Does Texas Need Another Free Standing Emergency Room?


In just 5 years, nearly 200 freestanding emergency rooms have sprung up across Texas. This represents nearly 50% of all free standing ERs in the United States making Texas the industry leader. This may beg the question: do we really need another free standing ER in Texas? Changes in the economy and demand for better, more convenient, affordable health care suggest we just might.

Why Texas is the Place for Freestanding ERs Texas was the first place for freestanding ERs allowing an ER to operate without hospital affiliation in 2010. This early adoption means patients recognize and understand freestanding ERs, and are more willing to receive care.

  • Texas has 30 successful companies and 50 hospitals that support freestanding ERs.

  • When stock in Adeptus Health (First Choice ER chain), the largest freestanding ER company in Texas, went public, the value of their stock tripled in less than a year!

  • They are more cost efficient due to Texas regulations for staffing, equipping, and space availability to operate a freestanding ER.

Texas Does Need Another Free Standing ER…But For those interested in joining the freestanding ER business boom, there may be a place for you, but you’ll need to keep the real estate mantra in mind: Location, Location, Location. Currently, large cities like Dallas, Houston, San Antonio, and Austin are facing market saturation. There are very few, if any, places where the population demands additional freestanding ERs to support the healthcare needs of the residents and local workers.

However, thanks to the decline in the number of rural hospitals and the transition of these hospitals into clinics or private practices, there is an ever increasing demand for adequate emergency care in surrounding mid-sized cities. Some of the currently booming markets include: Waco, Amarillo, Lubbock, and Corpus Christi. Recent studies reveal that the rural hospital is dying. At best, these hospitals may transition into seven-day a week urgent care clinics that still offer a variety of hours. However, these clinics still do not meet the needs of patients who need overnight help or extensive care and treatment for traumatic injury.

Freestanding emergency care can make significant strides toward filling this market gap. Rather than transporting patients long distances for medical care, freestanding ERs in mid-size cities give patients a better option for care closer to home. Additionally, these locations are able to serve double duty as a preventive care provider offering patients the opportunity to receive top-tier screenings and checkups in once convenient location.

There is a definite need for more freestanding ERs thanks to changes in the way that patients expect to receive care. Patients don’t want to wait for hours, have to visit multiple locations for treatment, or fear their insurance will not cover their care. In the state of Texas, freestanding ERs are leading the industry in convenience, and outstanding care with reduced wait times, a full range of services, and working closely with all medical insurers. Additionally, doctors love working for freestanding ERs as they are, typically, part-owner meaning they are financially invested in providing the best possible care.

There are areas within Texas that are optimal for freestanding emergency departments. To discuss these markets and additional opportunities outside of Texas, contact our ER real estate experts for a complimentary consultation.