physician for more than twenty years, and I’ve never seen anything like the tumultuous events of the last month. I’m talking of course about the sudden implosion last month of American Physician Partners, or APP. As of August 1st, the physician group abruptly closed its doors. It had been staffing 119 emergency departments around the country—and the rest of the industry rushed to pick up the pieces, practically overnight. All of this was directly on the heels of the bankruptcy in May of Envision, one of the two largest groups in the country. Together with APP, that’s nearly 600 hospital contracts, employing thousands of clinicians, and serving millions of patients. And this might not be the end of it. But what made APP’s bankruptcy actually unprecedented was that the rest of the industry had only two weeks to figure out how to staff all 119 emergency departments. We have simply never had that many transitions in that little time—EVER. The good news is that the rest of the industry stepped up huge. Millions of patients essentially won’t be able to notice what happened (although the physicians and APPs involved are a different story—we’ll get to that). Core Clinical Partners will be taking over management of two of APP’s contracts, while many other groups around the country stepped up to take on the management of dozens more. Collectively, the emergency medicine physician services industry did contract transitions that normally take 90 – 120 days each and instead did them in closer to 10 days.