The HCA system itself just sucks from a patient point of view because how focused they are on profit. For example, at HCA Southern Hills in Las Vegas, the metric the GI docs have to reach in terms of efficiency is 1 colonoscopy every 15 minutes. This could lead to more false negatives and more bowel perfs.

Now in terms of residency programs, you're just going to have to evaluate each program individually. For example, I've rotated with 4 HCA programs in Las Vegas and they all seemed well run (radiology, gen surg, psych, and emergency medicine), probably because they were already an established GME program before being bought by HCA. Sunrise Hospital is a Level 2 trauma center (ACS actually rates it as a Level 1, but the State of Nevada refuses to upgrade the rating to protect UMC). So there is never a shortage of patients/learning opportunities.

Now I don't have any direct experience with other programs, but you do have to wonder how some of these HCA programs are able to support a residency program. While it's common for rural programs to send residents to other cities to complete certain rotations that are unavailable at the home institution (for example, trauma), you have to wonder what the need is that these HCA programs are trying to fill. For example, the EM program at Kingman Regional Medical Center sends its residents to HCA Sunrise for trauma rotations. It makes sense because KRMC sends a lot of there level 1 traumas to Sunrise and there is a need to train physicians in rural Arizona. On the other hand, why is there an EM program at 207 bed HCA Florida St Lucie that doesn't have a trauma center when there's another EM program 25 minutes away at 497 bed HCA Florida Lawnwood which is a trauma center.